Negative selection of patients for dialysis and transplantation in the United Kingdom.

Challah, Sabri; Wing, A. J.; Bauer, Richard L.; Morris, Randy; Schroeder, Steven A.

doi:10.1136/bmj.288.6424.1119

Cited by 109 publications

(30 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this patient group, dialysis is likely to be for life, with only 15% of all adult transplantations taking place in those aged ≥65 years in the US in 2008 [1]. Twenty-five years ago, 45.1% of UK nephrologists responding to a survey would not offer renal replacement therapy to a 50-year-old man with ischaemic heart disease [2]. In contrast, 15 years later, dialysis was available in the UK for high-risk patients (higher age, severe comorbidities and dependent in relation to functional status) despite a low 1-year survival of 19.2% [3].…”

Section: Dialysis In Older People: a Growing Populationmentioning

confidence: 99%

Dialysis Options for End-Stage Renal Disease in Older People

Brown

Johansson

2011

Nephron Clin Pract

View full text Add to dashboard Cite

The numbers of older patients requiring dialysis therapy is rising, reflecting the ageing of the general population. Older dialysis patients have a tendency to present later for dialysis, have a higher number of comorbid conditions, are at higher risk of cognitive dysfunction and have increased levels of frailty. These are all barriers to home dialysis therapy so hospital haemodialysis (HD) is the predominant dialysis modality for older patients. Evidence suggests, however, that home treatment with peritoneal dialysis (PD) intrudes less into the life of older patients than hospital HD. Assisted PD is available in some countries and this enables more older patients to be treated in their own homes. Adjustments to patient education also need to be made to accommodate the barriers to learning and decision-making that often exist in older people.

show abstract

Section: Dialysis In Older People: a Growing Populationmentioning

confidence: 99%

Dialysis Options for End-Stage Renal Disease in Older People

Brown

Johansson

2011

Nephron Clin Pract

View full text Add to dashboard Cite

show abstract

“…Dialysis for the older and frailer individual is a comparatively new treatment option. As late as 1984, Challah et al [4] reported from a survey that 45% of a sample of UK nephrologists would decline dialysis in a 50-year-old man with ischaemic heart disease. Less than 20 years later outcomes of octogenarians on dialysis were being published [5].…”

Section: Introductionmentioning

confidence: 99%

Optimising Treatment of End-Stage Renal Disease in the Elderly

Power¹,

Brown²

2014

Nephron Clin Pract

View full text Add to dashboard Cite

The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore important to consider the impact of dialysis on lifestyle and whether survival will actually be improved for frail older patients. This review article considers how haemodialysis and peritoneal dialysis can be adjusted for older patients, and, in particular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their management.

show abstract

“…The doubling of dialysis provision during the 1980s in the UK was almost entirely through CAPD, with little or no choice offered to patients, whereas transplantation rates increased significantly. The concept of negative selection was apparent, publicized in the national media, and described (25). Conclusions were made that under-referral from nonspecialists was a leading factor.…”

Section: History Of Dialysis In the Ukmentioning

confidence: 97%