Optimising Treatment of End-Stage Renal Disease in the Elderly

Power, Albert; Brown, Edwina A.

doi:10.1159/000357433

Cited by 14 publications

(11 citation statements)

References 157 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vascular access, intradialytic hypotension, which may relate to myocardial dysfunction, and impaired autonomic function with hemodynamic instability, bleeding and amyloidotic arthropathy represent the most critical aspects of HD treatment. Furthermore, we should consider that PD is a less expensive treatment than HD [52,53]. However, PD patients should be constantly monitored with clinical and instrumental tools, including bioelectrical impedance, CTR and echocardiogram, since they are at increased risk of developing volume overload and cardiovascular disorders [54], as confirmed by the present study.…”

Section: Discussionsupporting

confidence: 53%

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Lai

Molfino

Russo³

et al. 2014

Cardiorenal Med

View full text Add to dashboard Cite

Introduction: Mortality in dialysis patients is higher than in the general population, and cardiovascular disease represents the leading cause of death. Hypertension and volume overload are important risk factors for the development of left ventricular hypertrophy (LVH) in hemodialysis (HD) and peritoneal dialysis (PD) patients. Other factors are mainly represented by hyperparathyroidism, vascular calcification, arterial stiffness and inflammation. The aim of this study was to compare blood pressure (BP) and metabolic parameters with cardiovascular changes [cardiothoracic ratio (CTR), aortic arch calcification (AAC) and LV mass index (LVMI)] between PD and HD patients. Materials and Methods: 45 patients (23 HD and 22 PD patients) were enrolled. BP measurements, echocardiography and chest X-ray were performed in each patient to determine the LVMI and to evaluate the CTR and AAC. Inflammatory indexes, intact parathyroid hormone (iPTH)andarterial blood gas analysis were also evaluated. Results: LVMI was higher in PD than HD patients (139 ± 19 vs. 104 ± 22; p = 0.04). In PD patients, a significant correlation between iPTH, C-reactive protein and the presence of LVH was observed (r = 0.70, p = 0.04; r = 0.70, p = 0.03, respectively). The CTR was increased in PD patients as compared to HD patients, while no significant differences in cardiac calcifications were determined. Conclusions: Our data indicate that HD patients present more effective BP control than PD patients. Adequate fluid and metabolic control are necessary to assess the adequacy of BP, which is strongly correlated with the increase in LVMI and with the increased CTR in dialysis patients. PD is a home therapy and allows a better quality of life, but PD patients may present a further increased cardiovascular risk if not adequately monitored. © 2014 S. Karger AG, Basel

show abstract

Section: Discussionsupporting

confidence: 53%

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Lai

Molfino

Russo³

et al. 2014

Cardiorenal Med

View full text Add to dashboard Cite

show abstract

“…Elderly RT recipients have an increased risk of infections and cardiovascular events than younger patients. 1,24 With aging, the immune system undergoes structural and functional changes, including qualitative alterations in T cell activation and/or quantitative differences in T cell subsets. 25 This results in higher incidence and severity of infectious complications in the elderly compared with younger transplant recipients for the same degree of immunosuppression.…”

Section: Risks Of Rt In the Elderlymentioning

confidence: 99%

“…65 Another very important strategy to increase RT in elderly candidates is to promote living donation. 24 The proportion of LD recipients 65 years or older doubled in the United States from 6.8% in 2001 to 13.7% in 2011. 66 Several studies 10,[91][92][93] showed that LD RT was associated with better graft survival rates than DD RT in elderly recipients, as well as in younger ones.…”

Section: Two Phenotypic Frailty Scalesmentioning

confidence: 99%

Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease

et al. 2016

View full text Add to dashboard Cite

During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.

show abstract

“…Today, most of the ESRD patients are older patients, which this naturally increases the number of elderly people in need of hemodialysis treatment (10)(11)(12). This can be due to increased longevity of ESRD patients, high prevalence of diseases such as diabetes and hypertension in the elderlies, as well as the development of technology and health services in recent years (10)(11)(12). Studies reported that the incidence of old age issues such as falling, decreased physical activity, poor nutrition and cognitive disorders in elderly with ESRD are higher than younger patients (13).…”

Section: Introductionmentioning

confidence: 99%

Caregiver burden among family caregivers of older patients receiving hemodialysis and its relevant factors

Senmar¹,

Rafiei²,

Yousefi³

et al. 2019

J Nephropharmacol

View full text Add to dashboard Cite

show abstract

Optimising Treatment of End-Stage Renal Disease in the Elderly

Cited by 14 publications

References 157 publications

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Cardiac, Inflammatory and Metabolic Parameters: Hemodialysis versus Peritoneal Dialysis

Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease

Caregiver burden among family caregivers of older patients receiving hemodialysis and its relevant factors

Contact Info

Product

Resources

About