Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

Chazot, Charles; Farrington, Ken; Nistor, Ionuţ; Biesen, Wim Van; Joosten, Hanneke; Teta, Daniel; Siriopol, Dimitrie; Covic, Adrian

doi:10.1007/s11255-015-1107-9

Cited by 8 publications

(5 citation statements)

References 82 publications

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“…In most countries, the use of peritoneal dialysis declines with increasing patient age, and in-hospital haemodialysis is usually the only modality suitable for frail, elderly patients 62 . However, this approach reduces quality of life because of the necessity for frequent travel and, in contrast to peritoneal dialysis, the associated adverse effects such as haemodynamic instability and intradialytic hypotension 63 . When patients are given information and involvement in choice, >50% choose a home-based treatment 64 , including elderly individuals.…”

Section: Dialysismentioning

confidence: 99%

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action

et al. 2017

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The treatment of chronic kidney disease (CKD) and of end-stage renal disease (ESRD) imposes substantial societal costs. Expenditure is highest for renal replacement therapy (RRT), especially in-hospital haemodialysis. Redirection towards less expensive forms of RRT (peritoneal dialysis, home haemodialysis) or kidney transplantation should decrease financial pressure. However, costs for CKD are not limited to RRT, but also include nonrenal health-care costs, costs not related to health care, and costs for patients with CKD who are not yet receiving RRT. Even if patients with CKD or ESRD could be given the least expensive therapies, costs would decrease only marginally. We therefore propose a consistent and sustainable approach focusing on prevention. Before a preventive strategy is favoured, however, authorities should carefully analyse the cost to benefit ratio of each strategy. Primary prevention of CKD is more important than secondary prevention, as many other related chronic diseases, such as diabetes mellitus, hypertension, cardiovascular disease, liver disease, cancer, and pulmonary disorders could also be prevented. Primary prevention largely consists of lifestyle changes that will reduce global societal costs and, more importantly, result in a healthy, active, and long-lived population. Nephrologists need to collaborate closely with other sectors and governments, to reach these aims.

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Section: Dialysismentioning

confidence: 99%

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action

et al. 2017

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“…As shown in Table 2, HD for the frail elderly presents challenges, and the clinician, patient, and patient's family need to balance the advantages and disadvantages of the therapy as well as the potential modifications of the standard 3 times weekly HD treatment regimen. 52 Recent literature has focused attention on some of the negative aspects of HD that potentially could have more adverse effects on frail, elderly patients than in younger, healthier patients. [53][54][55][56][57][58][59][60][61][62] Specific concerns for the elderly with HD involve the association of HD with hypotension, the impact of HD on myocardial and cerebral functioning, the risks of increasing inflammatory markers, the challenges of creating vascular access, the problem of postdialysis recovery time, and the risks of falls after dialysis.…”

Section: Hd: Advantages and Disadvantages For The Elderlymentioning

confidence: 99%

“…72 Customization of dialysis for older patients should also consider frequency of dialysis. 52 There is ample evidence to suggest that more frequent HD (>3 times per week) can improve left ventricular hypertrophy and blood pressure control, as well as various patient-reported outcome measures, suggesting an improved patient perception of their QoL. [73][74][75][76] Importantly, the time to recovery after a dialysis session decreases dramatically with more frequent HD.…”

Section: Hd: Advantages and Disadvantages For The Elderlymentioning

confidence: 99%

“…75 Depressive symptoms and sleep quality may improve, and scores on the Short Form-36 often increase with more frequent HD. [74][75][76] How frail elderly patients will respond to more frequent treatments is unclear and needs further study 52 ; the patients included in these studies were younger, and even in this population, there are concerns about loss of residual renal function. 77 In the short term, more frequent dialysis may enable more intensive rehabilitation, 78 but in the long term would carry significant treatment burden and intrusion into daily life, particularly when considering the increased requirement of transport to and from a dialysis center, unless the patient had support to carry out his or her own dialysis at home.…”

Section: Hd: Advantages and Disadvantages For The Elderlymentioning

confidence: 99%

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Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?

Brown

Finkelstein

Iyasere

et al. 2017

Kidney International

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Management of older people on dialysis requires focus on the wider aspects of aging as well as dialysis. Almost all frail and older patients receiving dialysis will default to in-center hemodialysis, although the availability of assisted peritoneal dialysis enables dialysis at home. As with any disease management decision, patients approaching end-stage renal disease need all the appropriate facts about their prognosis, the natural history of their disease without dialysis, and the resulting outcomes and complications of the different dialysis modalities. Hemodialysis in the older age group can be complicated by intradialytic hypotension, prolonged time to recovery, and vascular access-related problems. Peritoneal dialysis can be difficult for older patients with impaired physical or cognitive function and can become a considerable burden. Use of incremental dialysis, changes in hemodialysis frequency, and delivery and use of assistance for peritoneal dialysis can ameliorate quality of life for older patients. Understanding each individual's goals of care in the context of his or her life experience is particularly important in the elderly, when overall life expectancy is relatively short, and life experience or quality of life may be the priority. Indeed, some patients select the option of no dialysis or conservative care. With multifaceted assessments of care, physicians should be able to give individual patients the ability to select and continue to make the best decisions for their care.

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“…HD treatment was originally intended for a more robust demographic with lower levels of multimorbidity [ 9 ]. Debate about appropriate care for a frailer population has begun to emerge [ 10 ], yet there are relatively few studies of interventions which might improve outcomes, care, and experience for this vulnerable group [ 11 – 14 ]. Studies examining the impact of frailty on people receiving HD have primarily used observational designs.…”

Section: Introductionmentioning

confidence: 99%

Living with frailty and haemodialysis: a qualitative study

et al. 2022

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Background Frailty is highly prevalent in people receiving haemodialysis (HD) and is associated with poor outcomes. Understanding the lived experiences of this group is essential to inform holistic care delivery. Methods Semi-structured interviews with N = 25 prevalent adults receiving HD from 3 HD units in the UK. Eligibility criteria included a Clinical Frailty Scale (CFS) score of 4–7 and a history of at least one fall in the last 6 months. Sampling began guided by maximum variation sampling to ensure diversity in frailty status; subsequently theoretical sampling enabled exploration of preliminary themes. Analysis was informed by constructivist grounded theory; later we drew upon the socioecological model. Results Participants had a mean age of 69 ± 10 years, 13 were female, and 13 were White British. 14 participants were vulnerable or mildly frail (CFS 4–5), and 11 moderately or severely frail (CFS 6–7). Participants characterised frailty as weight loss, weakness, exhaustion, pain and sleep disturbance arising from multiple long-term conditions. Participants’ accounts revealed: the consequences of frailty (variable function and psychological ill-health at the individual level; increasing reliance upon family at the interpersonal level; burdensome health and social care interactions at the organisational level; reduced participation at the community level; challenges with financial support at the societal level); coping strategies (avoidance, vigilance, and resignation); and unmet needs (overprotection from family and healthcare professionals, transactional health and social care exchanges). Conclusions The implementation of a holistic needs assessment, person-centred health and social care systems, greater family support and enhancing opportunities for community participation may all improve outcomes and experience. An approach which encompasses all these strategies, together with wider public health interventions, may have a greater sustained impact. Trial registration ISRCTN12840463.

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Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

Cited by 8 publications

References 82 publications

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action

Reducing the costs of chronic kidney disease while delivering quality health care: a call to action

Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?

Living with frailty and haemodialysis: a qualitative study

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