The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes

Jager, Kitty J.; Dijk, Paul C. W. van; Dekker, FW; Stengel, Bénédicte; Simpson, Keith; Briggs, J. D.

doi:10.5414/cnp60352

Cited by 115 publications

(94 citation statements)

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“…The two most frequently used equations are the Cockcroft-Gault, from 1976 and the MDRD, developed during the study of the same name (Modification of Diet in Renal Disease -MDRD). However, these formulas, although recommended, still need validation in large samples, in individuals at very early stages of kidney dysfunction and in elderly individuals 35,36 . Microalbuminuria significantly increases with the reduced GF 4 .…”

Section: Discussionmentioning

confidence: 99%

Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica

França

Santos

Calado

et al. 2010

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica

França

Santos

Calado

et al. 2010

Arq. Bras. Cardiol.

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“…As the dialysis population has expanded in the developed world (1), the proportion of elderly patients undergoing dialysis has increased dramatically (2,3). Many elderly patients with advanced CKD have several comorbid conditions and increased dependency (4).…”

Section: Introductionmentioning

confidence: 99%

Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis

Silva-Gane

Wellsted

Greenshields

et al. 2012

Clinical Journal of the American Society of Nephrology

185

199

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SummaryBackground and objectives Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis.Design, setting, participants, & measurements Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5).Results After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR ± SD was similar (14.0±4.0 ml/min per 1.73 m 2 ) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scores were similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients. ConclusionsPatients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.

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“…As a result, in most Western countries the demand for dialysis is increasing more rapidly in elderly patients than in younger age groups (2)(3)(4). Data from the United States Renal Data System indicate that incidence of ESRD is increasing among persons aged Ͼ65 years and especially among those aged Ͼ80 years (4).…”

Section: Introductionmentioning

confidence: 99%

“…Data from the United States Renal Data System indicate that incidence of ESRD is increasing among persons aged Ͼ65 years and especially among those aged Ͼ80 years (4). Similarly in Europe the proportion of incident ESRD patients aged Ͼ65 years increased from 22% in 1980 to 55% in 2005 (3,5). As expected, mortality among elderly ESRD patients is high (4,6 -8).…”

Section: Introductionmentioning

confidence: 99%

Clinical Practices and Outcomes in Elderly Hemodialysis Patients

Canaud

Lin

Tentori

et al. 2011

Clinical Journal of the American Society of Nephrology

219

164

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SummaryBackground and objectives Demand for hemodialysis among elderly patients is increasing worldwide. Although clinical care of this high-risk group is complex and challenging, no guidelines exist to inform hemodialysis practices. The Dialysis Outcomes and Practice Patterns Study (DOPPS) provides a unique opportunity to assess dialysis practices and associated outcomes among elderly versus younger patients on chronic in-center hemodialysis in 12 countries. Results Although participant mean age increased over time in all DOPPS countries, the percentage of elderly varied widely. Overall, comorbidities and malnutrition were more common in the elderly. Fistulae were used less frequently among elderly versus younger patients in Europe and North America but not in Australia, New Zealand, and Japan. No difference in treatment time was observed between elderly and younger patients after normalizing for body weight. In all regions, ultrafiltration rates were lower among elderly patients. Elderly patients reported poorer quality of life with respect to the physical but not mental component scores. Mortality risk was three-to sixfold higher in the elderly group, whereas causes of death overall were similar for elderly and younger patients. Design, setting, participants, & measurements ConclusionsElderly patients represent a different proportion of DOPPS participants across countries, possibly reflecting differences in policies and clinical practices. In general, hemodialysis practices in the elderly reflected each region's clinical patterns, with some variation by age group depending upon the practice.

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The epidemic of aging in renal replacement therapy: an update on elderly patients and their outcomes

Cited by 115 publications

References 0 publications

Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica

Filtração glomerular e fatores associados em hipertensos atendidos na atenção básica

Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis

Clinical Practices and Outcomes in Elderly Hemodialysis Patients

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