Hemodialysis and the elderly

Since the 1990s, at least 45% of patients who undertook chronic dialysis treatments for the renal replacement therapy each year in the United States aged over 65. This rate is increasing every year and the same trend appears throughout the world. The relative age-related increase in the prevalence of CKD is equally impressive in Europe’s population as well, with minor differences among countries.

What is the most common cause of CKD in the elderly?

The most common cause of CKD in the elderly is secondary nephrosclerosis due to degenerative diseases such as diabetes mellitus and arterial hypertension.

What are the differences between elderly and younger patients?

Concomitant diseases such as impaired cardiac function, vascular disease, coronary heart disease, poor nutrition, reduced mental function as well as movement and orientation disorders are more common in the elderly. Moreover, psychosocial factors and also the role of the family that may influence the progress of the treatment should not be disregarded.

Under what conditions can renal replacement therapy benefit elderly patients?

Most elderly patients can often benefit in levels of functionality and quality of life in the same manner as a corresponding age group without kidney disease. However, there are also patients suffering from severe concomitant diseases that may reduce their life expectancy, such as severe dementia, chronic lung disease, malignant diseases and advanced heart failure.

What are the benefits of hemodialysis in the elderly?

There is a tendency that it is easier for the elderly patients to adapt to dialysis, to gain less weight between dialysis sessions, comply better with medical guidelines, and be more satisfied with their present lifestyle than younger patients. Moreover, the frequent control by the experienced medical and nursing staff of renal units can prevent any complications from other concomitant diseases.

Are there disadvantages in elderly patients?

Elderly patients with severe cardiovascular disease and diabetes mellitus are more prone to hemodynamic instability, hypotensive episodes and cardiac arrhythmias during hemodialysis treatments. Malnutrition - undernourishment as well as serious illnesses such as lung disease and dementia can significantly impact the life expectancy of these patients. Therefore, the monitoring of a suitable protein diet and nutrition as well as the assignment of proper medication treatment for elderly patients should be made on a regular basis.

Giasemi Skaneli, Scientific Associate at Mesogeios Dialysis Center in Palaio Faliro 

Bibliography

Gutch CF, Stoner MH, Corea AL: Review of hemodialysis for nurses and dialysis personnel, T.K. Agrafiotis, X.D. Sirgkanis, P.N. Zirogiannis (Ed), 2003

John T. Daugirdas, Peter G. Blake, Todd S. Ihg: Handbook of Dialysis. Panos Zirogiannis, Simella Provatopoulou (Ed.), 2008

S. Anand, M. Kurella Tamura and GM Chertow: The elderly patients on hemodialysis. Minerva Urol Nefrol., 62 (1): 87-101, 2012

 

 

 

Κορυφή