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

  • Nephrology - Review
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Abstract

In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein–energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients’ outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.

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Acknowledgments

Ionut Nistor is a fellow of European Renal Best Practice (ERBP) and supported by a Grant of the European Renal Association-European Dialysis Transplantation Association (ERA-EDTA).

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    Authors and Affiliations

    1. NephroCare Tassin-Charcot, Sainte Foy Les Lyon, France

      Charles Chazot

    2. Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK

      Ken Farrington

    3. Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK

      Ken Farrington

    4. ERBP, Ghent University Hospital, Ghent, Belgium

      Ionut Nistor & Wim Van Biesen

    5. Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium

      Wim Van Biesen

    6. Department of Internal Medicine, UMCG, Groningen, The Netherlands

      Hanneke Joosten

    7. Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland

      Daniel Teta

    8. Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania

      Ionut Nistor, Dimitrie Siriopol & Adrian Covic

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    Charles Chazot, Hanneke Joosten, Daniel Teta and Dimitrie Siriopol have no relevant disclosures. Ken Farrington is the Co-Chair of ERBP Elderly Development Guideline Group. Wim Van Biesen is the Chair of ERBP. Ionut Nistor is a member of the Methods Support Team of ERBP. Adrian Covic is the Co-Chair of ERBP Elderly Development Guideline Group. ERBP is currently in the process of developing a clinical practice guideline on the diagnosis and treatment of frail and elderly patients with advanced chronic kidney disease.

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    Charles Chazot and Ken Farrington have contributed equally to this manuscript.

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    Chazot, C., Farrington, K., Nistor, I. et al. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. Int Urol Nephrol 47, 1809–1816 (2015). https://doi.org/10.1007/s11255-015-1107-9

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