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

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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.
Keywords
Dialysis, Elderly, Frail, CHRONIC KIDNEY-DISEASE, QUALITY-OF-LIFE, RENAL REPLACEMENT THERAPY, TWICE-WEEKLY HEMODIALYSIS, THRICE-WEEKLY HEMODIALYSIS, INFORMED DECISION-MAKING, IN-CENTER HEMODIALYSIS, PRACTICE PATTERNS, FREQUENT HEMODIALYSIS, NUTRITIONAL-STATUS

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Chicago
Chazot, Charles, Ken Farrington, Ionut Nistor, Wim Van Biesen, Hanneke Joosten, Daniel Teta, Dimitrie Siriopol, and Adrian Covic. 2015. “Pro and Con Arguments in Using Alternative Dialysis Regimens in the Frail and Elderly Patients.” International Urology and Nephrology 47 (11): 1809–1816.
APA
Chazot, C., Farrington, K., Nistor, I., Van Biesen, W., Joosten, H., Teta, D., Siriopol, D., et al. (2015). Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. INTERNATIONAL UROLOGY AND NEPHROLOGY, 47(11), 1809–1816.
Vancouver
1.
Chazot C, Farrington K, Nistor I, Van Biesen W, Joosten H, Teta D, et al. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients. INTERNATIONAL UROLOGY AND NEPHROLOGY. 2015;47(11):1809–16.
MLA
Chazot, Charles, Ken Farrington, Ionut Nistor, et al. “Pro and Con Arguments in Using Alternative Dialysis Regimens in the Frail and Elderly Patients.” INTERNATIONAL UROLOGY AND NEPHROLOGY 47.11 (2015): 1809–1816. Print.
@article{7088797,
  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.},
  author       = {Chazot, Charles and Farrington, Ken and Nistor, Ionut and Van Biesen, Wim and Joosten, Hanneke and Teta, Daniel and Siriopol, Dimitrie and Covic, Adrian},
  issn         = {0301-1623},
  journal      = {INTERNATIONAL UROLOGY AND NEPHROLOGY},
  language     = {eng},
  number       = {11},
  pages        = {1809--1816},
  title        = {Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients},
  url          = {http://dx.doi.org/10.1007/s11255-015-1107-9},
  volume       = {47},
  year         = {2015},
}

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