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Dialysis modality choice in elderly patients with end-stage renal disease : a narrative review of the available evidence

Liviu Segall, Ionut Nistor UGent, Wim Van Biesen UGent, Edwina A Brown, James G Heaf, Elizabeth Lindley, Ken Farrington and Adrian Covic (2017) NEPHROLOGY DIALYSIS TRANSPLANTATION. 32(1). p.41-49
abstract
The number of elderly patients on maintenance dialysis has rapidly increased in the past few decades, particularly in developed countries, imposing a growing burden on dialysis centres. Hence, many nephrologists and healthcare authorities feel that greater emphasis should be placed on the promotion of home dialysis therapies such as peritoneal dialysis (PD) and home haemodialysis (HD). There is currently no general consensus as to the best dialysis modality for elderly patients with end-stage renal disease. In-centre HD is predominant in most countries, although it is widely recognized that PD has several advantages over HD, including the lack of need for vascular access, continuous slow ultrafiltration, less interference with patients' lifestyle and lower costs. Comparisons of outcomes between elderly patients on PD and HD rely on observational studies, as randomized controlled trials are lacking. The results of these studies are variable. However, most of them suggest that survival rates are largely similar between the two modalities, except for elderly patients with diabetes and/or beyond 1–3 years from dialysis initiation, in which cases HD appears to be superior. An equally important aspect to consider when choosing dialysis modality, particularly in this age group, is the quality of life, and in this regard most studies found no significant differences between PD and HD. In these circumstances, we believe that dialysis modality selection should be guided by patient's preference, based on comprehensive and unbiased information. A multidisciplinary team should review elderly patients starting on dialysis, aiming to identify possible barriers to PD and home HD, including physical, visual, cognitive, psychological and social problems, and to overcome such barriers by adequate care, education, psychological counselling and dialysis assistance.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
end-stage renal disease, elderly, haemodialysis, peritoneal dialysis, survival, CHRONIC KIDNEY-DISEASE, QUALITY-OF-LIFE, AUTOMATED PERITONEAL-DIALYSIS, REPLACEMENT THERAPY, COMPARING MORTALITY, ESRD PATIENTS, ARTERIOVENOUS-FISTULA, CLINICAL-OUTCOMES, HEMODIALYSIS, SURVIVAL
journal title
NEPHROLOGY DIALYSIS TRANSPLANTATION
Nephrol. Dial. Transplant.
volume
32
issue
1
pages
41 - 49
Web of Science type
Review
Web of Science id
000397023000009
ISSN
0931-0509
DOI
10.1093/ndt/gfv411
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
7089852
handle
http://hdl.handle.net/1854/LU-7089852
date created
2016-02-17 17:30:00
date last changed
2017-05-23 13:21:37
@article{7089852,
  abstract     = {The number of elderly patients on maintenance dialysis has rapidly increased in the past few decades, particularly in developed countries, imposing a growing burden on dialysis centres. Hence, many nephrologists and healthcare authorities feel that greater emphasis should be placed on the promotion of home dialysis therapies such as peritoneal dialysis (PD) and home haemodialysis (HD). There is currently no general consensus as to the best dialysis modality for elderly patients with end-stage renal disease. In-centre HD is predominant in most countries, although it is widely recognized that PD has several advantages over HD, including the lack of need for vascular access, continuous slow ultrafiltration, less interference with patients' lifestyle and lower costs. Comparisons of outcomes between elderly patients on PD and HD rely on observational studies, as randomized controlled trials are lacking. The results of these studies are variable. However, most of them suggest that survival rates are largely similar between the two modalities, except for elderly patients with diabetes and/or beyond 1--3 years from dialysis initiation, in which cases HD appears to be superior. An equally important aspect to consider when choosing dialysis modality, particularly in this age group, is the quality of life, and in this regard most studies found no significant differences between PD and HD. In these circumstances, we believe that dialysis modality selection should be guided by patient's preference, based on comprehensive and unbiased information. A multidisciplinary team should review elderly patients starting on dialysis, aiming to identify possible barriers to PD and home HD, including physical, visual, cognitive, psychological and social problems, and to overcome such barriers by adequate care, education, psychological counselling and dialysis assistance.},
  author       = {Segall, Liviu and Nistor, Ionut and Van Biesen, Wim and Brown, Edwina A and Heaf, James G and Lindley, Elizabeth and Farrington, Ken and Covic, Adrian},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {end-stage renal disease,elderly,haemodialysis,peritoneal dialysis,survival,CHRONIC KIDNEY-DISEASE,QUALITY-OF-LIFE,AUTOMATED PERITONEAL-DIALYSIS,REPLACEMENT THERAPY,COMPARING MORTALITY,ESRD PATIENTS,ARTERIOVENOUS-FISTULA,CLINICAL-OUTCOMES,HEMODIALYSIS,SURVIVAL},
  language     = {eng},
  number       = {1},
  pages        = {41--49},
  title        = {Dialysis modality choice in elderly patients with end-stage renal disease : a narrative review of the available evidence},
  url          = {http://dx.doi.org/10.1093/ndt/gfv411},
  volume       = {32},
  year         = {2017},
}

Chicago
Segall, Liviu, Ionut Nistor, Wim Van Biesen, Edwina A Brown, James G Heaf, Elizabeth Lindley, Ken Farrington, and Adrian Covic. 2017. “Dialysis Modality Choice in Elderly Patients with End-stage Renal Disease : a Narrative Review of the Available Evidence.” Nephrology Dialysis Transplantation 32 (1): 41–49.
APA
Segall, L., Nistor, I., Van Biesen, W., Brown, E. A., Heaf, J. G., Lindley, E., Farrington, K., et al. (2017). Dialysis modality choice in elderly patients with end-stage renal disease : a narrative review of the available evidence. NEPHROLOGY DIALYSIS TRANSPLANTATION, 32(1), 41–49.
Vancouver
1.
Segall L, Nistor I, Van Biesen W, Brown EA, Heaf JG, Lindley E, et al. Dialysis modality choice in elderly patients with end-stage renal disease : a narrative review of the available evidence. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2017;32(1):41–9.
MLA
Segall, Liviu, Ionut Nistor, Wim Van Biesen, et al. “Dialysis Modality Choice in Elderly Patients with End-stage Renal Disease : a Narrative Review of the Available Evidence.” NEPHROLOGY DIALYSIS TRANSPLANTATION 32.1 (2017): 41–49. Print.