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Is Kt/V useful in elderly dialysis patients? : pro and con arguments

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Abstract
Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age is accompanied by physiological and pathological changes that may modify the patient's response to uraemia and dialysis. Frailty and multi-morbidity are likely, but to a variable extent. Elderly patients could be more susceptible to the effects of uraemia and require a higher dose of dialysis. Conversely, the generation rate of uraemic toxins is lower in elderly patients, potentially reducing the need for dialysis. In the elderly, quality of life may be more adversely affected by multimorbidity than uraemic symptoms, thus the dose of dialysis may be less relevant. Higher doses of dialysis may be more difficult to achieve in the elderly and may be less well tolerated. We conclude that the prescription of dialysis in the elderly should be individualized, taking multiple factors into account. An individualized Kt/V may be useful in controlling dialysis dose and detecting problems in delivery. However, achievement of a specified Kt/V may not result in any benefit to an elderly patient and could be counterproductive.
Keywords
RESIDUAL RENAL-FUNCTION, QUALITY-OF-LIFE, RESTING ENERGY-EXPENDITURE, TWICE-WEEKLY HEMODIALYSIS, INCREMENTAL HEMODIALYSIS, PERITONEAL-DIALYSIS, FREQUENT HEMODIALYSIS, NUTRITIONAL-STATUS, PRACTICE, PATTERNS, UREMIC PRURITUS, dialysis, dialysis adequacy, elderly, haemodialysis, Kt/v

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Chicago
Tattersall, James, Ken Farrington, Giorgio Gentile, Jeroen Kooman, Juan F Macias Nunez, Ionut Nistor, Wim Van Biesen, and Adrian Covic. 2018. “Is Kt/V Useful in Elderly Dialysis Patients? : Pro and Con Arguments.” Nephrology Dialysis Transplantation 33 (5): 742–750.
APA
Tattersall, J., Farrington, K., Gentile, G., Kooman, J., Nunez, J. F. M., Nistor, I., Van Biesen, W., et al. (2018). Is Kt/V useful in elderly dialysis patients? : pro and con arguments. NEPHROLOGY DIALYSIS TRANSPLANTATION, 33(5), 742–750.
Vancouver
1.
Tattersall J, Farrington K, Gentile G, Kooman J, Nunez JFM, Nistor I, et al. Is Kt/V useful in elderly dialysis patients? : pro and con arguments. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2018;33(5):742–50.
MLA
Tattersall, James, Ken Farrington, Giorgio Gentile, et al. “Is Kt/V Useful in Elderly Dialysis Patients? : Pro and Con Arguments.” NEPHROLOGY DIALYSIS TRANSPLANTATION 33.5 (2018): 742–750. Print.
@article{8569339,
  abstract     = {Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age is accompanied by physiological and pathological changes that may modify the patient's response to uraemia and dialysis. Frailty and multi-morbidity are likely, but to a variable extent. Elderly patients could be more susceptible to the effects of uraemia and require a higher dose of dialysis. Conversely, the generation rate of uraemic toxins is lower in elderly patients, potentially reducing the need for dialysis. In the elderly, quality of life may be more adversely affected by multimorbidity than uraemic symptoms, thus the dose of dialysis may be less relevant. Higher doses of dialysis may be more difficult to achieve in the elderly and may be less well tolerated. We conclude that the prescription of dialysis in the elderly should be individualized, taking multiple factors into account. An individualized Kt/V may be useful in controlling dialysis dose and detecting problems in delivery. However, achievement of a specified Kt/V may not result in any benefit to an elderly patient and could be counterproductive.},
  author       = {Tattersall, James and Farrington, Ken and Gentile, Giorgio and Kooman, Jeroen and Nunez, Juan F Macias and Nistor, Ionut and Van Biesen, Wim and Covic, Adrian},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {RESIDUAL RENAL-FUNCTION,QUALITY-OF-LIFE,RESTING ENERGY-EXPENDITURE,TWICE-WEEKLY HEMODIALYSIS,INCREMENTAL HEMODIALYSIS,PERITONEAL-DIALYSIS,FREQUENT HEMODIALYSIS,NUTRITIONAL-STATUS,PRACTICE,PATTERNS,UREMIC PRURITUS,dialysis,dialysis adequacy,elderly,haemodialysis,Kt/v},
  language     = {eng},
  number       = {5},
  pages        = {742--750},
  title        = {Is Kt/V useful in elderly dialysis patients? : pro and con arguments},
  url          = {http://dx.doi.org/10.1093/ndt/gfy042},
  volume       = {33},
  year         = {2018},
}

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