Manjula Kurella Tamura1. 1. Division of Nephrology, Stanford University School of Medicine, Palo Alto, California 94304, USA. mktamura@stanford.edu
Abstract
PURPOSE OF REVIEW: The elderly constitute a substantial and growing fraction of the end-stage renal disease (ESRD) population. We review recent studies on ESRD incidence, management, and outcomes in the elderly. RECENT FINDINGS: Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. In studies with a large number of elderly patients, median survival after dialysis initiation is modest, and although a majority have reasonable life expectancy, a substantial minority of elderly patients experience very high early mortality rates after dialysis initiation. Quality of life results are mixed--compared with younger ESRD patients or non-ESRD elderly, mental well being is similar and physical well being is reduced in elderly patients with ESRD. In several studies, elderly patients with ESRD initiating peritoneal dialysis had higher mortality rates than elderly patients with ESRD initiating hemodialysis. Strategies such as nondialytic management of ESRD or dietary protein restriction and delayed dialysis initiation may be alternatives for elderly patients wishing to avoid dialysis initiation, but further studies are needed to determine the patients best suited for these approaches. Quality improvement initiatives in geriatric ESRD care have been successfully implemented in some centers and may ultimately improve care for elderly patients with ESRD. SUMMARY: These findings should help to clarify some of the risks and benefits of dialysis in the elderly and may be useful in dialysis decision-making and management.
PURPOSE OF REVIEW: The elderly constitute a substantial and growing fraction of the end-stage renal disease (ESRD) population. We review recent studies on ESRD incidence, management, and outcomes in the elderly. RECENT FINDINGS: Rates of treated ESRD among the elderly (>80 years) have risen by more than 50% in the last decade. In studies with a large number of elderly patients, median survival after dialysis initiation is modest, and although a majority have reasonable life expectancy, a substantial minority of elderly patients experience very high early mortality rates after dialysis initiation. Quality of life results are mixed--compared with younger ESRDpatients or non-ESRD elderly, mental well being is similar and physical well being is reduced in elderly patients with ESRD. In several studies, elderly patients with ESRD initiating peritoneal dialysis had higher mortality rates than elderly patients with ESRD initiating hemodialysis. Strategies such as nondialytic management of ESRD or dietary protein restriction and delayed dialysis initiation may be alternatives for elderly patients wishing to avoid dialysis initiation, but further studies are needed to determine the patients best suited for these approaches. Quality improvement initiatives in geriatric ESRD care have been successfully implemented in some centers and may ultimately improve care for elderly patients with ESRD. SUMMARY: These findings should help to clarify some of the risks and benefits of dialysis in the elderly and may be useful in dialysis decision-making and management.
Authors: Allan J Collins; Robert Foley; Charles Herzog; Blanche Chavers; David Gilbertson; Areef Ishani; Bertram Kasiske; Jiannong Liu; Lih-Wen Mau; Marshall McBean; Anne Murray; Wendy St Peter; Jay Xue; Qiao Fan; Haifeng Guo; Qi Li; Shuling Li; Suying Li; Yi Peng; Yang Qiu; Tricia Roberts; Melissa Skeans; Jon Snyder; Craig Solid; Changchun Wang; Eric Weinhandl; David Zaun; Rui Zhang; Cheryl Arko; Shu-Cheng Chen; Frederick Dalleska; Frank Daniels; Stephan Dunning; James Ebben; Eric Frazier; Christopher Hanzlik; Roger Johnson; Daniel Sheets; Xinyue Wang; Beth Forrest; Edward Constantini; Susan Everson; Paul Eggers; Lawrence Agodoa Journal: Am J Kidney Dis Date: 2008-01 Impact factor: 8.860
Authors: D L Lamping; N Constantinovici; P Roderick; C Normand; L Henderson; S Harris; E Brown; R Gruen; C Victor Journal: Lancet Date: 2000-11-04 Impact factor: 79.321
Authors: Roland Schmitt; Steven Coca; Mehmet Kanbay; Mary E Tinetti; Lloyd G Cantley; Chirag R Parikh Journal: Am J Kidney Dis Date: 2008-05-29 Impact factor: 8.860
Authors: Mark L Unruh; Anne B Newman; Brett Larive; Mary Amanda Dew; Dana C Miskulin; Tom Greene; Srinivasan Beddhu; Michael V Rocco; John W Kusek; Klemens B Meyer Journal: J Am Geriatr Soc Date: 2008-08-21 Impact factor: 5.562
Authors: Andrei D Javier; Rocio Figueroa; Edward D Siew; Huzaifah Salat; Jennifer Morse; Thomas G Stewart; Rakesh Malhotra; Manisha Jhamb; Jane O Schell; Cesar Y Cardona; Cathy A Maxwell; T Alp Ikizler; Khaled Abdel-Kader Journal: Am J Kidney Dis Date: 2017-02-15 Impact factor: 8.860
Authors: Wouter R Verberne; A B M Tom Geers; Wilbert T Jellema; Hieronymus H Vincent; Johannes J M van Delden; Willem Jan W Bos Journal: Clin J Am Soc Nephrol Date: 2016-03-17 Impact factor: 8.237
Authors: Gang Jee Ko; Yoshitsugu Obi; Tae Ik Chang; Melissa Soohoo; Rieko Eriguchi; Soo Jeong Choi; Daniel L Gillen; Csaba P Kovesdy; Elani Streja; Kamyar Kalantar-Zadeh; Connie M Rhee Journal: J Am Med Dir Assoc Date: 2019-01-25 Impact factor: 4.669
Authors: Gabriele Röhrig; Maria Cristina Polidori; Katherine Rascher; Mathias Schaller; Thomas Benzing; Gero von Gersdorff Journal: Z Gerontol Geriatr Date: 2016-11-10 Impact factor: 1.281
Authors: Marije H Kallenberg; Hilda A Kleinveld; Friedo W Dekker; Barbara C van Munster; Ton J Rabelink; Marjolijn van Buren; Simon P Mooijaart Journal: Clin J Am Soc Nephrol Date: 2016-06-24 Impact factor: 8.237