Hemodialysis and the elderly patient: complications and concerns.

The number of elderly people starting dialysis is continuously increasing. Despite the psychosocial conditions and limitations intrinsic to older age, the quality of life and survival in elderly patients on hemodialysis is frequently acceptable. A much grimmer picture of the life of elderly patients can be seen in patients with high comorbidity rates. In these patients, the early identification of the specific clinical problems that may cause many adverse effects for the dialysis treatment population becomes a relevant factor: e.g., cardiovascular diseases, malnutrition, inflammation, depression and cognitive disturbances. Many measures can be adopted to prevent serious complications in the elderly. Sodium, bicarbonate and potassium profiled dialysis can make the rapid corrections induced by dialysis less devastating, compared with constant ionic concentrations and constant bicarbonate content in the dialysate. The approach to the removal of excess fluid should be similar: the avoidance of large ultrafiltrations and, above all, rapid ultrafiltration rates. It is better to turn to ultrafiltration profiles, controlled blood volume dialysis and possible long-duration dialysis, preferably nocturnal or daily dialyses.