An integrative approach to advanced kidney disease in the elderly.
Chronic kidney disease (CKD) has increasingly become a "geriatric" disease, with a dramatic rise in incidence in the aging population. Patients aged >75 years have become the fastest growing population initiating dialysis. These patients have increased comorbid diseases and functional limitations which affect mortality and quality of life. This review describes the challenges of dialysis initiation and considerations for management of the elderly subpopulation. There is a need for an integrative approach to care, which addresses management issues, health-related quality of life, and timely discussion of goals of care and end-of-life issues. This comprehensive approach to patient care involves the integration of nephrology, geriatric, and palliative medicine practices.
Schell
Jane O
JO
Department of Medicine, Duke University Medical Center, Durham, NC 27705-3860, USA. jane.schell@duke.edu <jane.schell@duke.edu>
Germain
Michael J
MJ
Finkelstein
Fred O
FO
Tulsky
James A
JA
Cohen
Lewis M
LM
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D055048:Integrative Medicine; D007674:Kidney Diseases / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D011788:Quality of Life; D006435:Renal Dialysis