title: Elderly patients with CKD--dilemmas in dialysis therapy and vascular access.
abstract: The population of elderly patients with end-stage renal disease (ESRD) is growing rapidly worldwide. The high prevalence of comorbidities, limited life expectancy and complex quality of life issues associated with this population pose substantial challenges for clinicians in terms of clinical decision-making and providing optimal care. The first dilemma encountered in the management of an elderly patient with ESRD is deciding whether to initiate renal replacement therapy and, if so, selecting the most-suitable dialysis modality. Planning vascular access for haemodialysis is associated with additional challenges. Several clinical practice guidelines recommend an arteriovenous fistula, rather than a central venous catheter or arteriovenous graft, as the preferred access for maintenance haemodialysis therapy. However, whether this recommendation is applicable to elderly patients with ESRD and a limited life expectancy is unclear. Selection and planning of the most appropriate vascular access for an elderly patient with ESRD requires careful consideration of several factors and ultimately should lead to an improvement in the patient's quality of life.
authors.affiliation: Division of Nephrology, W. G. (Bill) Hefner Veterans Affairs Medical Center, 1601 Brenner Avenue, Salisbury, NC 28144, USA.
authors.forename: Tushar J
authors.initials: TJ
authors.lastname: Vachharajani
authors.affiliation: Kidney Clinical Research Unit, Division of Nephrology, Schulich School of Medicine and Dentistry, Victoria Hospital, Canada.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
authors.affiliation: Department of Vascular Surgery, Eastern Virginia Medical School, USA.
authors.forename: Marc H
authors.initials: MH
authors.lastname: Glickman
authors.affiliation: Division of Nephrology, University of Texas Southwestern Medical Center, USA.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Vazquez
authors.affiliation: Department of Medicine and Department of Nephrology, Monash Medical Center & Monash University, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Division of Nephrology, Department of Medicine, Toronto General Hospital and University of Toronto, Canada.
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, USA.
authors.forename: Timmy C
authors.initials: TC
authors.lastname: Lee
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling; D003657:Decision Making; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis