title: Optimizing outcomes in the elderly with end-stage renal disease--live long and prosper.
abstract: BACKGROUND
  The elderly form an expanding proportion of patients with chronic kidney disease and end-stage renal disease worldwide. The increased physiological frailty and functional morbidity associated with the aging process pose unique challenges when planning optimal management of an older patient needing renal replacement therapy (RRT).
  
  
  OBJECTIVE
  This position paper discusses current evidence regarding the optimal management of end-stage renal disease in the elderly with an emphasis on hemodialysis since it is the most common modality used in older patients. Further research is needed to define relevant patient-reported outcome measures for end-stage renal disease including functional assessments and psychological impacts of various forms of RRT. For those older patients who have opted for dialysis treatment, it is important to study the strategies that encourage greater uptake of home-based dialysis therapies and optimal vascular access.
  
  
  CONCLUSIONS
  The management of advanced chronic kidney disease in the elderly can be challenging but also extremely rewarding. The key issue is adopting a patient-focused and individualized approach that seeks to achieve the best outcomes based on a comprehensive holistic assessment of what is important to the patient.
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland - UK.|Nephrology Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland - UK.
authors.forename: Agnes
authors.initials: A
authors.lastname: Masengu
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland - UK.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hanko
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland - UK.|Nephrology Research Group, Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, Northern Ireland - UK.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
mesh_terms: D000367:Age Factors; D000368:Aged; D019317:Evidence-Based Medicine / Q000592:standards; D015577:Geriatric Assessment; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010347:Patient Care Planning / Q000592:standards*; D018579:Patient Selection; D018802:Patient-Centered Care / Q000379:methods / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom