title: Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients.
abstract: In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.
authors.affiliation: NephroCare Tassin-Charcot, Sainte Foy Les Lyon, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Chazot
authors.affiliation: Renal Unit, Lister Hospital, Stevenage, Hertfordshire, UK.|Postgraduate Medical School, University of Hertfordshire, Hatfield, Hertfordshire, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
authors.affiliation: ERBP, Ghent University Hospital, Ghent, Belgium.|Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Ionut
authors.initials: I
authors.lastname: Nistor
authors.affiliation: ERBP, Ghent University Hospital, Ghent, Belgium.|Renal Division, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.affiliation: Department of Internal Medicine, UMCG, Groningen, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Joosten
authors.affiliation: Service of Nephrology, Department of Medicine, University Hospital Lausanne, Lausanne, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Teta
authors.affiliation: Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania.
authors.forename: Dimitrie
authors.initials: D
authors.lastname: Siriopol
authors.affiliation: Nephrology Department, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania. accovic@gmail.com.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
mesh_terms: D000368:Aged; D016330:Frail Elderly; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010347:Patient Care Planning; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors
keywords: Dialysis; Elderly; Frail