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Do Elderly Patients Need Dialysis?

노인 환자에게 투석이 필요한가?

  • In O Sun (Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center)
  • Received : 2024.05.25
  • Accepted : 2024.06.10
  • Published : 2024.08.01

Abstract

Initiating dialysis at an advanced age is both a clinical challenge and an ethical dilemma, because the benefits in older adults with advanced chronic kidney disease may be offset by high rates of dialysis-related morbidity. Geriatric conditions, such as aging, frailty, functional impairment, and cognitive impairment, significantly influence the prognosis of elderly patients. Therefore, it becomes important to provide patients and families with prognostic information regarding timing of initiation, which is further complicated by the competing mortality risk. Shared decision-making by clinicians and patients can yield better clinical outcomes and quality of life. Through this approach, patients can opt for the most appropriate treatment based on their personal values, which often entails conservative management.

Keywords

References

  1. Korean Society of Nephrology. 2022 KORDS Registry (Korean Renal Data System) [Internet]. Seoul (KR): Korean Society of Nephrology, c2022 [cited 2024 May 1]. Available from: https://www.ksn.or.kr/bbs/?code=report_eng.
  2. Chan KE, Maddux FW, Tolkoff-Rubin N, Karumanchi SA, Thadhani R, Hakim RM. Early outcomes among those initiating chronic dialysis in the United States. Clin J Am Soc Nephrol 2011;6:2642-2649. https://doi.org/10.2215/CJN.03680411
  3. Moorhouse P, Rockwood K. Frailty and its quantitative clinical evaluation. J R Coll Physicians Edinb 2012;42:333-340. https://doi.org/10.4997/JRCPE.2012.412
  4. Jung HW, Yoo HJ, Park SY, et al. The Korean version of the FRAIL scale: clinical feasibility and validity of assessing the frailty status of Korean elderly. Korean J Intern Med 2016;31:594-600. https://doi.org/10.3904/kjim.2014.331
  5. Moss AH, Ganjoo J, Sharma S, et al. Utility of the "surprise" question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol 2008;3:1379-1384. https://doi.org/10.2215/CJN.00940208
  6. Hong YA, Chung S, Park WY, et al. Nephrologists' perspectives on decision making about life-sustaining treatment and palliative care at end of life: a questionnaire survey in Korea. J Palliat Med 2021;24:527-535. https://doi.org/10.1089/jpm.2020.0248
  7. Couchoud C, Labeeuw M, Moranne O, et al. A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant 2009;24:1553-1561. https://doi.org/10.1093/ndt/gfn698
  8. Couchoud CG, Beuscart JB, Aldigier JC, Brunet PJ, Moranne OP; REIN registry. Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 2015;88:1178-1186. https://doi.org/10.1038/ki.2015.245