Dialysis Versus Conservative Care in the Elderly: Making a Choice

  • Aine BurnsEmail author


The aging process results in marked alterations in the kidneys, impairing their ability to maintain homeostasis, adapt to changing local environments and recover from injury. These changes are both anatomical and functional and have been considered the cause of the increased propensity of the elderly to acute or chronic renal failure that may be accelerated and/or accentuated by diseases such as diabetes mellitus and hypertension.


Older Elderly Chronic Kidney Disease Dialysis Conservative Care Renal Supportive Care 


  1. 1.
    Thorsteinsdottir B, Montori V, Prokop L, Murad MH (2013) Ageism vs the technical imperative, applying the GRADE framework to the evidence on haemodialysis in very elderly patients. Clin Interv Aging 8:797–807CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Murtagh FE, Addington-Hall J, Higginson IJ (2007) The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis 14(1):82–99CrossRefPubMedGoogle Scholar
  3. 3.
    Jassal SV, Chiu E, Hladunewich M (2009) Loss of independence in patients starting dialysis at over 80 years of age or older. N Engl J Med 361(16):1612–1613CrossRefPubMedGoogle Scholar
  4. 4.
    O’Connor N, Kmar P (2012) Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med 15(2):228–234CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Schell J, Da Silva-Gane M, Germain M (2013) Recent insights into life expectancy with and without dialysis, vol 22(2).
  6. 6.
    Isaacs A, Burns A, Davenport A (2012) Should maximum conservative management be the standard paradigm for very elderly adults with chronic kidney disease or is there a role for dialysis? J Am Geriatr Soc 60(7):1376–1378CrossRefPubMedGoogle Scholar
  7. 7.
    Carson RC, Juszczak M, Davenport A, Burns A (2009) Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol 4(10):1611–1619CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hussain JA, Mooney A, Russon L (2013) Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease. Palliat Med 27:829–839CrossRefPubMedGoogle Scholar
  9. 9.
    Da Silva-Gane M, Welisted D, Greenshields H, Norton S, Chandna SM, Farrington K (2012) Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol 7(12):2002–2009CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE (2007) Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 22(7):1955–1962CrossRefPubMedGoogle Scholar
  11. 11.
    Murtagh FE, Addington-Hall JM, Higginson IJ (2011) End-stage renal disease: a new trajectory of functional decline in the last year of life. J Am Geriatr Soc 59(2):304–308CrossRefPubMedGoogle Scholar
  12. 12.
    Murtagh FEM, Chai MO, Donohoe P, Edmonds PM, Higginson IJ (2007) The use of opioid analgesia in end-stage renal disease patients managed without dialysis: recommendations for practice. J Pain Palliat Care Pharmacother 21(2):5–16PubMedGoogle Scholar
  13. 13.
    Goncalves AR, Ahmed AK, El Kossi M, El Nahas M (2011) Stopping rennin-angiotensin system inhibitors in chronic kidney disease: predictors of response. Nephron Clin Pract 119(4):348–354CrossRefGoogle Scholar
  14. 14.
    Morton RL, Tong A, Howard K, Snelling P, Webster AC (2010) The views of patients and carers in treatment decision making for chronic kidney disease: systematic review an thematic synthesis of qualitative studies. BMJ 340:c112CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Morton RL, Snelling P, Webster AC et al (2012) Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ 184(5):E277–E283CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Van De Luijtgaarden MW, Noordzij M et al (2013) Conservative care in Europe- nephrologists’ experience with the decision not to start renal replacement therapy. Nephrol Dial Transplant 28:2604–2612CrossRefPubMedGoogle Scholar
  17. 17.
    Davison SN, Torgunrud C (2007) The creation of an advance care planning process for patients with ESRD. Am J Kidney Dis 49(1):27–36CrossRefPubMedGoogle Scholar
  18. 18.
    NHS Kidney Care GMMKC, Advanced Renal Care (ARC) Project (2012) Getting it right: end of life care in advanced kidney diseaseGoogle Scholar
  19. 19.
    Lee BO, Lin CC, Chaboyer W, Chiang CL, Hung CC (2007) The fatigue experience of haemodialysis patients in Taiwan. J Clin Nurs 16(2):407–413CrossRefPubMedGoogle Scholar
  20. 20.
    Keithi-Reddy SR, Patel TV, Armstrong AW, Singh AK (2007) Uremic pruritus. Kidney Int 72(3):373–377CrossRefPubMedGoogle Scholar
  21. 21.
    Medcalf P, Bhatia KP (2006) Restless legs syndrome. BMJ 333(7566):457–458CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE (2002) A systematic review of the use of opioids in the management of dyspnoea. Thorax 57(11):939–944CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Medicine, Centre for NephrologyUniversity College London, Royal Free NHS Foundation TrustLondonUK

Personalised recommendations