Abstract
Only a few patients over the age of 70 will be eligible for transplantation, so the older patient starting dialysis will remain on this treatment for the rest of their life. Choice of dialysis modality will not affect patient survival but will have a major impact on patient lifestyle and therefore quality of life. The decision about dialysis modality is therefore a crucially important one, and the choice should be made with the patient. This requires the clinician (nephrologist, dialysis educator, etc.) to have a realistic understanding about life on haemodialysis (HD) and peritoneal dialysis (PD) for older people in general and for the patient in particular. The patient (and family/carers) also needs appropriate unbiased education about the pros and cons of HD and PD and how both will affect their lifestyle and overall prognosis. This process is called “shared decision making”. To ensure that this happens with each patient about to start patient, it is useful to break the process down into a series of steps as shown in Table 2.1.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Brown EA, Johansson L (2011) Epidemiology and management of end-stage renal disease in the elderly. Nat Rev Nephrol 7:591–598
Jassal SV, Chiu E, Hladunewich M (2009) Loss of independence in patients starting dialysis at 80 years of age or older. N Engl J Med 361:1612–1613
Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE (2009) Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 361:1539–1547
Etgen T, Chonchol M, Förstl H, Sander D (2012) Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 35:474–482
Buchman AS, Tanne D, Boyle PA, Shah RC, Leurgans SE, Bennett DA (2009) Kidney function is associated with the rate of cognitive decline in the elderly. Neurology 73:920–927
French registry for peritoneal dialysis and home haemodialysis. http://www.rdplf.org/profils/808-profil2014.html accessed 30 Sept 2015 (in French)
Jassal SV, Trpeski L, Zhu N, Fenton S, Hemmelgarn B (2007) Changes in survival among elderly patients initiating dialysis from 1990 to 1999. Can Med Assoc J 177:1033–1038
van de Luijtgaarden M, Noordzij M, Stel VS, Ravani P, Jarraya F, Collart F, Schön S, Leivestad T, Puttinger H, Wanner C, Jager KJ (2011) Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol Dial Transplant 26:2940–2947
Lamping DL, Constantinovici N, Roderick P, Normand C, Henderson L, Harris S, Brown E, Gruen R, Victor C (2000) Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study. Lancet 356:1543–1550
Harris SA, Lamping DL, Brown EA, Constantinovici N (2002) Clinical outcomes and quality of life in elderly patients on peritoneal dialysis versus hemodialysis. Perit Dial Int 22:463–470
Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, da Silva-Gane M, Beckett N, Hickson M (2010) Broadening Options for Long-term Dialysis for the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol Dial Transplant 25:3755–3763
Graham JE, Rockwood K, Beattie BL, Eastwood R, Gauthier S, Tuokko H, McDowell I (1997) Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 9068:1793–1796
Murray AM, Tupper DE, Knopman DS, Gilbertson DT, Pederson SL, Li S, Smith GE, Hochhalter AK, Collins AJ, Kane RL (2006) Cognitive impairment in hemodialysis patients is common. Neurology 2:216–223
Winterbottom A, Conner M, Mooney A, Bekker HL (2007) Evaluating the quality of patient leaflets about renal replacement therapy across UK renal units. Nephrol Dial Transplant 22:2291–2296
Flesch R (1946) A new readability yardstick. J Appl Psychol 32:221–233
Bergman B, Rosenhall U (2001) Vision and hearing in old age. Scand Audiol 30:255–263
Statistical Bulletin - Office for National Statistics (2014) Internet access- households and individuals. www.ons.gov.uk/ons/dcp171778_373584.pdf
Finucane ML, Mertz CK, Slovic P, Schmidt ES (2005) Task complexity and older adults’ decision-making competence. Psychol Aging 20(1):71–84
Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R (2011) Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev (10):CD001431. doi:10.1002/14651858.CD001431.pub3
O’Connor AM. User manual – stage of decision making (document on internet). Ottawa: Ottawa Hospital Research Institute; © 2000. Available from http://decisionaid.ohri.ca/docs/develop/User_Manuals/UM_Stage_Decision_Making.pdf
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Science+Business Media New York
About this chapter
Cite this chapter
Johansson, L., Brown, E.A. (2016). How to Choose the Type of Dialysis in the Elderly Patient. In: Misra, M. (eds) Dialysis in Older Adults. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3320-4_2
Download citation
DOI: https://doi.org/10.1007/978-1-4939-3320-4_2
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-3318-1
Online ISBN: 978-1-4939-3320-4
eBook Packages: MedicineMedicine (R0)