Dialysis in the Elderly

Chronic kidney disease (CKD) leading to end-stage kidney disease (ESKD) is a growing global issue. If and how to provide renal replacement therapy (RRT) is a complex issue. The results of RRT in the aging population are encouraging, and when RRT is chosen as a therapeutic option, proper prescription and modality selection may be critical to support quantity and quality of life. Dialysis in the aging population must consider the physical changes of aging, especially in the CKD population. Specifically, cardiovascular status and cognitive impairment should be evaluated and understood by the entire interdisciplinary team. Cardiovascular changes, particularly left ventricular hypertrophy and reduced cardiac function, are common, and proper modality and prescription could positively or negatively affect care and success. However, cognitive decline and social determinants of health also drive modality and prescription. With hemodialysis, both home and in-center therapies may be viable and successful. Understanding the effects of frequency and ultrafiltration rates are critical in provision of these therapies. Peritoneal dialysis is also an effective and well-tolerated therapy in the aging population. The alternatives of manual continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD) need to be understood to prescribe the best individualized treatment. Regardless of prescription and modality, reassessment of response along with assessment of cardiovascular and cognitive function may need to be followed longitudinally to ensure best care.