Management of chronic kidney disease in elderly patients is complex
Planning for renal replacement therapy and dialysis vascular access requires evaluation of comorbidities and quality of life
Selection of the ideal vascular access for an elderly patient requires pre-operative vessel mapping and consideration of vascular biology, the patient's ability to function independently and their anticipated life expectancy
Ethical issues, optimal timing of vascular access creation and predicting the outcomes of various types of permanent access remain challenging
The population of elderly patients with end-stage renal disease (ESRD) is growing rapidly worldwide. The high prevalence of comorbidities, limited life expectancy and complex quality of life issues associated with this population pose substantial challenges for clinicians in terms of clinical decision-making and providing optimal care. The first dilemma encountered in the management of an elderly patient with ESRD is deciding whether to initiate renal replacement therapy and, if so, selecting the most-suitable dialysis modality. Planning vascular access for haemodialysis is associated with additional challenges. Several clinical practice guidelines recommend an arteriovenous fistula, rather than a central venous catheter or arteriovenous graft, as the preferred access for maintenance haemodialysis therapy. However, whether this recommendation is applicable to elderly patients with ESRD and a limited life expectancy is unclear. Selection and planning of the most appropriate vascular access for an elderly patient with ESRD requires careful consideration of several factors and ultimately should lead to an improvement in the patient's quality of life.
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The authors declare no competing financial interests.
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Vachharajani, T., Moist, L., Glickman, M. et al. Elderly patients with CKD—dilemmas in dialysis therapy and vascular access. Nat Rev Nephrol 10, 116–122 (2014). https://doi.org/10.1038/nrneph.2013.256
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