Advances in chronic kidney disease
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Adv Chronic Kidney Dis · Nov 2011
ReviewGeriatric nephrology: a paradigm shift in the approach to renal replacement therapy.
The population of elderly individuals diagnosed with CKD continues to grow. Many have multiple comorbid conditions that will impact life expectancy as well as decisions about whether to pursue renal replacement therapy. Nephrologists are uniquely positioned to assist their patients and caregivers in this regard and spend considerable time counseling them about the benefits and risks associated with dialysis therapy. This article presents an overview of many of the issues facing nephrologists, and provides tools to assist busy clinicians in helping their elderly patients in deciding whether to consider dialysis or intensive, nondialysis care.
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Increasing numbers of patients are starting dialysis who have limited prognoses for 6-month survival. The presence of multiple comorbidities, aging, and frailty contributes to this phenomenon. ⋯ One option is to consider and discuss the "no dialysis" option with patients and family. Patients need to be identified who may benefit from this option, and their medical management needs to be reviewed.