E-Mail karger@karger.com Minireview Nephron Clin Pract 2013;124:202–208 DOI: 10.1159/000357433 Optimising Treatment of End-Stage Renal Disease in the Elderly Albert Power Edwina Brown Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK Background It is not surprising that the dialysis population is age- ing given the ageing general population and the fact that chronic kidney disease prevalence increases with age. In the UK, the dialysis population of adults aged ≥65 years grew by 29% from 2005 to 2008 compared to only 16% in those aged 18–65 years [1, 2]. In the USA from 2005 to 2008, the highest growth rate was seen in the oldest old ( ≥85 years) [3]. Dialysis for the older and frailer individ- ual is a comparatively new treatment option. As late as 1984, Challah et al. [4] reported from a survey that 45% of a sample of UK nephrologists would decline dialysis in a 50-year-old man with ischaemic heart disease. Less than 20 years later outcomes of octogenarians on dialysis were being published [5]. This first major report of outcomes in the ‘old elderly’ focused on survival as the outcome measure with a median survival of 28.9 months. More re- cent papers have focused on physical function as well as survival. Longitudinal data of 97 patients >80 years from Toronto showed that whereas 75% of patients at the start of dialysis were functionally independent and living at home, within 6 months 30% required community sup- port or transfer to a nursing home. At 12 months only Key Words Conservative management · Dialysis · Elderly · End-stage renal disease Abstract The features of ageing complicate the management of end- stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore impor- tant to consider the impact of dialysis on lifestyle and wheth- er survival will actually be improved for frail older patients. This review article considers how haemodialysis and perito- neal dialysis can be adjusted for older patients, and, in par- ticular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their man- agement. © 2014 S. Karger AG, Basel Published online: January 4, 2014 Dr. Albert Power Room 5N8A, Commonwealth Building, Hammersmith Campus Imperial College London Du Cane Road, London W12 0NN (UK) E-Mail albert.power  @  nhs.net © 2014 S. Karger AG, Basel 1660–2110/14/1244–0202$39.50/0 www.karger.com/nec Downloaded by: 198.143.37.97 - 3/31/2016 1:32:58 AM