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        Is Kt/V useful in elderly dialysis patients? : Pro- and Con arguments

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        Author
        Tattersall, James
        Farrington, Ken
        Gentile, Giorgio
        Kooman, Jeroen
        Macias Núñez, Juan F
        Nistor, Ionut
        Van Biesen, Wim
        Covic, Adrian
        European Renal Best Practice Guidelines Group and the European Union of Geriatric Medicine Societies (EUGMS)
        Attention
        2299/21435
        Abstract
        Current guidelines for dialysis specify a minimum Kt/V. For haemodialysis (HD) patients, minimum treatment time and frequency is also specified. The guidelines allow for modification to take account of renal function. The guidelines are not specifically aimed at the elderly and may not be appropriate for all patients in this group. Increasing age is accompanied by physiological and pathological changes that may modify the patient's response to uraemia and dialysis. Frailty and multi-morbidity are likely, but to a variable extent. Elderly patients could be more susceptible to the effects of uraemia and require a higher dose of dialysis. Conversely, the generation rate of uraemic toxins is lower in elderly patients, potentially reducing the need for dialysis. In the elderly, quality of life may be more adversely affected by multimorbidity than uraemic symptoms, thus the dose of dialysis may be less relevant. Higher doses of dialysis may be more difficult to achieve in the elderly and may be less well tolerated. We conclude that the prescription of dialysis in the elderly should be individualized, taking multiple factors into account. An individualized Kt/V may be useful in controlling dialysis dose and detecting problems in delivery. However, achievement of a specified Kt/V may not result in any benefit to an elderly patient and could be counterproductive.
        Publication date
        2018-05-01
        Published in
        Nephrology Dialysis Transplantation
        Published version
        https://doi.org/10.1093/ndt/gfy042
        Other links
        http://hdl.handle.net/2299/21435
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        School of Life and Medical Sciences
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