Once the elderly patients get the diagnosis of CKD, the doctor is asked to choose the future disease management; especially whether dialysis treatment is the most appropriate choice.
The available options are conservative treatment or RRT, ie hemodialysis, peritoneal dialysis or kidney transplantation. According to the 2012 Annual Report of the US Kidney Data System, the RRR adjusted accident rate for patients over 75 years of age has risen to 1773 people per million, and the ESRD prevalence rate for patients over 75 years of age has increased to 5865 [204] In these patients, more than 90% of people treated with hemodialysis. Finally, since 2000, the number of transplanted donor deaths over the age of 65 has more than doubled (n = 2031).
Conservative treatment
As more and more older people receive ESRD diagnosis, conservative treatment rather than RRT has been increasingly seen as a suitable treatment regimen. Whenever the RRT's decision was given up, the patient was not given up and continued to receive kidney disease care.
Although the median survival of RRT patients is usually longer than conservative treatment (see below), the "no dialysis" option may be appropriate for patients with severe complications, including dementia or simply refusing dialysis, even if their clinical status And has not been seriously affected. No matter when the decision to make dialysis treatment should not be carried out, supportive care should be ensured by a multidisciplinary team.
Kidney palliative care includes the principles of the elderly in interdisciplinary teams; appropriate assessment and treatment with elderly symptoms (pain, fatigue, insomnia, depression, itching and constipation) while ensuring active treatment of renal complications (fluid overload, electrolyte imbalance, anemia, hypertension , Acidosis and CKD-mineral bone disease) and syndromes are designed to integrate services between primary care practitioners, community nurses and palliative care teams to optimize quality of life and avoid unnecessary hospitalization Treatment, in some cases, allow death at home with dignity. In this field, a recent study showed that conservative treatment of older ESRD patients reported a dramatic increase in symptoms and health-related problems in the first 2 months of death; therefore, health care should predict and address this increase in proximity to death Patients to provide support.
A prospective study from the UK, ESRD, a conservative patient managed by a multidisciplinary team, had an overall patient life span of 1.95 years with a 1-year survival rate of 65%; and 60% of the patients were hospitalized during the 3-year follow-up , 71% of deaths were done at home.
Appropriate diets may represent a useful conservative approach. A randomized study was designed to assess the noninferiorability of diets compared with dialysis, and a 1-year mortality in 56 ESRD patients assigned to very low protein diets (supplemented with amino and keto) or dialysis. Compared with dialysis patients, the 1-year survival rate (83.7%) was higher in the simple diet group (87.3%). In addition, the nutritional parameters of the two groups remained similar (no malnutrition in the diet group). Finally, a very low protein diet delayed dialysis starting at 9.8 months. Thus, in elderly patients with good dietary compliance, a supplemental low-protein diet can be safely presumed to avoid or at least delay RRT. Such a delayed initiation of dialysis should not be considered a failure to provide appropriate care based on a well thought-out approach to the patient's personal circumstances. However, if severe hyperkalemia, reduced urine output, refractory fluid overload, uremic symptoms or malnutrition symptoms, kidney physicians and patients may decide to start early RRT.
Although the lack of specific guidelines for secondary hyperparathyroidism in older adults, high levels of calcium, serum phosphate and Parkinson's hormones play a key role in the progressive development of extensive medial calcification in these patients, Increased risk of arteriosclerosis, CV events. Since serum calcification occurs in elderly patients with stage 3 CKD, careful control of CKD-mineral skeletal disorders plays a key role in reducing the risk of CV in these patients. Secondary hyperparathyroidism is also considered to be the main mechanism by which vitamin D deficiency may contribute to the onset of hip fracture in the elderly.
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