Advances in Chronic Kidney Disease
Volume 17, Issue 4 , Pages 368-377, July 2010

An Integrative Approach to Advanced Kidney Disease in the Elderly

  • Jane O. Schell

      Affiliations

    • Department of Medicine, Division of Nephrology, Duke University Medical Center
    • Corresponding Author InformationAddress correspondence to Jane Schell, MD, Duke University Medical Center, Hock Plaza, Suite 1105, 2424 Erwin Road, Box 2720, Durham, NC 27705-3860.
    • ,
  • Michael J. Germain

      Affiliations

    • Department of Medicine, Section of Nephrology, Baystate Medical Center, Springfield, MA
    • ,
  • Fred O. Finkelstein

      Affiliations

    • Hospital of St. Raphael, Yale University, New Haven, CT
    • ,
  • James A. Tulsky

      Affiliations

    • Department of Medicine, Center for Palliative Care, Duke University Medical Center
    • ,
  • Lewis M. Cohen

      Affiliations

    • Department of Psychiatry, Baystate Medical Center, Springfield, MA

Chronic kidney disease (CKD) has increasingly become a “geriatric” disease, with a dramatic rise in incidence in the aging population. Patients aged >75 years have become the fastest growing population initiating dialysis. These patients have increased comorbid diseases and functional limitations which affect mortality and quality of life. This review describes the challenges of dialysis initiation and considerations for management of the elderly subpopulation. There is a need for an integrative approach to care, which addresses management issues, health-related quality of life, and timely discussion of goals of care and end-of-life issues. This comprehensive approach to patient care involves the integration of nephrology, geriatric, and palliative medicine practices.

Key Words: Dialysis, Palliative care, Elderly, Geriatrics, Hospice, Quality of life, Withdrawal from dialysis, Withold from dialysis, Conservative care, Mortality

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PII: S1548-5595(10)00047-9

doi:10.1053/j.ackd.2010.03.004

Advances in Chronic Kidney Disease
Volume 17, Issue 4 , Pages 368-377, July 2010

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