Elderly on dialysis

Question 1

What is happening to the prevalence of elderly on renal replacement therapy.

Answer 1

It is increasing.

Question 2

What are the main goals for patients when starting renal replacement therapy. (4)

Answer 2

Relief of symptoms.
Achieve quality of life goals.
Extend life.
Avoid complications of treatment.

Question 3

What are the main goals for physicians when starting a patient on renal replacement therapy. (4)

Answer 3

Desire to help sick patient.
Patient has to meet criteria for starting dialysis.
How many spaces are available in HD unit.
Belief that dialysis will benfit the patient.

Question 4

What do you have to consider when starting an elderly person on dialysis. (9)

Answer 4

Multiple comorbidities. 
Physical function. 
Cognitive function. 
Nutritional status. 
Depression. 
Social isolation. 
Vision. 
Hearing. 
Social support.

Question 5

What age group has the highest 10 year survival rate on dialysis.

Answer 5

18-34

Question 6

What age group has the lowest 10 year survival rate on dialysis.

Answer 6

75+

Question 7

What do you use to predict 6 month prognosis for patients >75 years old. (8)

Answer 7

BMI

Question 8

What are the ethical principles to consider when putting elderly patients on dialysis. (4)

Answer 8

Patient autonomy.
Beneficence.
Avoid harm.
Justice.

Question 9

What should you consider in terms of patient autonomy when putting patients on dialysis. (3)

Answer 9

Patients must be given realistic and accurate information to enable them to make appropriate decision.
Patients cannot demand treatment if not appropriate.
Not relevant if patient lacks capacity.

Question 10

What should you consider in terms of beneficence when putting patients on dialysis. (3)

Answer 10

Dialysis should benefit patient:
Prolongs survival.
Improves quality of life.
Improves symptom burden.

Question 11

What should you consider in terms of avoiding patient harm when putting patients on dialysis. (3)

Answer 11

Dialysis should not harm patient:
Shortens survival.
No improvement or worse quality of life.
Increases symptom burden.

Question 12

What should you consider in terms of justice when putting patients on dialysis. (4)

Answer 12

Limited resources in all healthcare systems.
Dialysing patients who would not benefit leads to:
Dialysis staff/machines not being available for patient who may benefit.
Money/resources not being available for other healthcare needs.

Question 13

What is involved in conservative care of an elderly patient who is not put on dialysis. (4)

Answer 13

Active management of anaemia with ESA and intravenous iron.
BP control – slow rate of decline and lower stroke risk.
Optimise fluid balance – avoid over and under hydration.
Symptom control, including pain.
Joint management with palliative care team at end of life phase.