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

James Tattersall, Ken Farrington*, Giorgio Gentile, Jeroen Kooman, Juan F. Macias Nunez, Ionut Nistor, Wim Van Biesen, Adrian Covic, European Renal Best Practice Guide; European Union Geriatric Med Soc E

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)742-750
Number of pages9
JournalNephrology Dialysis Transplantation
Volume33
Issue number5
DOIs
Publication statusPublished - 1 May 2018

Keywords

  • dialysis
  • dialysis adequacy
  • elderly
  • haemodialysis
  • Kt/v
  • RESIDUAL RENAL-FUNCTION
  • QUALITY-OF-LIFE
  • RESTING ENERGY-EXPENDITURE
  • TWICE-WEEKLY HEMODIALYSIS
  • INCREMENTAL HEMODIALYSIS
  • PERITONEAL-DIALYSIS
  • FREQUENT HEMODIALYSIS
  • NUTRITIONAL-STATUS
  • PRACTICE PATTERNS
  • UREMIC PRURITUS
  • NUTRITIONAL PARAMETERS
  • MAINTENANCE HEMODIALYSIS
  • INTENSIVE HEMODIALYSIS

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