Managing end-stage renal disease in the elderly: state-of-the-art, challenges and opportunities

Abstract

The global population is progressively aging, to the extent that over 1.5 billion people worldwide will be aged 65 years or more by 2050, and the prevalence of end-stage renal disease in the elderly will remain high in forthcoming years. Since older patients typically suffer from several comorbidities, the above issue poses a hefty financial burden on healthcare systems. Although current guidelines might be useful for older individuals with fewer comorbidities and no significant disability, a tailored therapeutic approach is often essential in individuals with severe comorbidities, short life expectancy or poor treatment compliance. In such patients, rather than aggressively pursuing different therapeutic targets, physicians should strive to enhance quality of life by treating comorbidity-related symptoms and addressing common geriatric syndromes, including cognitive impairment, depression, incontinence, falls and polypharmacy, and the decision about starting dialysis should be guided not only by medical reasons, but also by patients‘ personal beliefs and preferences.