[Treatment of uremia in frail elderly patients: the issue of prolonged conservative management]. / L'anziano fragile e la terapia dell'uremia: il tema della terapia conservativa prolungata.

The chronic use of renal replacement therapy in frail elderly patients sometimes provides no tangible benefits and may even have a negative fallout on their quality of life, making prolonged conservative management a reasonable option. However, this is mostly a feeling, since very few papers have addressed this issue and there is no evidence-based medicine related to it. On the other hand, ethical issues are extraordinarily relevant and in this clinical setting extend beyond topics such as end-of-life care and advance care planning. It is evident that clinical decision-making in frail elderly patients with endstage renal disease may be very difficult and needs to be supported by ad hoc clinical trials. In the meantime, the ethical issues must be discussed in society.