[Renal replacement procedures in the very old]. / Nierenersatzverfahren bei Hochbetagten.

ABSTRACT

Very old people have a 1­year mortality on hemodialysis, which in association with comorbidities and a catheter as dialysis access exceeds 30%; however, meta-analyses show that timely preparation and individually selected procedures decisively improve the morbidity and mortality even in old age. With increasing age and frailty the treatment targets shift away from prolongation of the lifespan to improvement of the quality of life. In this way the preference of home dialysis procedures, also as assisted peritoneal dialysis, can also achieve importance just as specialist nephrological treatment without renal replacement therapy with a palliative treatment target. In advanced age comorbidities, cognitive impairment, frailty and the overall prognosis determine the meaningful approach. Even with the placement of a vascular access there are other criteria for making decisions in very old people with respect to the anastomosis site and timing of access placement. Recommendations on the duration and frequency of dialysis follow the quality of life with incremental and at the end of life also with decremental treatment regimens. The demographic development is a special challenge for nephrology with an increase in older patients. Timely clarification of all renal replacement procedures and establishment of individual treatment targets with a careful selection of the dialysis modality and intensity can make a decisive contribution to improvement of the prognosis and particularly to the quality of life even in the very old.