Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients

Charles Chazot, Ken Farrington, Ionut Nistor, Wim Van Biesen, Hanneke Joosten, Daniel Teta, Dimitrie Siriopol, Adrian Covic

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)


In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients.

Original languageEnglish
Pages (from-to)1809-16
Number of pages8
JournalInternational urology and nephrology
Issue number11
Early online date16 Sept 2015
Publication statusPublished - 1 Nov 2015


  • Aged
  • Frail Elderly
  • Humans
  • Kidney Failure, Chronic
  • Patient Care Planning
  • Renal Dialysis
  • Time Factors
  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Review


Dive into the research topics of 'Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients'. Together they form a unique fingerprint.

Cite this