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Nierenersatzverfahren bei Hochbetagten
Very old people have a 1‑year 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. Wit...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Medizin
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361401/ https://www.ncbi.nlm.nih.gov/pubmed/34405030 http://dx.doi.org/10.1007/s11560-021-00518-x |
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author | Bechtel, Ulrike Abu-Tair, Mariam |
author_facet | Bechtel, Ulrike Abu-Tair, Mariam |
author_sort | Bechtel, Ulrike |
collection | PubMed |
description | Very old people have a 1‑year 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. |
format | Online Article Text |
id | pubmed-8361401 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Medizin |
record_format | MEDLINE/PubMed |
spelling | pubmed-83614012021-08-13 Nierenersatzverfahren bei Hochbetagten Bechtel, Ulrike Abu-Tair, Mariam Nephrologe Leitthema Very old people have a 1‑year 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. Springer Medizin 2021-08-13 2021 /pmc/articles/PMC8361401/ /pubmed/34405030 http://dx.doi.org/10.1007/s11560-021-00518-x Text en © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic. |
spellingShingle | Leitthema Bechtel, Ulrike Abu-Tair, Mariam Nierenersatzverfahren bei Hochbetagten |
title | Nierenersatzverfahren bei Hochbetagten |
title_full | Nierenersatzverfahren bei Hochbetagten |
title_fullStr | Nierenersatzverfahren bei Hochbetagten |
title_full_unstemmed | Nierenersatzverfahren bei Hochbetagten |
title_short | Nierenersatzverfahren bei Hochbetagten |
title_sort | nierenersatzverfahren bei hochbetagten |
topic | Leitthema |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361401/ https://www.ncbi.nlm.nih.gov/pubmed/34405030 http://dx.doi.org/10.1007/s11560-021-00518-x |
work_keys_str_mv | AT bechtelulrike nierenersatzverfahrenbeihochbetagten AT abutairmariam nierenersatzverfahrenbeihochbetagten |