The elderly population who are diagnosed with chronic renal failure is growing. Many have multiple comorbidities, and in particular those with end-stage renal disease (ESRD) have a significantly higher mortality and morbidity, affecting both their life expectancy, that the decision whether to take the renal replacement therapy.
These patients need palliative care and supportive care large and unique, and often for years before manifesting itself death. However, most of these patients die without access to palliative care services. The high rates of mortality, together with the significant burden of symptoms both physical and psychosocial and spiritual, and the decision increasingly common for these patients to discontinue or withdraw from dialysis, emphasize the importance of integrating palliative care into the overall management of the patient with ESRD. The components of palliative care for ESRD include the management of pain and symptom management, advanced care planning, psychosocial and spiritual support, and other ethical issues.
Although dialysis may deliver higher quality and quantity of life in general when compared with conservative management, this is not always true, especially for elderly patients with multiple comorbidities. In fact, many of these patients have a poor prognosis once they start dialysis, while conservative management or a low-protein diet would be less deleterious. Moreover, among dialysis patients, elderly ones are those which show the highest rates of hospitalization, and complications due to the dialysis, compared to the other age groups.
When you opt for the solution "no dialysis" is required active management of kidney disease and active end of life care are necessary, an approach that requires a devoted attention to patient and family, and a multidisciplinary approach.
