Shared decision making in elderly patients with kidney failure.

Autor:	Kanbay M; Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey., Basile C; Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy., Battaglia Y; Department of Medicine, University of Verona, Verona, Italy.; Nephrology and Dialysis Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy., Mantovani A; Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy., Yavuz F; Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey., Pizzarelli F; Past Director, Nephrology Unit, SM Annunziata Hospital, Florence, Italy., Luyckx VA; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.; Department of Paediatrics and Child Health, University of Cape Town, South Africa.; Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Covic A; Nephrology Clinic, Dialysis and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania., Liakopoulos V; Second Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece., Mitra S; Manchester Academy of Health Sciences Centre (MAHSC), Manchester University Hospitals and University of Manchester, Manchester, UK.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2024 Apr 26; Vol. 39 (5), pp. 742-751.
DOI:	10.1093/ndt/gfad211
Abstrakt:	'Elderly' is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it haemodialysis, peritoneal dialysis or conservative kidney management, is complex because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or addressing selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision-making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs conservative kidney management, dialysis modality and optimal vascular access. (© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.)
Databáze:	MEDLINE
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