PD in the Older Person

Abstract

Changes in life expectancy across the globe has led to a marked demographic shift which, combined with an increasing burden of comorbidity, has led to a markedly older dialysis population. However, dialysis is only one component of the overall care of the older person with renal disease. Recognizing and assessing frailty, a process distinct from aging, is important before commencing and while on dialysis. Having assessed frailty, shared decisionmaking with the patient and family is no less important in the older person than any other patient. Shared decision-making should cover realistic care goals including quality of life, minimizing treatment burden and symptom control. While underutilized, there are many features of peritoneal dialysis which make it a suitable treatment for the older person. Individualization of the prescription should focus on preserving residual kidney function, use of low-intensity incremental regimes where possible, and assisted peritoneal dialysis where needed.