| [ Summary ] |
The number of elderly patients on dialysis continues to increase over time. Elderly patients often also require nursing care or assistance during the dialysis procedure. These needs remain unmet and represent an emerging social problem. Accordingly, establishment of a coordinated social support system is a pressing requirement. In Japan, there are no criteria for withholding and withdrawal of dialysis from elderly patients, and this is an underlying cause of the present situation. When recommending dialysis for elderly patients, physicians should take into consideration the wishes of the patient and family members, as well as the distinctive features of elderly dialysis patients, and should aim at the adequate dialysis dose for maintenance therapy. It is also important to take the patient's nutritional status into account. For hemodialysis, use of a highly permeable dialyzer membrane that allows the passage of large molecules and albumin is not recommended. For peritoneal dialysis, leakage of albumin across the peritoneum should be taken into account, and minimal bag exchange may be adequate. There are great individual variations among the elderly, so physicians should select the most suitable method and duration of dialysis for individual patients based on a multifactorial perspective. |