Dialysis may affect mobility in frail elderly with end-stage renal disease

Researchers suggest that before offering the treatment, kidney specialists need to weigh which elderly patient suffering from end-stage renal disease (ESRD) would benefit the most from either dialysis or conservative therapies.

Dialysis provides artificial replacement of lost kidney function, passing a patient's blood through a machine that filters out impurities normally captured in the organ. The treatment can be lengthy and physically challenging for patients.

Conservative treatment, which does not involve dialysis, focus on medicines to decrease the symptoms of the kidney failure places less physical stress on patients and can result in a better quality of life, particularly for patients in ESRD.

The researchers have found that elderly patients with ESRD have multiple functional impairments, physical symptoms and a high rate of depression, facts that require an integrated, holistic approach to the care.

There are also increased rates of frailty, cognitive dysfunction and geriatric syndromes such as falls and hospitalization involving elders undergoing dialysis.

"To care effectively for these persons, we must now learn much more - we must define who among this population will benefit most from dialysis and who will benefit most from conservative therapy," said the researchers.

Lead researchers Mark L. Zeidel, and Robert M. Arnold said that small studies that examine the outcome of patients who elect conservative therapy over dialysis suggest that mortality and quality-of-life outcomes do not differ very much among selected patients who undergo dialysis and those who do not.

They believe it is critical that larger studies be designed to determine the actual benefit of dialysis for frail elders.

The study conducted over home residents on dialysis. It found poor overall outcomes, in the first year after initiation of dialysis with 58 percent of residents dying and 29 percent having a decrease in functional status. Only 13 percent maintained functional status.

They found that elderly patients with ESRD have multiple functional impairments, physical symptoms and a high rate of depression, facts that require an integrated, holistic approach to the care.

There are also increased rates of frailty, cognitive dysfunction and geriatric syndromes such as falls and hospitalization involving elders undergoing dialysis.