Wu Henry H L, Dhaygude Ajay P, Mitra Sandip, Tennankore Karthik K
Renal Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital & The University of Sydney, St Leonards, NSW, Australia.
Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK.
Clin Kidney J. 2022 Oct 7;16(3):422-431. doi: 10.1093/ckj/sfac220. eCollection 2023 Mar.
There is a rising demand for dialysis in the older population given the increased numbers of older adults living with chronic kidney disease (CKD) progressing to kidney failure. Home dialysis, i.e. peritoneal dialysis (PD) and home hemodialysis (HHD), has been available for decades, but more recently there has been a rapid increase in home dialysis utilization as patients and clinicians consider its practical and clinical advantages. For older adults, incident home dialysis utilization more than doubled and prevalent home dialysis growth nearly doubled over the past decade. Whilst its advantages and recent rise in popularity are evident, there are numerous barriers and challenges that are important to consider prior to initiating older adults on home dialysis. Some nephrology healthcare professionals do not view home dialysis as an option for older adults. Successful delivery of home dialysis for older adults may be made even more difficult by physical or cognitive limitations, concerns around dialysis adequacy, and treatment-related complications, as well as challenges relating to caregiver burnout and patient frailty that are unique to home dialysis and older adults. Ultimately, it would be important for clinicians, patients and their caregivers to define what constitutes a 'successful therapy' to ensure treatment goals are aligned towards each individual's priorities of care, considering the complex challenges that surround an older adult receiving home dialysis. In this review, we evaluate some of the key challenges surrounding the delivery of home dialysis to older adults and propose potential solutions based on updated evidence to overcome these challenges.
鉴于患有慢性肾脏病（CKD）并进展至肾衰竭的老年人数量增加，对老年人群体的透析需求不断上升。家庭透析，即腹膜透析（PD）和家庭血液透析（HHD），已经存在了几十年，但最近随着患者和临床医生认识到其实际和临床优势，家庭透析的使用率迅速上升。在过去十年中，老年人群中新发家庭透析的使用率增加了一倍多，家庭透析的普遍使用率增长了近一倍。虽然其优势和近期受欢迎程度的上升显而易见，但在开始让老年人进行家庭透析之前，有许多障碍和挑战需要考虑。一些肾脏病医疗专业人员并不认为家庭透析是老年人的一种选择。身体或认知限制、对透析充分性的担忧、与治疗相关的并发症，以及家庭透析和老年人特有的护理人员倦怠和患者虚弱等挑战，可能会使为老年人成功提供家庭透析变得更加困难。最终，临床医生、患者及其护理人员明确什么构成“成功的治疗”非常重要，以确保治疗目标与每个人的护理优先事项相一致，同时考虑到围绕老年人接受家庭透析的复杂挑战。在本综述中，我们评估了为老年人提供家庭透析所面临的一些关键挑战，并根据最新证据提出了潜在的解决方案以克服这些挑战。
