Wu Henry H L, Poulikakos Dimitrios, Hurst Helen, Lewis David, Chinnadurai Rajkumar
Department of Renal Medicine, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia.
Renal Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.
Kidney Dis (Basel). 2023 Jun 23;9(5):358-370. doi: 10.1159/000531367. eCollection 2023 Oct.
An aging population living with chronic kidney disease and progressing to kidney failure, subsequently receiving peritoneal dialysis (PD) is growing. A significant proportion of these patients are also living with multi-morbidities and some degree of frailty. Recent practice recommendations from the International Society of Peritoneal Dialysis advocate for high-quality, goal-directed PD prescription, and the Standardized Outcomes of Nephrology-PD initiative emphasized the need for an individualized, goal-based care approach in all patients receiving PD treatment. In older patients, this approach to PD care is even more important. A frailty screening assessment, followed by a comprehensive geriatric assessment (CGA) prior to PD initiation and when dictated by change in relevant circumstances is paramount in tailoring PD care and prescription according to the needs, life goals, as well as clinical status of older patients with kidney failure.
Our review aimed to summarize the different dimensions to be taken into account when delivering PD care to the older patient - from frailty screening and CGA in older patients receiving PD to employing a personalized, goal-directed PD prescription strategy, to preserving residual kidney function, optimizing blood pressure (BP) control, and managing anemia, to addressing symptom burden, to managing nutritional intake and promoting physical exercise, and to explore telehealth opportunities for the older PD population.
What matters most to older PD patients may not be simply extending survival, but more importantly, to be living comfortably on PD treatment with minimal symptom burden in a home environment and to minimize treatment complications.
患慢性肾脏病并进展至肾衰竭、随后接受腹膜透析（PD）的老年人口正在增加。这些患者中有很大一部分还患有多种疾病且有一定程度的虚弱。国际腹膜透析学会最近的实践建议提倡高质量、目标导向的腹膜透析处方，而肾脏病 - 腹膜透析标准化结局倡议强调在所有接受腹膜透析治疗的患者中需要采用个体化、基于目标的护理方法。在老年患者中，这种腹膜透析护理方法更为重要。在开始腹膜透析之前以及在相关情况发生变化时进行虚弱筛查评估，随后进行全面老年评估（CGA），对于根据肾衰竭老年患者的需求、生活目标以及临床状况调整腹膜透析护理和处方至关重要。
我们的综述旨在总结在为老年患者提供腹膜透析护理时需要考虑的不同方面——从接受腹膜透析的老年患者的虚弱筛查和全面老年评估，到采用个性化、目标导向的腹膜透析处方策略，再到保留残余肾功能、优化血压（BP）控制和管理贫血，解决症状负担，管理营养摄入和促进体育锻炼，以及探索老年腹膜透析人群的远程医疗机会。
对老年腹膜透析患者最重要的可能不仅仅是延长生存期，更重要的是，在家庭环境中以最小的症状负担舒适地接受腹膜透析治疗，并尽量减少治疗并发症。
