Peritoneal dialysis in the elderly

In the last decade the number of patients older than 75 years old on dialysis has approximately doubled. The care of the elderly, who require chronic dialysis by either peritoneal dialysis (PD) or haemodialysis, is more complex than the management of their younger counterparts, due to their frequent comorbid con­ditions, numerous impairments, functional limitations, and lack of social support. Also, the ideal timing of dialysis initiation has not been clarified in the elderly with slowly progressing chronic kidney disease. Nephrologists may have to identify the factors that may affect negatively the outcome of patients so as to start dialysis earlier. Multiple comorbidities may contribute also to the final decision to select peritoneal dialysis as a more suitable home modality than center haemodialysis. Though quality of life and mortality seem to be similar in elderly patients on both haemo­dialysis and peritoneal dialysis, selection bias may confound these findings. Among several methods of peritoneal dialysis, assisted PD seems to be a suitable method for elderly patients. Finally, the decision to withhold or withdraw from dialysis fre­quently challenges the nephrologist who looks after elderly patients.