Mrs Lynette Murray (knuth)1
1Health Nz Taranaki, New Plymouth, New Zealand
Biography:
I am an experienced renal clinician with nearly two decades of dedicated practice. I began working in Taranaki Base Hospitals renal service in 2006, where I have gained comprehensive experience across all areas or dialysis, transplant and CKD. In 2020 I advanced my practice and qualified as a Nurse Practitioner with a focus on CKD, Transplant and Haemodialysis.
Abstract:
Background:
The decision to initiate dialysis in patients aged over 80 years has shifted in recent years from an age-based approach to one that considers comorbid burden, frailty, and cognitive function. Evidence suggests that dialysis in this population may not significantly extend survival and may increase hospitalisation, highlighting the importance of individualised decision-making.
Case Presentation:
I present two elderly male patients referred to a pre-dialysis clinic. The first was an 86-year-old man with chronic kidney disease secondary to ischaemic nephropathy and a background of coronary artery disease; he was a non-smoker and non-drinker. The second was a 92-year-old man with a single kidney following right nephrectomy for transitional cell carcinoma, a history of a T11 osteolytic lesion, and a 30-year history of pipe smoking. Despite their age and comorbidities, both patients were cognitively intact, non-frail, and highly functional, each playing 18 holes of golf twice weekly.
Discussion:
This case study explores the shared decision-making process regarding dialysis initiation, incorporating functional status, comorbidities, patient values, and anticipated outcomes. The contrasting clinical backgrounds but similarly high functional capacity of these patients highlight the limitations of chronological age alone in guiding dialysis decisions.
Conclusion:
Dialysis decision-making in patients over 80 years should be individualised, with careful consideration of frailty, cognition, functional status, and patient preferences. These cases illustrate the complexity of balancing potential benefits and burdens of dialysis in very elderly yet robust individuals