Managing end-stage renal disease in the elderly: state-of-the-art, challenges and opportunities

References

• 1  Mignon F, Michel C, Mentre F, Viron B. Worldwide demographics and future trends of the management of renal failure in the elderly. Kidney Int. Suppl.41,S18–S26 (1993).
  Medline CASGoogle Scholar
• 2  CDC. Trends in aging – United States and worldwide. MMWR Morb. Mort. Wkly Rep.52(6),101–104, 106 (2003).
  MedlineGoogle Scholar
• 3  Levey AS, Stevens LA, Coresh J. Conceptual model of CKD: applications and implications. Am. J. Kidney Dis.53(3 Suppl. 3),S4–S16 (2009).
  MedlineGoogle Scholar
• 4  Roderick PJ, Atkins RJ, Smeeth L et al. CKD and mortality risk in older people: a community-based population study in the United Kingdom. Am. J. Kidney Dis.53(6),950–960 (2009).
  MedlineGoogle Scholar
• 5  Stevens LA, Viswanathan G, Weiner DE. Chronic kidney disease and end-stage renal disease in the elderly population: current prevalence, future projections, and clinical significance. Adv. Chronic Kidney Dis.17(4),293–301 (2010).
  MedlineGoogle Scholar
• 6  Winchester JF, Rakowski TA. End-stage renal disease and its management in older adults. Clin. Geriatr. Med.14(2),255–265 (1998).
  Medline CASGoogle Scholar
• 7  Levin A, Stevens PE. Summary of KDIGO guideline: behind the scenes, need for guidance, and a framework for moving forward. Kidney Int. doi:10.1038/ki.2013.192 (2013) (Epub ahead of print).
  Google Scholar
• 8  Collins AJ, Foley R, Herzog C et al. Excerpts from the United States Renal Data System 2007 annual data report. Am. J. Kidney Dis.51(1 Suppl. 1),S1–S320 (2008).
  MedlineGoogle Scholar
• 9  Iseki K, Tozawa M, Iseki C, Takishita S, Ogawa Y. Demographic trends in the Okinawa Dialysis Study (OKIDS) registry (1971–2000). Kidney Int.61(2),668–675 (2002).
  MedlineGoogle Scholar
• 10  Holley JL. Age, eGFR, and CKD complications. Clin. J. Am. Soc. Nephrol.6(12),2729–2731 (2011).
  Medline CASGoogle Scholar
• 11  Eggers PW. The aging pandemic: demographic changes in the general and end-stage renal disease populations. Semin. Nephrol.29(6),551–554 (2009).
  MedlineGoogle Scholar
• 12  Coresh J, Selvin E, Stevens LA et al. Prevalence of chronic kidney disease in the United States. JAMA298(17),2038–2047 (2007).
  Medline CASGoogle Scholar
• 13  Kurella Tamura M. Incidence, management, and outcomes of end-stage renal disease in the elderly. Curr. Opin. Nephrol. Hypertens.18(3),252–257 (2009).
  MedlineGoogle Scholar
• 14  Mau LW, Liu J, Qiu Y et al. Trends in patient characteristics and first-year medical costs of older incident hemodialysis patients, 1995–2005. Am. J. Kidney Dis.55(3),549–557 (2010).
  MedlineGoogle Scholar
• 15  Glassock RJ, Rule AD. The implications of anatomical and functional changes of the aging kidney: with an emphasis on the glomeruli. Kidney Int.82(3),270–277 (2012).
  MedlineGoogle Scholar
• 16  Kaplan C, Pasternack B, Shah H, Gallo G. Age-related incidence of sclerotic glomeruli in human kidneys. Am. J. Pathol.80(2),227–234 (1975).
  Medline CASGoogle Scholar
• 17  Rule AD, Amer H, Cornell LD et al. The association between age and nephrosclerosis on renal biopsy among healthy adults. Ann. Intern. Med.152(9),561–567 (2010).
  MedlineGoogle Scholar
• 18  Rule AD, Semret MH, Amer H et al. Association of kidney function and metabolic risk factors with density of glomeruli on renal biopsy samples from living donors. Mayo Clin. Proc.86(4),282–290 (2011).
  MedlineGoogle Scholar
• 19  Rowe JW, Andres R, Tobin JD, Norris AH, Shock NW. The effect of age on creatinine clearance in men: a cross-sectional and longitudinal study. J. Gerontol.31(2),155–163 (1976).
  Medline CASGoogle Scholar
• 20  Fliser D, Franek E, Ritz E. Renal function in the elderly – is the dogma of an inexorable decline of renal function correct? Nephrol. Dial. Transplant.12(8),1553–1555 (1997).
  Medline CASGoogle Scholar
• 21  Fliser D. Ren sanus in corpore sano: the myth of the inexorable decline of renal function with senescence. Nephrol. Dial. Transplant.20(3),482–485 (2005).
  MedlineGoogle Scholar
• 22  Choudhury D, Levi M. Kidney aging – inevitable or preventable? Nat. Rev. Nephrol.7(12),706–717 (2011).
  Medline CASGoogle Scholar
• 23  Levey AS, Stevens LA, Schmid CH et al. A new equation to estimate glomerular filtration rate. Ann. Intern. Med.150(9),604–612 (2009).
  MedlineGoogle Scholar
• 24  Gaspari F, Ruggenenti P, Porrini E et al. The GFR and GFR decline cannot be accurately estimated in Type 2 diabetics. Kidney Int.84(1),164–173 (2013).• Questions the use of any estimation formula to identify hyperfiltering patients and monitor renal disease progression and response to treatment in Type 2 diabetics without overt nephropathy.
  Medline CASGoogle Scholar
• 25  Glassock RJ. Estimated glomerular filtration rate: time for a performance review? Kidney Int.75(10),1001–1003 (2009).
  MedlineGoogle Scholar
• 26  Schaeffner ES, van der Giet M, Gaedeke J et al. The Berlin initiative study: the methodology of exploring kidney function in the elderly by combining a longitudinal and cross-sectional approach. Eur. J. Epidemiol.25(3),203–210 (2010).•• The ongoing Berlin Initiative Study will help to better establish the boundaries of ‘normal‘ glomerular filtration rate in older patients and help address the issue of proper chronic kidney disease diagnosis in older individuals, by using iohexol clearance as the gold standard.
  MedlineGoogle Scholar
• 27  Gentile G, Trillini M. Chronic kidney disease and risk of mortality, cardiovascular events or end-stage renal disease in older patients with hypertension. Expert Rev. Cardiovasc. Ther.10(10),1213–1216 (2012).
  Medline CASGoogle Scholar
• 28  Van Pottelbergh G, Bartholomeeusen S, Buntinx F, Degryse J. The evolution of renal function and the incidence of end-stage renal disease in patients aged ≥50 years. Nephrol. Dial. Transplant.27(6),2297–2303 (2012).
  MedlineGoogle Scholar
• 29  Stengel B, Metzger M, Froissart M et al. Epidemiology and prognostic significance of chronic kidney disease in the elderly – the Three-City prospective cohort study. Nephrol. Dial. Transplant.26(10),3286–3295 (2011).
  MedlineGoogle Scholar
• 30  Toussaint ND, Lau KK, Strauss BJ, Polkinghorne KR, Kerr PG. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrol. Dial. Transplant.23(2),586–593 (2008).
  MedlineGoogle Scholar
• 31  Tracy RE, Ishii T. Hypertensive renovasculopathies and the rise of blood pressure with age in Japan and USA. Int. Urol. Nephrol.32,109–117 (2000).
  Medline CASGoogle Scholar
• 32  Heeneman S, Sluimer J, Daemen M. Angiotensin-converting enzyme and vascular remodeling. Circ. Res.101,441–454 (2007).
  Medline CASGoogle Scholar
• 33  Hill GS. Hypertensive nephrosclerosis. Curr. Opin. Nephrol. Hypertens17(3),266–270 (2008).
  MedlineGoogle Scholar
• 34  Melsom T, Mathisen UD, Eilertsen BA et al. Physical exercise, fasting glucose, and renal hyperfiltration in the general population: the Renal Iohexol Clearance Survey in Tromso 6 (RENIS-T6). Clin. J. Am. Soc. Nephrol.7(11),1801–1810 (2012).
  MedlineGoogle Scholar
• 35  Chagnac A, Weinstein T, Herman M, Hirsh J, Gafter U, Ori Y. The effects of weight loss on renal function in patients with severe obesity. J. Am. Soc. Nephrol.14(6),1480–1486 (2003).
  MedlineGoogle Scholar
• 36  Hsu CY, McCulloch CE, Fan D, Ordonez JD, Chertow GM, Go AS. Community-based incidence of acute renal failure. Kidney Int.72(2),208–212 (2007).
  MedlineGoogle Scholar
• 37  Coca SG. Acute kidney injury in elderly persons. Am. J. Kidney Dis.56(1),122–131 (2010).
  MedlineGoogle Scholar
• 38  Lea JP. Metabolic syndrome, CKD progression, and death: the good, the bad, and the ugly. Clin. J. Am. Soc. Nephrol.8(6),893–895 (2013).
  Medline CASGoogle Scholar
• 39  Morley JE. The metabolic syndrome and aging. J. Gerontol. A Biol. Sci. Med. Sci.59(2),M139–M142 (2004).
  MedlineGoogle Scholar
• 40  Baylis C. Sexual dimorphism in the aging kidney: differences in the nitric oxide system. Nat. Rev. Nephrol.5(7),384–396 (2009).
  Medline CASGoogle Scholar
• 41  Anderson S. Ageing and the renin-angiotensin system. Nephrol. Dial. Transplant.12(6),1093–1094 (1997).
  Medline CASGoogle Scholar
• 42  Fox CS, Larson MG, Leip EP, Culleton B, Wilson PW, Levy D. Predictors of new-onset kidney disease in a community-based population. JAMA291(7),844–850 (2004).
  Medline CASGoogle Scholar
• 43  Vlassara H, Torreggiani M, Post JB, Zheng F, Uribarri J, Striker GE. Role of oxidants/inflammation in declining renal function in chronic kidney disease and normal aging. Kidney Int. Suppl. (114),S3–S11 (2009).
  MedlineGoogle Scholar
• 44  Perico N, Remuzzi G, Benigni A. Aging and the kidney. Curr. Opin. Nephrol. Hypertens.20(3),312–317 (2011).
  Medline CASGoogle Scholar
• 45  Glassock RJ, Winearls C. Ageing and the glomerular filtration rate: truths and consequences. Trans. Am. Clin. Climatol. Assoc.120,419–428 (2009).
  MedlineGoogle Scholar
• 46  Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J. Am. Coll. Cardiol.52(19),1527–1539 (2008).• Presents a new classification of the cardiorenal syndrome with five subtypes that reflect the pathophysiology, the time-frame and the nature of concomitant cardiac and renal dysfunction.
  MedlineGoogle Scholar
• 47  Santoro A. Heart failure and cardiorenal syndrome in the elderly. J. Nephrol.25(Suppl. 19),S67–S72 (2012).
  MedlineGoogle Scholar
• 48  Metra M, Cotter G, Gheorghiade M, Dei Cas L, Voors AA. The role of the kidney in heart failure. Eur. Heart J.33(17),2135–2142 (2012).
  Medline CASGoogle Scholar
• 49  Zoccali C, Leonardis D, Enia G et al. Heart rate, age and the risk of progression to kidney failure in patients with CKD. J. Nephrol.25(Suppl. 19),S20–S27 (2012).
  Medline CASGoogle Scholar
• 50  Collins AJ, Foley RN, Chavers B et al. United States Renal Data System 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Am. J. Kidney Dis.59(1 Suppl. 1),A7, e1–420 (2012).
  MedlineGoogle Scholar
• 51  Villar E, Remontet L, Labeeuw M, Ecochard R. Effect of age, gender, and diabetes on excess death in end-stage renal failure. J. Am. Soc. Nephrol.18(7),2125–2134 (2007).
  MedlineGoogle Scholar
• 52  Fried L, Tangen C, Walston J et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci.56(3),146–156 (2001).
  Medline CASGoogle Scholar
• 53  Shlipak MG, Stehman-Breen C, Fried LF et al. The presence of frailty in elderly persons with chronic renal insufficiency. Am. J. Kidney Dis.43(5),861–867 (2004).
  MedlineGoogle Scholar
• 54  Johansen KL, Chertow GM, Jin C, Kutner NG. Significance of frailty among dialysis patients. J. Am. Soc. Nephrol.18(11),2960–2967 (2007).
  MedlineGoogle Scholar
• 55  Ortiz GG, Arias-Merino ED, Flores-Saiffe M et al. Prevalence of cognitive impairment and depression among a population aged over 60 years in the metropolitan area of Guadalajara, Mexico. Curr. Gerontol. Geriatr. Res. 6 2012,175019 (2012).
  MedlineGoogle Scholar
• 56  Katsikas JL, Nelson FV, Bacchus S, Nissenson AR. Opinion: applying frail-elderly care principles. Semin. Dial.22(1),22–24 (2009).
  MedlineGoogle Scholar
• 57  Abdel-Rahman EM, Turgut F, Turkmen K, Balogun RA. Falls in elderly hemodialysis patients. QJM104(10),829–838 (2011).
  Medline CASGoogle Scholar
• 58  Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health12,201 (2012).
  MedlineGoogle Scholar
• 59  Quiñones AR, Liang J, Bennett JM, Xu X, Ye W. How does the trajectory of multimorbidity vary across black, white, and Mexican–Americans in middle and old age? J. Gerontol. B Psychol. Sci. Soc. Sci.66(6),739–749 (2011).
  MedlineGoogle Scholar
• 60  Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam. Pract.13,56 (2012).• Reveals a range of factors affecting the general practitioners‘ deprescribing for elderly patients with multimorbidity.
  MedlineGoogle Scholar
• 61  Myers OB, Adams C, Rohrscheib MR et al. Age, race, diabetes, blood pressure, and mortality among hemodialysis patients. J. Am. Soc. Nephrol.21(11),1970–1978 (2010).
  MedlineGoogle Scholar
• 62  Fried L, Ferrucci L, Darer J, Williamson J, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J. Gerontol. A Biol. Sci. Med. Sci.59(3),255–263 (2004).
  MedlineGoogle Scholar
• 63  Reboldi G, Gentile G, Angeli F, Verdecchia P. Blood pressure lowering in the oldest old. J. Hypertens.28(7),1373–1376 (2010).
  Medline CASGoogle Scholar
• 64  Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ338,b1665 (2009).•• Meta-analysis of 147 randomized trials shows that the benefits of blood pressure reduction on cardiovascular events become smaller in patients aged 60–69 years and, even more, aged 70–79 years.
  Medline CASGoogle Scholar
• 65  Beckett NS, Peters R, Fletcher AE et al. Treatment of hypertension in patients 80 years of age or older. N. Engl. J. Med.358(18),1887–1898 (2008).
  Medline CASGoogle Scholar
• 66  Staessen JA, Fagard R, Thijs L et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet350(9080),757–764 (1997).
  Medline CASGoogle Scholar
• 67  Turnbull F, Neal B, Ninomiya T et al.; Blood Pressure Lowering Treatment Trialists‘ Collaboration. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ336(7653),1121–1123 (2008).
  Medline CASGoogle Scholar
• 68  Grossman E, Verdecchia P, Shamiss A, Angeli F, Reboldi G. Diuretic treatment of hypertension. Diabetes Care34(Suppl. 2),S313–S319 (2011).
  MedlineGoogle Scholar
• 69  Rahman M, Ford CE, Cutler JA et al. Long-term renal and cardiovascular outcomes in Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants by baseline estimated GFR. Clin. J. Am. Soc. Nephrol.7(6),989–1002 (2012).
  MedlineGoogle Scholar
• 70  National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am. J. Kidney Dis.39(2 Suppl. 1),S1–S266 (2002).
  MedlineGoogle Scholar
• 71  Dasgupta I, Rayner HC. In good conscience – safely withholding dialysis in the elderly. Semin. Dial.22(5),476–479 (2009).
  MedlineGoogle Scholar
• 72  Noble H. Supportive and palliative care for the patient with end-stage renal disease. Br. J. Nurs.17(8),498–504 (2008).
  MedlineGoogle Scholar
• 73  Berzoff J, Swantkowski J, Cohen LM. Developing a renal supportive care team from the voices of patients, families, and palliative care staff. Palliat. Support Care6(2),133–139 (2008).
  MedlineGoogle Scholar
• 74  Carson RC, Juszczak M, Davenport A, Burns A. Is maximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin. J. Am. Soc. Nephrol.4(10),1611–1619 (2009).
  MedlineGoogle Scholar
• 75  Murtagh FE, Cohen LM, Germain MJ. The ‘no dialysis‘ option. Adv. Chronic Kidney Dis.18(6),443–449 (2011).
  MedlineGoogle Scholar
• 76  Swidler M. Chapter 37. Dialysis decisions in the elderly patient with advanced CKD and the role of nondialytic therapy. In: American Society of Nephrology Geriatric Nephrology Curriculum. Oreopoulos D, Wiggins J (Eds). American Society of Nephrology, Washington, DC, USA, 1–7 (2009).Wong CF, McCarthy M, Howse ML, Williams PS. Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis. Ren. Fail.29(6),653–659 (2007).
  MedlineGoogle Scholar
• 77  Wong CF, McCarthy M, Howse ML, Williams PS. Factors affecting survival in advanced chronic kidney disease patients who choose not to receive dialysis. Ren. Fail.29(6),653–659 (2007).
  Medline CASGoogle Scholar
• 78  Brunori G, Viola BF, Parrinello G et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am. J. Kidney Dis.49(5),569–580 (2007).
  Medline CASGoogle Scholar
• 79  Brunori G. Treatment of chronic kidney disease in the elderly: diet or conservative management. J. Nephrol.25(Suppl. 19),S28–S31 (2012).
  Medline CASGoogle Scholar
• 80  Bruce DG, St John A, Nicklason F, Goldswain PR. Secondary hyperparathyroidism in patients from western Australia with hip fracture: relationship to type of hip fracture, renal function, and vitamin D deficiency. J. Am. Geriatr. Soc.47(3),354–359 (1999).
  Medline CASGoogle Scholar
• 81  Lips P. Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr. Rev.22(4),477–501 (2001).
  Medline CASGoogle Scholar
• 82  Levin A, Bakris GL, Molitch M et al. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease: results of the study to evaluate early kidney disease. Kidney Int.71(1),31–38 (2007).
  Medline CASGoogle Scholar
• 83  Rix M, Andreassen H, Eskildsen P, Langdahl B, Olgaard K. Bone mineral density and biochemical markers of bone turnover in patients with predialysis chronic renal failure. Kidney Int.56(3),1084–1093 (1999).
  Medline CASGoogle Scholar
• 84  Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N. Engl. J. Med.351(13),1296–1305 (2004).
  Medline CASGoogle Scholar
• 85  Ye X, Rastogi A, Nissenson AR. Renal replacement therapy in the elderly. Clin. Geriatr. Med.25(3),529–542 (2009).
  MedlineGoogle Scholar
• 86  Letourneau I, Ouimet D, Dumont M, Pichette V, Leblanc M. Renal replacement in end-stage renal disease patients over 75 years old. Am. J. Nephrol.23(2),71–77 (2003).
  Medline CASGoogle Scholar
• 87  Jassal SV, Chiu E, Hladunewich M. Loss of independence in patients starting dialysis at 80 years of age or older. N. Engl. J. Med.361(16),1612–1613 (2009).
  Medline CASGoogle Scholar
• 88  De Biase V, Tobaldini O, Boaretti C et al. Prolonged conservative treatment for frail elderly patients with end-stage renal disease: the Verona experience. Nephrol. Dial. Transplant.23(4),1313–1317 (2008).
  MedlineGoogle Scholar
• 89  Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol. Dial. Transplant.22(7),1955–1962 (2007).
  MedlineGoogle Scholar
• 90  Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol. Dial. Transplant.26(5),1608–1614 (2011).
  MedlineGoogle Scholar
• 91  Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Choosing not to dialyse: evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron Clin. Pract.95(2),c40–c46 (2003).
  MedlineGoogle Scholar
• 92  Joly D, Anglicheau D, Alberti C et al. Octogenarians reaching end-stage renal disease: cohort study of decision-making and clinical outcomes. J. Am. Soc. Nephrol.14(4),1012–1021 (2003).
  MedlineGoogle Scholar
• 93  Genestier S, Meyer N, Chantrel F et al. Prognostic survival factors in elderly renal failure patients treated with peritoneal dialysis: a nine-year retrospective study. Perit. Dial. Int.30(2),218–226 (2010).
  MedlineGoogle Scholar
• 94  Selgas R, Cirugeda A, Fernandez-Perpen A et al. Comparisons of hemodialysis and CAPD in patients over 65 years of age: a meta-analysis. Int. Urol. Nephrol.33(2),259–264 (2001).
  Medline CASGoogle Scholar
• 95  Vonesh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int. Suppl. (103),S3–S11 (2006).
  MedlineGoogle Scholar
• 96  Saxena R, Yu X, Giraldo M et al. Renal transplantation in the elderly. Int. Urol. Nephrol.41(1),195–210 (2009).
  MedlineGoogle Scholar
• 97  Cravedi P, Ruggenenti P, Remuzzi G. Old donors for kidney transplantation: how old? Gerontology57(6),513–520 (2011).
  MedlineGoogle Scholar
• 98  Otero-Ravina F, Rodriguez-Martinez M, Gude F, Gonzalez-Juanatey JR, Valdes F, Sanchez-Guisande D. Renal transplantation in the elderly: does patient age determine the results? Age Ageing34(6),583–587 (2005).
  MedlineGoogle Scholar
• 99  Couchoud C, Moranne O, Frimat L, Labeeuw M, Allot V, Stengel B. Associations between comorbidities, treatment choice and outcome in the elderly with end-stage renal disease. Nephrol. Dial. Transplant.22(11),3246–3254 (2007).
  MedlineGoogle Scholar
• 100  Heldal K, Hartmann A, Grootendorst DC et al. Benefit of kidney transplantation beyond 70 years of age. Nephrol. Dial. Transplant.25(5),1680–1687 (2010).
  MedlineGoogle Scholar
• 101  Rebollo P, Ortega F, Baltar JM et al. Health-related quality of life (HRQOL) in end stage renal disease (ESRD) patients over 65 years. Geriatr. Nephrol. Urol.8(2),85–94 (1998).
  Medline CASGoogle Scholar
• 102  Dousdampanis P, Trigka K, Fourtounas C. Diagnosis and management of chronic kidney disease in the elderly: a field of ongoing debate. Aging Dis.3(5),360–372 (2012).
  MedlineGoogle Scholar
• 103  Hubbard WJ, Dashti N. Aging and transplantation – a topic for biomedicine or bioethics? Aging Dis.2(2),181–185 (2011).
  MedlineGoogle Scholar
• 104  Remuzzi G, Cravedi P, Perna A et al. Long-term outcome of renal transplantation from older donors. N. Engl. J. Med.354(4),343–352 (2006).•• Both single and dual kidney transplantation achieved excellent rates of long-term survival and were acceptable and feasible choices for expanding the donor-organ pool, particularly in the elderly.
  Medline CASGoogle Scholar
• 105  McKay D, Jameson J. Kidney transplantation and the ageing immune system. Nat. Rev. Nephrol.8(12),700–708 (2012).• Comprehensive review that addresses what is currently known about aging and the immune system, highlighting age-related changes that affect the outcome of transplantation in elderly individuals.
  Medline CASGoogle Scholar
• 106  Tullius SG, Tran H, Guleria I, Malek SK, Tilney NL, Milford E. The combination of donor and recipient age is critical in determining host immunoresponsiveness and renal transplant outcome. Ann. Surg.252(4),662–674 (2010).
  MedlineGoogle Scholar
• 107  Tullius SG, Milford E. Kidney allocation and the aging immune response. N. Engl. J. Med.364(14),1369–1370 (2011).
  MedlineGoogle Scholar
• 108  Lim WH, Dogra G, Chadban SJ et al. Lack of impact of donor age on patient survival for renal transplant recipients ≥60 years. Transpl. Int.25(4),401–408 (2012).
  MedlineGoogle Scholar
• 109  Frei U, Noeldeke J, Machold-Fabrizii V et al. Prospective age-matching in elderly kidney transplant recipients – a 5-year analysis of the Eurotransplant Senior Program. Am. J. Transplant.8(1),50–57 (2008).
  Medline CASGoogle Scholar
• 110  Pratschke J, Merk V, Reutzel-Selke A et al. Potent early immune response after kidney transplantation in patients of the European senior transplant program. Transplantation87(7),992–1000 (2009).
  MedlineGoogle Scholar
• 111  Ahmed S, Addicott C, Qureshi M, Pendleton N, Clague JE, Horan MA. Opinions of elderly people on treatment for end-stage renal disease. Gerontology45(3),156–159 (1999).
  Medline CASGoogle Scholar
• 112  Davison SN. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clin. J. Am. Soc. Nephrol.5(2),195–204 (2010).
  MedlineGoogle Scholar
• 113  Stringer S, Baharani J. Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom. Int. Urol. Nephrol.44(1),295–300 (2012).
  MedlineGoogle Scholar
• 114  Visser A, Dijkstra GJ, Kuiper D et al. Accepting or declining dialysis: considerations taken into account by elderly patients with end-stage renal disease. J. Nephrol.22(6),794–799 (2009).
  MedlineGoogle Scholar
• 115  Brown EA, Johansson L. Epidemiology and management of end-stage renal disease in the elderly. Nat. Rev. Nephrol.7(10),591–598 (2011).
  MedlineGoogle Scholar
• 116  Brown EA, Johansson L, Farrington K et al. Broadening options for long-term dialysis in the elderly (BOLDE): differences in quality of life on peritoneal dialysis compared with haemodialysis for older patients. Nephrol. Dial. Transplant.25(11),3755–3763 (2010).
  MedlineGoogle Scholar
• 117  Thorsteinsdottir B, Swetz KM, Feely MA, Mueller PS, Williams AW. Are there alternatives to hemodialysis for the elderly patient with end-stage renal failure? Mayo Clin. Proc.87(6),514–516 (2012).
  MedlineGoogle Scholar
• 118  Intiso D, Di Rienzo F, Russo M et al. Rehabilitation strategy in the elderly. J. Nephrol.25(Suppl. 19),S90–S95 (2012).
  MedlineGoogle Scholar
• 119  Del Vecchio L, Locatelli F. Ethical considerations in nephro-geriatrics. J. Nephrol.25(Suppl. 19),S6–S10 (2012).
  MedlineGoogle Scholar
• 120  Galla J. Clinical practice guideline on shared decision-making in the appropriate initiation of and withdrawal from dialysis. J. Am. Soc. Nephrol.11(7),1340–1342 (2000).
  Medline CASGoogle Scholar
• 121  Germain MJ, Davison SN, Moss AH. When enough is enough: the nephrologist‘s responsibility in ordering dialysis treatments. Am. J. Kidney Dis.58(1),135–143 (2011).
  MedlineGoogle Scholar
• 122  Renal Physicians Association. Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis. Clinical Practice Guideline (2nd edition). Renal Physicians Association National Office, Rockville, MD, USDA (2010).
  Google Scholar
• 123  Germain MJ, Cohen LM, Davison SN. Withholding and withdrawal from dialysis: what we know about how our patients die. Semin. Dial.20(3),195–199 (2007).• Summarizes the advances in palliative care and provides an approach for decision-making and treatment for patients who are not likely to benefit from dialysis therapy.
  MedlineGoogle Scholar
• 124  Greco A, Cascavilla L, Paris F et al. The nephro-geriatric unit in a lean-oriented in-hospital model of care. J. Nephrol.25(Suppl. 19),S16–S19 (2012).
  MedlineGoogle Scholar
• 201  Older Americans 2008. Key indicators of well-being (2008). www.agingstats.gov/agingstatsdotnet/Main_Site/Data/2008_Documents/OA_2008.pdf (Accessed 28 August 2013)
  Google Scholar
• 202  United Nations Publications. Department of Economic and Social Affairs. World population ageing 2009. www.un.org/esa/population/publications/WPA2009/WPA2009_WorkingPaper.pdf (Accessed 11 September 2013)
  Google Scholar
• 203  American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity (2012). www.americangeriatrics.org/files/documents/MCC.principles.pdf (Accessed 1 August 2013)•• Comprehensive document delineates a management approach that takes into account the multiple problems particular to each older individual with multimorbidity.
  Google Scholar
• 204  US Renal Data System. Annual data report (2012). www.usrds.org/2012/view/v2_01.aspx (Accessed 1 August 2013)
  Google Scholar