How to Choose the Type of Dialysis in the Elderly Patient

Only a few patients over the age of 70 will be eligible for transplantation, so the older patient starting dialysis will remain on this treatment for the rest of their life. Choice of dialysis modality will not affect patient survival but will have a major impact on patient lifestyle and therefore quality of life. The decision about dialysis modality is therefore a crucially important one, and the choice should be made with the patient. This requires the clinician (nephrologist, dialysis educator, etc.) to have a realistic understanding about life on haemodialysis (HD) and peritoneal dialysis (PD) for older people in general and for the patient in particular. The patient (and family/carers) also needs appropriate unbiased education about the pros and cons of HD and PD and how both will affect their lifestyle and overall prognosis. This process is called “shared decision making”. To ensure that this happens with each patient about to start patient, it is useful to break the process down into a series of steps as shown in Table 2.1.