Hemodialysis in the elderly. Do we need a special approach?

Elderly dialysis patients with multiple comorbidities often have poorer tolerance to hemodialysis treatment than younger patients. Typical complications, such as intra-dialytic hypotension, cramps, atrial fibrillation and post-dialysis fatigue contribute to a rapid loss of independence in this vulnerable patient population. The underlying etiology is a reduced tolerance to intravascular volume changes during dialysis, which is caused by impaired cardiovascular hemodynamic responses in combination with uremic and/or diabetic autonomous neuropathy. Significant reduction in organ perfusion occurring in the intestines, liver, kidneys, heart and brain contribute to the development of inflammation, malnutrition, heart failure, frailty, depression and dementia. To protect vulnerable elderly dialysis patients from these fatal complications of intradialytic tissue hypoxia, the prescription of hemodialysis needs to be individually adjusted in numerous aspects to the sensitivities of multimorbid elderly patients.