Advantages and disadvantages of dialysis modalities specifically relevant for older patients.


Haemodialysis Peritoneal Dialysis
Advantages
  • Does not rely on patient input so better for frail or confused patients.
  • Does not place a burden on family or carer.
  • Dialysis unit provide a social structure.
  • Can be carried out at home.
  • Access usually easier to achieve and maintain.
  • Access infections usually less severe.
  • Anaemia usually less severe.
  • Safer for patients with cardiovascular disease.
  • Transport to hospital only needed for clinic visits.
Disadvantages
  • May precipitate angina, myocardial ischaemia or stroke
  • Access may be more difficult. Complications of line sepsis may be particularly severe due to immunosenescence.
  • Intradialytic problems (e.g.hypotension, leg cramps and arrhythmias) may be less well tolerated in older patients.
  • Anaemia may be more severe.
  • Repeated hospital visits disruptive and unsettling.
  • Hospital transport difficult to arrange. Lengthy waits can mean missed meals, deranged diabetic control, leaving a dependant partner at home etc.
  • Difficult for patients with impaired functional mobility, muscle weakness, reduced manual dexterity or confusion et.c.
  • Can place a huge burden on family or carer.