choice to maintain QOL. Non-dialysis therapy provided
by a multidisciplinary nephrology team can offer comparable
survival rates without the risks and impact on
QOL from RRT (9). Many believe that the emotional investment
of patients and health care professionals in
life-prolonging RRT in some patients may cause unnecessary
death or medicalization, including invasive testing,
procedures, and hospitalizations with only marginal
benefit (10). Carson et al. recently demonstrated that, on
average, dialysis prolongs survival for elderly patients
with ESRD with significant comorbidity by 2 years, but
that patients who chose conservative management can
survive for a substantial length of time while achieving a
similar number of hospital-free days (11). Ideally, patients
with advancing CKD should be evaluated by a multidisciplinary
team including geriatric specialists to assess the
medical, social, and family environment prior to any decision
about PD, HD, or conservative treatment (12).
choice to maintain QOL. Non-dialysis therapy providedby a multidisciplinary nephrology team can offer comparablesurvival rates without the risks and impact onQOL from RRT (9). Many believe that the emotional investmentof patients and health care professionals inlife-prolonging RRT in some patients may cause unnecessarydeath or medicalization, including invasive testing,procedures, and hospitalizations with only marginalbenefit (10). Carson et al. recently demonstrated that, onaverage, dialysis prolongs survival for elderly patientswith ESRD with significant comorbidity by 2 years, butthat patients who chose conservative management cansurvive for a substantial length of time while achieving asimilar number of hospital-free days (11). Ideally, patientswith advancing CKD should be evaluated by a multidisciplinaryteam including geriatric specialists to assess themedical, social, and family environment prior to any decisionabout PD, HD, or conservative treatment (12).
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