Treatments for Older Adults with Kidney Disease
Mount Sinai's Geriatric Nephrology and Renal Palliative Care service takes a multi-dimensional approach to the evaluation and treatment of kidney diseases in patients over the age of 60, and offers both dialysis and non-dialysis options. Communication between doctor, patient, and family and the use of palliative care concepts are cornerstones of the care provided by our highly-skilled physicians, who value the importance of making shared treatment decisions to determine the best plan for each patient.
When an elderly adult with advanced kidney disease is referred to Mount Sinai—whether or not they have begun dialysis—our physicians provide a comprehensive assessment, medication review in the context of kidney disease, and a multidisciplinary approach that draws on specialists throughout the medical center with the goals of minimizing hospital time and optimizing quality of life. Our kidney disease inpatients have the benefit of access to consultations with palliative care and geriatrics physicians within the hospital. Outpatients can be treated at our Faculty Practice Associates or the Geriatric Nephrology Clinic at the Martha Stewart Center for Living which provides expert primary geriatrics care and supplemental services such as social work support, home care referrals, and mindfulness therapy. Whatever the setting, Mount Sinai is proud to formally integrate kidney and geriatric specialties to offer comprehensive, compassionate care uniquely suited to the needs of each patient.
Understanding Kidney Disease in the Elderly
Chronic Kidney Disease (CKD), which is a progressive wear and tear of kidney tissue leading to loss of kidney function and eventual kidney failure, can remain silent with no symptoms for years. In conjunction with the normal aging process, diseases such as diabetes, atherosclerosis, and hypertension can accelerate kidney injury. CKD is an important risk factor for cardiac and circulation problems, and is associated with geriatric conditions such as frailty, functional decline, and cognitive dysfunction. Early diagnosis and treatment of CKD can slow the rate of kidney function loss, limit its complications, and postpone the need for decisions about dialysis.
Understanding CKD is important for each patient and their family. Mount Sinai nephrologists empower patients with facts about kidney disease and realistic expectations regarding its progression. Patients can learn about indicators of their kidney status such as their creatinine, GFR (glomerular filtration rate), blood pressure, and urinary protein levels. They also receive guidance about which medications are appropriate or harmful and how to avoid or minimize further kidney damage. Awareness helps patients make informed decisions about treatments, which is important for older patients who face complicated choices about maximizing quality of life without compromising independence or causing discomfort.
Treatment Options for Older Patients with Kidney Failure or End-Stage Renal Disease (ESRD)-Dialysis and Transplantation
For older patients who choose dialysis, Mount Sinai offers a number of options. We also provide time-limited dialysis trials for patients having difficulty deciding whether dialysis is the right treatment choice.
Mount Sinai's Kidney Center offers two modes of dialysis, which are available to both inpatients and outpatients:
- Hemodialysis circulates the patient's blood from a tube in the arm through a machine to filter out toxins. Each session typically last up to four hours and is performed three times a week.
- Peritoneal Dialysis (PD) filters blood by flowing a solution into the patient's abdominal cavity through a surgically-inserted catheter, then draining the solution and toxins a few hours later. The treatment may be performed several times daily or overnight. Mount Sinai has an active PD clinic and their Home Dialysis Program trains patients to perform the procedure at home.
Those geriatric patients who are in reasonably good health with a stable cardiac status and no active medical issues are encouraged to undergo a transplant evaluation at Mount Sinai's Recanati/Miller Transplantation Institute.
Treatment Options for Older Patients with Kidney Failure or End-Stage Renal Disease (ESRD)-Non-Dialysis Treatment Options
For patients interested in a treatment choice other than dialysis, Mount Sinai offers the unique option of non-dialysis medical therapy. This treatment approach uses medications instead of dialysis to actively treat renal problems such as anemia, bone disease, fluid imbalance, acidosis, and high blood pressure. It avoids some of the potential burdens associated with dialysis such as pain, loss of function, post-dialysis fatigue, infections, recurrent hospitalizations, and psychological distress —which can be very difficult for elderly patients especially those who are frail and have a lot of medical problems. The focus is maximizing patient comfort and independence.
Renal Palliative Care
Mount Sinai's geriatric renal program offers a unique, highly personalized approach to care, based on open communication and shared decision making with patients and their families. By integrating state-of-the-art palliative care approaches to treating patients with advanced kidney disease and offering flexibility in dialysis and non-dialysis treatment choices, we help older patients with advanced kidney disease and their families live as comfortably and as fully as possible. This comprehensive approach includes the following components:
- Advance care planning, a process of communication that explores patient goals, values, and preferences and incorporates them into an appropriate medical plan to prepare for future events
- Active medical treatment of renal complications
- Active symptom management which uses prescriptions, life-style, and holistic interventions to manage symptoms or burdens that cause discomfort and suffering.
- Patient and family practical support which uses coordinated services at Mount Sinai available through the geriatrics and palliative care clinics as a patient's symptoms progress and their needs change.
- Hospice referral when survival is estimated at less than 6 months