Dialysis in Older Adults: A Clinical Handbook

220 Pages·2016·4.05 MB·English

by  Madhukar Misra (eds.)

Dialysis in
Older Adults
A Clinical Handbook
Madhukar Misra
Editor
123
Dialysis in Older Adults

Madhukar Misra
Editor
Dialysis in Older Adults
A Clinical Handbook
Editor
Dr. Madhukar Misra MD FRCP(UK) FACP FASN
Division of Nephrology
Department of Medicine
University of Missouri
Columbia, MO
USA
ISBN 978-1-4939-3318-1 ISBN 978-1-4939-3320-4 (eBook)
DOI 10.1007/978-1-4939-3320-4
Library of Congress Control Number: 2015959721
Springer New York Heidelberg Dordrecht London
© Springer Science+Business Media New York 2016
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The more I live, the more I learn. The more
I learn, the more I realize, the less I know.
― Michel Legrand

To
My wife Shamita, my best friend and
eternal cheerleader,
and
my children, Runjhun and Sidhant, who
mean everything to us.

Pref ace
I will always be indebted to three remarkable individuals who helped shape my
career in ways I could never have imagined. Professor Edwina A Brown, who was
a guiding force through my early days in Nephrology, Professor Karl D Nolph
(deceased), who believed in me and took me under his wings within a few minutes
of meeting me in Sweden and Professor Zbylut J Twardowski, a brillliant scientist
and inventor, who continues to amaze me with his intellectual curiosity to this day.
O lder adults comprise a steadily increasing segment of the dialysis population.
They are a special patient subset with needs that are different from the average adult
patient on dialysis. From the time of decision to initiate patients on dialysis, up to
the time of their death or withdrawal from dialysis, nephrologists often encounter
situations that may seem uniquely challenging. Their dialysis prescription as well as
the management of dialysis-related complications is often based on information
extrapolated from observations derived from younger adults.
This clinical handbook is not meant to provide the reader with information about
the technical or other general aspects of dialysis. In fact, it assumes that one is
already conversant with such information. This book attempts to embed such knowl-
edge base with the nuances of managing an older patient with ESRD.
The authors of various chapters are recognized experts in their respective fi elds.
This ensures clarity of content throughout the book. Each chapter ends with certain
key points highlighting the main message of the chapter. This is meant to provide a
quick reference tool when looking for specifi c information in the book.
T he book is structured to provide specifi c topics related to dialyzing the older
adult in a logical sequence. The key theme underpinning this book is the focus on
managing the older patient as a whole. Consequently, the range of the book is wide
and comprehensive. The early part of the book focuses on chapters related to the
scope of this problem as well as the impact of pre-dialysis education on modality
choice. Topics like these as well as the later topics near the end of the book deal with
subjects that even though of great signifi cance, often do not receive the attention
that they deserve. The chapters related to hemodialysis focus on important issues
particularly relevant to the older patient including access, hemodynamic consider-
ations, and home hemodialysis. Likewise, the modality of peritoneal dialysis is
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