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Acute Dialysis in Older Patients

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Managing Renal Injury in the Elderly Patient

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Abstract

Acute kidney injury (AKI) occurs more commonly in older patients and is associated with poorer outcomes compared with younger patients. Despite this, there is a lack of evidence about treatment of AKI in older patients, and treatment recommendations currently need to be generalized from studies of patients of all ages. Initiation of renal replacement therapy for AKI can be based on clinical parameters (fluid, electrolyte, and metabolic status), although consideration should also be given to the potential complications of treatment including those associated with vascular access (infection and inflammation) and myocardial ischemia. Continuous therapies are generally adopted for treatment of patients with cardiovascular instability and those with multiorgan failure. Recent randomized controlled trials have demonstrated no benefit for more intense dialysis in AKI. Recommended doses for intermittent hemodialysis of Kt/V of 3.9 per week and an effluent volume of 20–25 mL/kg/h for continuous renal replacement therapy are respectively derived from practice in maintenance dialysis and observational studies.

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Authors and Affiliations

  1. Renal and Metabolic Division, The George Institute for Global Health, University of Sydney, Level 10, KGV Missenden Road, Camperdown, Sydney, NSW, 2050, Australia

    Celine Foote MBBS, FRACP

  2. Department of Renal, Royal Prince Alfred Hospital Sydney, Renal and Metabolic Division, Nephrology Department, The George Institute for Global Health, Concord Repatriation General Hospital, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia

    Meg J. Jardine MBBS, PhD

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  1. Celine Foote MBBS, FRACP
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  2. Meg J. Jardine MBBS, PhD
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Correspondence to Celine Foote MBBS, FRACP .

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Editors and Affiliations

  1. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Michael Haase

  2. Dep. of Nephrology and Hypertension, Otto von Guericke University Magdeburg, Magdeburg, Germany

    Anja Haase-Fielitz

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Foote, C., Jardine, M.J. (2014). Acute Dialysis in Older Patients. In: Haase, M., Haase-Fielitz, A. (eds) Managing Renal Injury in the Elderly Patient. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-39947-3_7

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  • DOI: https://doi.org/10.1007/978-3-642-39947-3_7

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