What are considered major contraindications to dialysis in the elderly?
The major contraindications to dialysis are advanced malignancy, irreversible dementia, or advanced liver disease.
Observational studies of elderly with poor functional status as determined by inability to achieve some independence in performing activities of daily living as well as increased numbers of comorbid conditions, including high cardiovascular disease burden, particularly those dependent on nursing home care, appear to have little survival advantage or improved quality of life with dialysis over conservative management of no dialysis. Therefore, while not a contraindication, weighed benefits of survival and quality of life with dialysis to risks of infection, access surgery, hemodynamic shifts, as well as resource efforts should be individually and carefully considered and conveyed to elderly patients and or family and surrogates making decisions for dialysis initiation in the elderly.
