{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T20:21:26Z","timestamp":1789676486210,"version":"4.0.1"},"reference-count":152,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geriatrics"],"abstract":"<jats:p>The hemodialysis population has progressively aged over the past two decades; in several settings, adults aged \u226575 years represent one of the fastest-growing populations receiving dialysis. Frailty, characterized by reduced physiological reserve and heightened vulnerability to stressors, has emerged as a critical determinant of outcomes and is commonly assessed using validated instruments such as the Fried Frailty Phenotype or the Clinical Frailty Scale (CFS). Reported frailty prevalence in hemodialysis varies widely (approximately 20% to &gt;80%), largely depending on the assessment instrument and the population studied, with consistently higher prevalence in older cohorts. It is consistently associated with older age, female sex, diabetes, lower serum albumin, cardiovascular disease, longer dialysis vintage, and lower physical activity. Compared with non-frail patients, frail hemodialysis patients have a substantially higher risk of death (approximately two-fold in pooled analyses). Seminal trials and large observational programs that shaped hemodialysis targets underrepresented very old, frail, and highly comorbid patients, limiting generalizability. In frail older adults with limited life expectancy and substantial comorbidity burden, standard thrice-weekly schedules, higher ultrafiltration intensity, and a uniform \u2018fistula-first\u2019 approach may increase treatment burden without clear proportional gains in patient-centered outcomes. This review examines evidence supporting individualized hemodialysis strategies in frail older adults. As the dialysis population continues to age, proficiency in goal-concordant, personalized prescribing is increasingly important for nephrologists and dialysis teams.<\/jats:p>","DOI":"10.3390\/geriatrics11020040","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:03:47Z","timestamp":1775563427000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Personalized Hemodialysis Approaches in Frail Older Individuals"],"prefix":"10.3390","volume":"11","author":[{"given":"Guido","family":"Gembillo","sequence":"first","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0171-3358","authenticated-orcid":false,"given":"Luca","family":"Soraci","sequence":"additional","affiliation":[{"name":"Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5557-9791","authenticated-orcid":false,"given":"Matteo","family":"Floris","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Dialysis, and Transplantation, ARNAS G. Brotzu, 09134 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9112-5540","authenticated-orcid":false,"given":"Lorenzo","family":"Lo Cicero","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Lo Re","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2899-0575","authenticated-orcid":false,"given":"Elvira","family":"Filicetti","sequence":"additional","affiliation":[{"name":"Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), 87100 Cosenza, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Calderone","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo Giorgio","family":"Benenati","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7276-3256","authenticated-orcid":false,"given":"Andrea","family":"Corsonello","sequence":"additional","affiliation":[{"name":"Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), 87100 Cosenza, Italy"},{"name":"Department of Pharmacy and Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4279-6559","authenticated-orcid":false,"given":"Domenico","family":"Santoro","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"A7","DOI":"10.1053\/j.ajkd.2021.01.002","article-title":"US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"77","author":"Johansen","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1177\/11297298221097233","article-title":"Hemodialysis Vascular Access in Elderly Patients: A Comprehensive Review","volume":"25","author":"Yan","year":"2024","journal-title":"J. Vasc. Access."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1007\/s11255-017-1547-5","article-title":"Prevalence of Frailty in End-Stage Renal Disease: A Systematic Review and Meta-Analysis","volume":"49","author":"Kojima","year":"2017","journal-title":"Int. Urol. Nephrol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1038\/s41598-025-86715-3","article-title":"A Machine Learning-Based Model for Predicting the Risk of Cognitive Frailty in Elderly Patients on Maintenance Hemodialysis","volume":"15","author":"Cao","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.kint.2024.02.026","article-title":"Frailty in Patients on Dialysis","volume":"106","author":"Chan","year":"2024","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Bossola, M., Mariani, I., Antocicco, M., Pepe, G., and Di Stasio, E. (2025). Frailty, All-Cause Mortality, and Hospitalization in Patients on Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144914"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Lee, H.-J., and Son, Y.-J. (2021). Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18073471"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1056\/NEJMoa021583","article-title":"Effect of Dialysis Dose and Membrane Flux in Maintenance Hemodialysis","volume":"347","author":"Eknoyan","year":"2002","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1093\/ndt\/gfad211","article-title":"Shared Decision Making in Elderly Patients with Kidney Failure","volume":"39","author":"Kanbay","year":"2024","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1080\/0886022X.2019.1628061","article-title":"Frailty in Hemodialysis and Prediction of Poor Short-Term Outcome: Mortality, Hospitalization and Visits to Hospital Emergency Services","volume":"41","author":"Rodenas","year":"2019","journal-title":"Ren. Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"91","DOI":"10.5455\/msm.2015.27.91-94","article-title":"Mortality in Hemodialysis Patients Over 65 Years of Age","volume":"27","author":"Coric","year":"2015","journal-title":"Mater. Socio Medica"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1503\/cmaj.050051","article-title":"A Global Clinical Measure of Fitness and Frailty in Elderly People","volume":"173","author":"Rockwood","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s12603-012-0084-2","article-title":"A Simple Frailty Questionnaire (FRAIL) Predicts Outcomes in Middle Aged African Americans","volume":"16","author":"Morley","year":"2012","journal-title":"J. Nutr. Health Aging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A Short Physical Performance Battery Assessing Lower Extremity Function: Association with Self-Reported Disability and Prediction of Mortality and Nursing Home Admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J. Gerontol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"100960","DOI":"10.1016\/j.xkme.2024.100960","article-title":"Frailty Assessment Tools in Chronic Kidney Disease: A Systematic Review and Meta-Analysis","volume":"7","author":"Puri","year":"2025","journal-title":"Kidney Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.2147\/CIA.S329665","article-title":"The Impact of Frailty on Prognosis in Elderly Hemodialysis Patients: A Prospective Cohort Study","volume":"16","author":"Li","year":"2021","journal-title":"Clin. Interv. Aging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2367716","DOI":"10.1080\/0886022X.2024.2367716","article-title":"Association between Frailty and Adverse Outcomes in Patients Undergoing Maintenance Hemodialysis: A Systematic Review and Meta-Analysis","volume":"46","author":"Cheng","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pereira, M., Tocino, M.L.S., Mas-Fontao, S., Manso, P., Burgos, M., Carneiro, D., Ortiz, A., Arenas, M.D., and Gonz\u00e1lez-Parra, E. (2024). Dependency and Frailty in the Older Haemodialysis Patient. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04973-8"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/1744-9987.14164","article-title":"The Frailty in Older Hemodialysis Patients and Associations with Depression, Functional Status, Dialysis Adequacy","volume":"28","author":"Bulbul","year":"2024","journal-title":"Ther. Apher. Dial."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1159\/000533418","article-title":"Association between Physical Frailty and Sleep Disturbances among Patients on Hemodialysis: A Cross-Sectional Study","volume":"148","author":"Yoshikoshi","year":"2024","journal-title":"Nephron"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kennard, A.L., Rainsford, S., Glasgow, N.J., and Talaulikar, G.S. (2023). Use of Frailty Assessment Instruments in Nephrology Populations: A Scoping Review. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04101-y"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1093\/ndt\/gfaf024","article-title":"Haemodiafiltration versus High-Flux Haemodialysis\u2014A Consensus Statement from the EuDial Working Group of the ERA","volume":"40","author":"Battaglia","year":"2025","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1053\/j.ajkd.2015.07.015","article-title":"KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update","volume":"66","author":"Daugirdas","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.kint.2017.01.013","article-title":"Treatment Tolerance and Patient-Reported Outcomes Favor Online Hemodiafiltration Compared to High-Flux Hemodialysis in the Elderly","volume":"91","author":"Morena","year":"2017","journal-title":"Kidney Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1056\/NEJMoa2304820","article-title":"Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure","volume":"389","author":"Blankestijn","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zhu, Y., Li, J., Lu, H., Shi, Z., and Wang, X. (2024). Effect of Hemodiafiltration and Hemodialysis on Mortality of Patients with End-Stage Kidney Disease: A Meta-Analysis. BMC Nephrol., 25.","DOI":"10.1186\/s12882-024-03810-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1111\/sdi.13105","article-title":"Clinical Performance, Intermediate and Long-term Outcomes of High-volume Hemodiafiltration in Patients with Kidney Failure","volume":"35","author":"Guedes","year":"2022","journal-title":"Semin. Dial."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"iii41","DOI":"10.1093\/ndt\/gfy202","article-title":"Expanded Haemodialysis: From Operational Mechanism to Clinical Results","volume":"33","author":"Ronco","year":"2018","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/sdi.13257","article-title":"The Multidimensional Impact of Expanded Hemodialysis: A Comprehensive Review","volume":"38","author":"Kosmadakis","year":"2025","journal-title":"Semin. Dial."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Castillo, J.C., Doria, C., Cely, J., Camargo, D., Orozco, V., Ducuara, D., Vesga, J., Sanabria, M., Rivera, A., and Lindholm, B. (2025). Efficacy in the Reduction Ratios of Middle Molecules with the Use of Medium Cut-off Dialyzers and Reduced Dialysate Flows: A Cohort Study. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1663750"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Zakrzewska, A., Biedunkiewicz, J., Komorniczak, M., Jankowska, M., Jasiulewicz, K., P\u0142onka, N., Biedunkiewicz, B., Ma\u0142gorzewicz, S., Tarasewicz, A., and Puchalska-Regli\u0144ska, E. (2024). Intradialytic Tolerance and Recovery Time in Different High-Efficiency Hemodialysis Modalities. J. Clin. Med., 13.","DOI":"10.3390\/jcm13020326"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1093\/ndt\/gfv248","article-title":"Improved Survival Associated with Acetate-Free Haemodialysis in Elderly: A Registry-Based Study","volume":"30","author":"Mercadal","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"5467","DOI":"10.1038\/s41598-025-89197-5","article-title":"A Randomized Trial Comparing Medium Cut-off Membrane Dialyzers with Online Hemodiafiltration for Uremic Toxins Clearance in Hemodialysis Patients","volume":"15","author":"Lukkanalikitkul","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/S0272-6386(96)90165-1","article-title":"A Prospective Comparison of Bicarbonate Dialysis, Hemodiafiltration, and Acetate-Free Biofiltration in the Elderly","volume":"27","author":"Movilli","year":"1996","journal-title":"Am. J. Kidney Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1053\/j.ajkd.2014.01.014","article-title":"Recovery Time, Quality of Life, and Mortality in Hemodialysis Patients: The Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"64","author":"Rayner","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.kint.2016.08.026","article-title":"Peritoneal or Hemodialysis for the Frail Elderly Patient, the Choice of 2 Evils?","volume":"91","author":"Brown","year":"2017","journal-title":"Kidney Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.xkme.2019.10.010","article-title":"Intradialytic Symptoms and Recovery Time in Patients on Thrice-Weekly In-Center Hemodialysis: A Cross-Sectional Online Survey","volume":"2","author":"Alvarez","year":"2020","journal-title":"Kidney Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s40620-019-00611-4","article-title":"Incremental Hemodialysis, a Valuable Option for the Frail Elderly Patient","volume":"32","author":"Basile","year":"2019","journal-title":"J. Nephrol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1053\/j.ajkd.2014.04.019","article-title":"Twice-Weekly and Incremental Hemodialysis Treatment for Initiation of Kidney Replacement Therapy","volume":"64","author":"Unruh","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1053\/j.ajkd.2016.01.008","article-title":"Incremental Hemodialysis, Residual Kidney Function, and Mortality Risk in Incident Dialysis Patients: A Cohort Study","volume":"68","author":"Obi","year":"2016","journal-title":"Am. J. Kidney Dis."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Bolasco, P. (2025). Incremental Hemodialysis: Review of Clinical Trials Focused on Patients Undergoing Once-Weekly Hemodialysis. Nutrients, 17.","DOI":"10.20944\/preprints202501.1508.v1"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/j.1492-7535.2004.00076.x","article-title":"Nightly Home Hemodialysis: Five and One-half Years of Experience in Lynchburg, Virginia","volume":"8","author":"Lockridge","year":"2004","journal-title":"Hemodial. Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1038\/ki.2009.291","article-title":"Survival and Hospitalization among Patients Using Nocturnal and Short Daily Compared to Conventional Hemodialysis: A USRDS Study","volume":"76","author":"Johansen","year":"2009","journal-title":"Kidney Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/ki.2010.383","article-title":"Rapid Fluid Removal during Dialysis Is Associated with Cardiovascular Morbidity and Mortality","volume":"79","author":"Flythe","year":"2011","journal-title":"Kidney Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3547","DOI":"10.1093\/ndt\/gfm466","article-title":"Association between High Ultrafiltration Rates and Mortality in Uraemic Patients on Regular Haemodialysis. A 5-Year Prospective Observational Multicentre Study","volume":"22","author":"Movilli","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-Induced Cardiac Injury: Determinants and Associated Outcomes","volume":"4","author":"Burton","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2215\/CJN.04610510","article-title":"Circulating Endotoxemia: A Novel Factor in Systemic Inflammation and Cardiovascular Disease in Chronic Kidney Disease","volume":"6","author":"McIntyre","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1080\/0886022X.2020.1853570","article-title":"High Ultrafiltration Rate Induced Intradialytic Hypotension Is a Predictor for Cardiac Remodeling: A 5-Year Cohort Study","volume":"43","author":"Yu","year":"2021","journal-title":"Ren. Fail."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/sdi.12627","article-title":"A Brief Review of Intradialytic Hypotension with a Focus on Survival","volume":"30","author":"Chou","year":"2017","journal-title":"Semin. Dial."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"798","DOI":"10.2215\/CJN.09930913","article-title":"Attending Rounds: A Patient with Intradialytic Hypotension","volume":"9","author":"Reilly","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1159\/000486231","article-title":"Intradialytic Hypotension as an Independent Risk Factor for Long-Term Mortality in Maintaining Hemodialysis Patients: A 5-Year Follow-Up Cohort Study","volume":"45","author":"Yu","year":"2018","journal-title":"Blood Purif."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"173","DOI":"10.2147\/IJNRD.S245621","article-title":"Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects","volume":"16","author":"Hamrahian","year":"2023","journal-title":"Int. J. Nephrol. Renov. Dis."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"100914","DOI":"10.1016\/j.xkme.2024.100914","article-title":"The Surprise Question in Hemodialysis, Frailty, Nutrition, Patient-Reported Quality of Life, and All-Cause Mortality: The Osaka Dialysis Complication Study (ODCS)","volume":"6","author":"Shoji","year":"2024","journal-title":"Kidney Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"767","DOI":"10.2215\/CJN.0000000000000144","article-title":"Ultrafiltration Rate Levels in Hemodialysis Patients Associated with Weight-Specific Mortality Risks","volume":"18","author":"Mermelstein","year":"2023","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"693","DOI":"10.2215\/CJN.0000000000000181","article-title":"Risk-Based Thresholds for Hemodialysis Ultrafiltration Rates: A Warning Signal or a Call to Action?","volume":"18","author":"Canney","year":"2023","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1038\/sj.ki.5000186","article-title":"Longer Treatment Time and Slower Ultrafiltration in Hemodialysis: Associations with Reduced Mortality in the DOPPS","volume":"69","author":"Saran","year":"2006","journal-title":"Kidney Int."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Ng, J.K.-C., Lau, S.L.-F., Chan, G.C.-K., Tian, N., and Li, P.K.-T. (2023). Nutritional Assessments by Bioimpedance Technique in Dialysis Patients. Nutrients, 16.","DOI":"10.3390\/nu16010015"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"442","DOI":"10.2215\/CJN.04580415","article-title":"Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis: A Systematic Review and Meta-Analysis","volume":"11","author":"Mustafa","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Arasnezhad, M., Namazinia, M., Mazlum, S.R., and Miri, K. (2024). The Effect of Ascending- Descending Ultrafiltration and Sodium Profiles on Blood Pressure in Hemodialysis Patients: A Randomized Cross-over Study. BMC Nephrol., 25.","DOI":"10.1186\/s12882-024-03554-6"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1007\/s40620-023-01844-0","article-title":"Comparison of Blood Volume Biofeedback Hemodialysis and Conventional Hemodialysis on Cardiovascular Stability and Blood Pressure Control in Hemodialysis Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"37","author":"Mambelli","year":"2024","journal-title":"J. Nephrol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.kint.2022.09.021","article-title":"Fluid Volume Management in Hemodialysis: Never Give Up!","volume":"103","author":"Hecking","year":"2023","journal-title":"Kidney Int."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1159\/000501277","article-title":"Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis","volume":"143","author":"Goto","year":"2019","journal-title":"Nephron"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Bossola, M., Mariani, I., Strizzi, C.T., Piccinni, C.P., and Di Stasio, E. (2025). How to Limit Interdialytic Weight Gain in Patients on Maintenance Hemodialysis: State of the Art and Perspectives. J. Clin. Med., 14.","DOI":"10.3390\/jcm14061846"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.2215\/CJN.01030117","article-title":"Randomized Crossover Trial of Blood Volume Monitoring\u2013Guided Ultrafiltration Biofeedback to Reduce Intradialytic Hypotensive Episodes with Hemodialysis","volume":"12","author":"Leung","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Vascular Access Work Group (2006). Clinical Practice Guidelines for Vascular Access. Am. J. Kidney Dis., 48, S176\u2013S247.","DOI":"10.1053\/j.ajkd.2006.04.029"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/j.ajkd.2013.08.023","article-title":"Patency Rates of the Arteriovenous Fistula for Hemodialysis: A Systematic Review and Meta-Analysis","volume":"63","author":"Oliver","year":"2014","journal-title":"Am. J. Kidney Dis."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1681\/ASN.2012070643","article-title":"Associations between Hemodialysis Access Type and Clinical Outcomes: A Systematic Review","volume":"24","author":"Ravani","year":"2013","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"2164","DOI":"10.1001\/jama.299.18.2164","article-title":"Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis: A Randomized Controlled Trial","volume":"299","author":"Dember","year":"2008","journal-title":"JAMA"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1007\/s11255-021-02822-w","article-title":"Outcomes of Arteriovenous Fistula in Elderly Patients on Maintenance Haemodialysis","volume":"53","author":"Liu","year":"2021","journal-title":"Int. Urol. Nephrol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"2387205","DOI":"10.1080\/0886022X.2024.2387205","article-title":"Vascular Access Type and Prognosis in Elderly Hemodialysis Patients: A Propensity-Score-Matched Study","volume":"46","author":"Liu","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1053\/j.ajkd.2018.03.023","article-title":"Tradeoffs in Vascular Access Selection in Elderly Patients Initiating Hemodialysis with a Catheter","volume":"72","author":"Lee","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1053\/j.ajkd.2020.12.019","article-title":"Catheter Dependence After Arteriovenous Fistula or Graft Placement Among Elderly Patients on Hemodialysis","volume":"78","author":"Lyu","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jvs.2023.12.022","article-title":"Frailty Screening for Determination of Hemodialysis Access Placement","volume":"79","author":"McDonnell","year":"2024","journal-title":"J. Vasc. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1016\/j.jvs.2006.10.035","article-title":"A Meta-Analysis of Dialysis Access Outcome in Elderly Patients","volume":"45","author":"Lazarides","year":"2007","journal-title":"J. Vasc. Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2019.12.001","article-title":"KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update","volume":"75","author":"Lok","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1016\/j.jvs.2018.05.219","article-title":"Vascular Access for Hemodialysis in the Elderly","volume":"69","author":"Arhuidese","year":"2019","journal-title":"J. Vasc. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1046\/j.1523-1755.1999.00784.x","article-title":"Effect of Membrane Composition and Structure on Solute Removal and Biocompatibility in Hemodialysis","volume":"56","author":"Clark","year":"1999","journal-title":"Kidney Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1038\/s41581-018-0002-x","article-title":"Haemodialysis Membranes","volume":"14","author":"Ronco","year":"2018","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000321753","article-title":"Biocompatibility of the Dialysis Membrane","volume":"Volume 168","author":"Kawanishi","year":"2011","journal-title":"Contributions to Nephrology"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"\u00c1vila, E., Sep\u00falveda, R.A., Retamal, J., and Hachim, D. (2025). Biocompatibility in Hemodialysis: Artificial Membrane and Human Blood Interactions. BMC Nephrol., 26.","DOI":"10.1186\/s12882-025-04401-y"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"2338217","DOI":"10.1080\/0886022X.2024.2338217","article-title":"Effects of Low-Flux and High-Flux Hemodialysis on the Survival of Elderly Maintenance Hemodialysis Patients","volume":"46","author":"Huang","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1681\/ASN.2008060590","article-title":"Effect of Membrane Permeability on Survival of Hemodialysis Patients","volume":"20","author":"Locatelli","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"E246","DOI":"10.1111\/aor.13268","article-title":"Biocompatibility of Polysulfone Hemodialysis Membranes and Its Mechanisms: Involvement of Fibrinogen and Its Integrin Receptors in Activation of Platelets and Neutrophils","volume":"42","author":"Koga","year":"2018","journal-title":"Artif. Organs"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/hdi.12939","article-title":"Polyvinylpyrrolidone in Hemodialysis Membranes: Impact on Platelet Loss during Hemodialysis","volume":"25","author":"Zawada","year":"2021","journal-title":"Hemodial. Int."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1177\/0391398818823767","article-title":"A New Hydrophilic Polysulfone Hemodialysis Membrane Can Prevent Platelet\u2013Neutrophil Interactions and Successive Neutrophil Activation","volume":"42","author":"Koga","year":"2019","journal-title":"Int. J. Artif. Organs"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1053\/j.ajkd.2020.02.449","article-title":"Arteriovenous Fistula Placement, Maturation, and Patency Loss in Older Patients Initiating Hemodialysis","volume":"76","author":"Qian","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1159\/000468959","article-title":"Expanded Hemodialysis: A New Therapy for a New Class of Membranes","volume":"Volume 190","author":"Ronco","year":"2017","journal-title":"Contributions to Nephrology"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1093\/ndt\/gfw310","article-title":"Performance of Hemodialysis with Novel Medium Cut-off Dialyzers","volume":"32","author":"Kirsch","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1159\/000505567","article-title":"A tRial Evaluating Mid Cut-Off Value Membrane Clearance of Albumin and Light Chains in HemoDialysis Patients: A Safety Device Study","volume":"49","author":"Krishnasamy","year":"2020","journal-title":"Blood Purif."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"20543581211067087","DOI":"10.1177\/20543581211067087","article-title":"Clinical Outcomes with Medium Cut-Off Versus High-Flux Hemodialysis Membranes: A Systematic Review and Meta-Analysis","volume":"9","author":"Kandi","year":"2022","journal-title":"Can. J. Kidney Health Dis."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"100431","DOI":"10.1016\/j.xkme.2022.100431","article-title":"Medium Cutoff Versus High-Flux Hemodialysis Membranes and Clinical Outcomes: A Cohort Study Using Inverse Probability Treatment Weighting","volume":"4","author":"Molano","year":"2022","journal-title":"Kidney Med."},{"key":"ref_93","doi-asserted-by":"crossref","unstructured":"Kim, T.H., Kim, S., Kim, T.Y., Park, H.Y., Jung, K.S., Lee, M.H., Jhee, J.H., Lee, J.E., Choi, H.Y., and Park, H.C. (2020). Removal of Large Middle Molecules via Haemodialysis with Medium Cut-off Membranes at Lower Blood Flow Rates: An Observational Prospective Study. BMC Nephrol., 21.","DOI":"10.1186\/s12882-019-1669-3"},{"key":"ref_94","first-page":"29","article-title":"Inflammation and Arterial Stiffness as Drivers of Cardiovascular Risk in Kidney Disease","volume":"15","author":"Lentini","year":"2025","journal-title":"Cardiorenal Med."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Zickler, D., Schindler, R., Willy, K., Martus, P., Pawlak, M., Storr, M., Hulko, M., Boehler, T., Glomb, M.A., and Liehr, K. (2017). Medium Cut-Off (MCO) Membranes Reduce Inflammation in Chronic Dialysis Patients\u2014A Randomized Controlled Clinical Trial. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169024"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1111\/j.1542-4758.2006.00088.x","article-title":"Intradialytic Complications during Hemodialysis","volume":"10","author":"Davenport","year":"2006","journal-title":"Hemodial. Int."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of Mortality Risk with Various Definitions of Intradialytic Hypotension","volume":"26","author":"Flythe","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1111\/j.1525-139X.2008.00474.x","article-title":"Dialysis Disequilibrium Syndrome: A Narrative Review","volume":"21","author":"Patel","year":"2008","journal-title":"Semin. Dial."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"1934","DOI":"10.1046\/j.1523-1755.2003.00924.x","article-title":"Review on Uremic Toxins: Classification, Concentration, and Interindividual Variability","volume":"63","author":"Vanholder","year":"2003","journal-title":"Kidney Int."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1053\/j.jrn.2011.10.011","article-title":"The Removal of Protein-Bound Solutes by Dialysis","volume":"22","author":"Meyer","year":"2012","journal-title":"J. Ren. Nutr."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"18448","DOI":"10.1038\/srep18448","article-title":"MCO Membranes: Enhanced Selectivity in High-Flux Class","volume":"5","author":"Voigt","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1038\/sj.ki.5000447","article-title":"Mortality Risk for Patients Receiving Hemodiafiltration versus Hemodialysis: European Results from the DOPPS","volume":"69","author":"Canaud","year":"2006","journal-title":"Kidney Int."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1093\/ckj\/sfac167","article-title":"Comparison of Four Medium Cut-off Dialyzers","volume":"15","author":"Maduell","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1159\/000338807","article-title":"Vitamin E as a Functional and Biocompatibility Modifier of Synthetic Hemodialyzer Membranes: An Overview of the Literature on Vitamin E-Modified Hemodialyzer Membranes","volume":"35","author":"Piroddi","year":"2012","journal-title":"Am. J. Nephrol."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"2300269","DOI":"10.1002\/mnfr.202300269","article-title":"Vitamin E Treatment Improves the Antioxidant Capacity of Patients Receiving Dialysis: A Systematic Review and Meta-Analysis","volume":"67","author":"Ni","year":"2023","journal-title":"Mol. Nutr. Food Res."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1159\/000453444","article-title":"Effects of Vitamin E-Coated versus Conventional Membranes in Chronic Hemodialysis Patients: A Systematic Review and Meta-Analysis","volume":"43","author":"Baggetta","year":"2017","journal-title":"Blood Purif."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"556","DOI":"10.5301\/jn.5000195","article-title":"Vitamin E\u2013Coated Polysulfone Membrane Improved Red Blood Cell Antioxidant Status in Hemodialysis Patients","volume":"26","author":"Bargnoux","year":"2013","journal-title":"JN"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1159\/000350847","article-title":"Adsorption Dialysis: From Physical Principles to Clinical Applications","volume":"35","author":"Aucella","year":"2013","journal-title":"Blood Purif."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s10047-022-01323-6","article-title":"Comprehensive Analysis of Cytokine Adsorption Properties of Polymethyl Methacrylate (PMMA) Membrane Material","volume":"25","author":"Kishikawa","year":"2022","journal-title":"J. Artif. Organs"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1159\/000529971","article-title":"Enhancing Immune Protection in Hemodialysis Patients: Role of the Polymethyl Methacrylate Membrane","volume":"52","author":"Franzin","year":"2023","journal-title":"Blood Purif."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1159\/000350849","article-title":"Polymethylmethacrylate Membrane and Serum Free Light Chain Removal: Enhancing Adsorption Properties","volume":"35","author":"Fabbrini","year":"2013","journal-title":"Blood Purif."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000529716","article-title":"Evaluation of the Effect of the PMMA Dialysis Membrane on the Level of Inflammation in Patients on Hemodialysis","volume":"52","author":"Shutov","year":"2023","journal-title":"Blood Purif."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"v8","DOI":"10.1093\/ndt\/gfm293","article-title":"Uraemic Itching: Do Polymethylmethacrylate Dialysis Membranes Play a Role?","volume":"22","author":"Aucella","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Abe, M., Hamano, T., Wada, A., Nakai, S., Masakane, I., and on behalf of the Renal Data Registry Committee, Japanese Society for Dialysis Therapy (2017). Effect of Dialyzer Membrane Materials on Survival in Chronic Hemodialysis Patients: Results from the Annual Survey of the Japanese Nationwide Dialysis Registry. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0184424"},{"key":"ref_115","first-page":"697","article-title":"SOLFA Study: A Multicenter, Open-Label, Prospective, Randomized Study to Investigate the Clotting Propensity of Asymmetric Cellulose Triacetate Membrane Compared to Synthetic Membranes in on Line HDF","volume":"38","author":"Puerta","year":"2025","journal-title":"J. Nephrol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"325","DOI":"10.23876\/j.krcp.20.243","article-title":"The Removal Capacity of Asymmetric Cellulose Triacetate during Post-Dilution Online Hemodiafiltration","volume":"40","author":"Santos","year":"2021","journal-title":"Kidney Res. Clin. Pract."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s41100-019-0215-x","article-title":"Multipotentials of New Asymmetric Cellulose Triacetate Membrane for On-Line Hemodiafiltration Both in Postdilution and Predilution","volume":"5","author":"Tanaka","year":"2019","journal-title":"Ren. Replace. Ther."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1700140","DOI":"10.1002\/prca.201700140","article-title":"Proteomic Characterization of a New Asymmetric Cellulose Triacetate Membrane for Hemodialysis","volume":"12","author":"Ronci","year":"2018","journal-title":"Proteom. Clin. Appl."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1159\/000477361","article-title":"Dialysis Therapy and Conservative Management of Advanced Chronic Kidney Disease in the Elderly: A Systematic Review","volume":"137","author":"Wongrakpanich","year":"2017","journal-title":"Nephron"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"2002","DOI":"10.2215\/CJN.01130112","article-title":"Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis","volume":"7","author":"Wellsted","year":"2012","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1089\/jpm.2011.0207","article-title":"Conservative Management of End-Stage Renal Disease without Dialysis: A Systematic Review","volume":"15","author":"Kumar","year":"2012","journal-title":"J. Palliat. Med."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1111\/nep.12586","article-title":"Survival Outcomes of Supportive Care versus Dialysis Therapies for Elderly Patients with End-stage Kidney Disease: A Systematic Review and Meta-analysis","volume":"21","author":"Foote","year":"2016","journal-title":"Nephrology"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.2215\/CJN.00510109","article-title":"Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?","volume":"4","author":"Carson","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1093\/ndt\/gfm153","article-title":"Dialysis or Not? A Comparative Survival Study of Patients over 75 Years with Chronic Kidney Disease Stage 5","volume":"22","author":"Murtagh","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_125","doi-asserted-by":"crossref","unstructured":"Buur, L.E., Madsen, J.K., Eidemak, I., Krarup, E., Lauridsen, T.G., Taasti, L.H., and Finderup, J. (2021). Does Conservative Kidney Management Offer a Quantity or Quality of Life Benefit Compared to Dialysis? A Systematic Review. BMC Nephrol., 22.","DOI":"10.1186\/s12882-021-02516-6"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.1093\/ndt\/gfl380","article-title":"Longitudinal Validation of a Modified Edmonton Symptom Assessment System (ESAS) in Haemodialysis Patients","volume":"21","author":"Davison","year":"2006","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"633","DOI":"10.2215\/CJN.07510715","article-title":"Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis","volume":"11","author":"Verberne","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1159\/000347220","article-title":"Trajectory of Quality of Life for Poor Prognosis Stage 5D Chronic Kidney Disease with and without Dialysis","volume":"37","author":"Seow","year":"2013","journal-title":"Am. J. Nephrol."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jpainsymman.2010.01.021","article-title":"Symptoms in the Month Before Death for Stage 5 Chronic Kidney Disease Patients Managed Without Dialysis","volume":"40","author":"Murtagh","year":"2010","journal-title":"J. Pain Symptom Manag."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/0269216308101099","article-title":"Symptom Burden and Quality of Life in End-Stage Renal Disease: A Study of 179 Patients on Dialysis and Palliative Care","volume":"23","author":"Yong","year":"2009","journal-title":"Palliat. Med."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1089\/jpm.2007.0017","article-title":"Symptoms in Advanced Renal Disease: A Cross-Sectional Survey of Symptom Prevalence in Stage 5 Chronic Kidney Disease Managed without Dialysis","volume":"10","author":"Murtagh","year":"2007","journal-title":"J. Palliat. Med."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"260","DOI":"10.2215\/CJN.03330414","article-title":"CKD in Elderly Patients Managed without Dialysis: Survival, Symptoms, and Quality of Life","volume":"10","author":"Brown","year":"2015","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Verberne, W.R., Dijkers, J., Kelder, J.C., Geers, A.B.M., Jellema, W.T., Vincent, H.H., Van Delden, J.J.M., and Bos, W.J.W. (2018). Value-Based Evaluation of Dialysis versus Conservative Care in Older Patients with Advanced Chronic Kidney Disease: A Cohort Study. BMC Nephrol., 19.","DOI":"10.1186\/s12882-018-1004-4"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1177\/0269216313484380","article-title":"Comparison of Survival Analysis and Palliative Care Involvement in Patients Aged over 70 Years Choosing Conservative Management or Renal Replacement Therapy in Advanced Chronic Kidney Disease","volume":"27","author":"Hussain","year":"2013","journal-title":"Palliat. Med."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"sfad269","DOI":"10.1093\/ckj\/sfad269","article-title":"Factors That Influence the Selection of Conservative Management for End-Stage Renal Disease\u2014A Systematic Review","volume":"17","author":"Sakthivel","year":"2024","journal-title":"Clin. Kidney J."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1007\/s11606-013-2494-1","article-title":"Dialysis in the Frail Elderly\u2014A Current Ethical Problem, an Impending Ethical Crisis","volume":"28","author":"Thorsteinsdottir","year":"2013","journal-title":"J. Gen. Intern. Med."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"E277","DOI":"10.1503\/cmaj.111355","article-title":"Factors Influencing Patient Choice of Dialysis versus Conservative Care to Treat End-Stage Kidney Disease","volume":"184","author":"Morton","year":"2012","journal-title":"Can. Med. Assoc. J."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"854","DOI":"10.2215\/CJN.05760516","article-title":"Serious Illness Conversations in ESRD","volume":"12","author":"Mandel","year":"2017","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1111\/jorc.12195","article-title":"Depression, Anxiety and Health-related Quality of Life amongst Patients Who Are Starting Dialysis Treatment","volume":"43","year":"2017","journal-title":"J. Ren. Care"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.2215\/CJN.09301010","article-title":"Early Start of Dialysis: A Critical Review","volume":"6","author":"Rosansky","year":"2011","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1038\/ki.2015.110","article-title":"Executive Summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: Developing a Roadmap to Improving Quality Care","volume":"88","author":"Davison","year":"2015","journal-title":"Kidney Int."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1093\/ndt\/gfm772","article-title":"Prolonged Conservative Treatment for Frail Elderly Patients with End-Stage Renal Disease: The Verona Experience","volume":"23","author":"Tobaldini","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1053\/j.ackd.2007.07.008","article-title":"Dialysis Discontinuation: Quo Vadis?","volume":"14","author":"Murtagh","year":"2007","journal-title":"Adv. Chronic Kidney Dis."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1093\/ndt\/gfw411","article-title":"Clinical Practice Guideline on Management of Older Patients with Chronic Kidney Disease Stage 3b or Higher (eGFR<45 mL\/Min\/1.73 M2): A Summary Document from the European Renal Best Practice Group","volume":"32","author":"Farrington","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"63","DOI":"10.3349\/ymj.2024.0178","article-title":"Management of Elderly Patients with Chronic Kidney Disease","volume":"66","author":"Park","year":"2025","journal-title":"Yonsei Med. J."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"c112","DOI":"10.1136\/bmj.c112","article-title":"The Views of Patients and Carers in Treatment Decision Making for Chronic Kidney Disease: Systematic Review and Thematic Synthesis of Qualitative Studies","volume":"340","author":"Morton","year":"2010","journal-title":"BMJ"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1159\/000476076","article-title":"Higher Ultrafiltration Rate Is Associated with Longer Dialysis Recovery Time in Patients Undergoing Conventional Hemodialysis","volume":"46","author":"Hussein","year":"2017","journal-title":"Am. J. Nephrol."},{"key":"ref_148","doi-asserted-by":"crossref","unstructured":"Elsayed, M.M., Zeid, M.M., Hamza, O.M.R., and Elkholy, N.M. (2022). Dialysis Recovery Time: Associated Factors and Its Association with Quality of Life of Hemodialysis Patients. BMC Nephrol., 23.","DOI":"10.1186\/s12882-022-02926-0"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMoa0904655","article-title":"Functional Status of Elderly Adults before and after Initiation of Dialysis","volume":"361","author":"Covinsky","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.2215\/CJN.13131118","article-title":"Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden","volume":"14","author":"Goto","year":"2019","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/s11136-018-2000-7","article-title":"Development and Content Validity of a Hemodialysis Symptom Patient-Reported Outcome Measure","volume":"28","author":"Flythe","year":"2019","journal-title":"Qual. Life Res."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/BF00451725","article-title":"Development of the Kidney Disease Quality of Life (KDQOLTM) Instrument","volume":"3","author":"Hays","year":"1994","journal-title":"Qual. Life Res."}],"container-title":["Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/40\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:34:59Z","timestamp":1775565299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3417\/11\/2\/40"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":152,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["geriatrics11020040"],"URL":"https:\/\/doi.org\/10.3390\/geriatrics11020040","relation":{},"ISSN":["2308-3417"],"issn-type":[{"value":"2308-3417","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]}}}