Tough Choices: Dialysis, Palliative Care, or a Third Option for Elderly ESRD
- 19 October 2012
- journal article
- Published by Wiley in Seminars in Dialysis
- Vol. 25 (6), 633-639
- https://doi.org/10.1111/sdi.12018
Abstract
Dialysis should not be presumed to be the treatment of choice for all elderly chronic kidney disease stage 5 patients. Nondialysis active medical management, as an alternative to dialysis or palliative care, is a reasonable alternative in select cases. Early referral of CKD 5 elderly patients may lead to early initiation of dialysis, which may not be advantageous; it also provides an opportunity to institute active management as a treatment alternative. The informed decision to proceed with dialysis must involve both an assessment of evidence-based outcomes applicable to the patient, and allowance of patient preference. Prognostic tools are increasingly sought to aid in decision-making for elderly CKD 5 patients. Chronological age alone is not a sufficient predictor of benefit from dialysis treatments, according to observational studies and limited clinical trial data. The survival advantage of dialysis appears to be lost in patients with high levels of comorbidity. Establishing patient preference is an imperfect process, and many patients appear to regret their decision to undergo dialysis. With active medical management, efforts shift from prolonging life to emphasis on symptom control, dietary and medical treatment, and quality of life. Patient survival time can be remarkably long.Keywords
This publication has 44 references indexed in Scilit:
- Dialysis Modality Preference of Patients With CKD and Family Caregivers: A Discrete-Choice StudyAmerican Journal of Kidney Diseases, 2012
- Are There Alternatives to Hemodialysis for the Elderly Patient With End-Stage Renal Failure?Mayo Clinic Proceedings, 2012
- Discussions of the Kidney Disease Trajectory by Elderly Patients and Nephrologists: A Qualitative StudyAmerican Journal of Kidney Diseases, 2012
- Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney diseaseCMAJ : Canadian Medical Association Journal, 2012
- Too Little? Too Much? Primary Care Physicians' Views on US Health CareArchives of Internal Medicine, 2011
- Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapyNephrology Dialysis Transplantation, 2010
- A Randomized, Controlled Trial of Early versus Late Initiation of DialysisNew England Journal of Medicine, 2010
- Functional Status of Elderly Adults before and after Initiation of DialysisNew England Journal of Medicine, 2009
- CKD and Mortality Risk in Older People: A Community-Based Population Study in the United KingdomAmerican Journal of Kidney Diseases, 2009
- A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal diseaseNephrology Dialysis Transplantation, 2008