The decision to initiate chronic dialysis should be part of an individualized, shared decision-making process between patients, their families, and their nephrology health care team. This process includes eliciting individual patient goals and preferences and providing information on prognosis and expected benefits and harms of dialysis within the context of these goals and preferences. Limited observational data suggest that survival may not differ substantially for older adults with a high burden of comorbidity who initiate chronic dialysis versus those managed conservatively.
Sources:
Chandna SM, et al. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011 May;26(5):1608-14. PMID: 21098012.
Jassal SV, et al. Changes in survival among elderly patients initiating dialysis from 1990 to 1999. CMAJ. 2007 Oct 23;177(9):1033-8. PMID: 17954892.
Kurella M, et al. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med. 2007 Feb 6;146(3):177-83. PMID: 17283348.
Kurella Tamura M, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009 Oct 15;361(16):1539-47. PMID: 19828531.
Murtagh FE, et al. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant. 2007 Jul;22(7):1955-62. PMID: 17412702.
Related Resources:
Patient Pamphlet: Chronic Kidney Disease: Making hard choices