Nephrologists should weigh the benefits of dialysis over more conservative therapies for frail elders

November 25, 2015

The authors also believe nephrologists need to become more aware of national guidelines on shared decision making regarding the initiation and withdrawal of dialysis, citing the fact that 30 percent of the patients older than 75 withdraw from dialysis indicate "the ability to counsel patients about potentially foregoing dialysis should be a core competency for nephrologists."

Arnold and Zeidel note than elderly patients with ESRD have multiple functional impairments, physical symptoms and a high rate of depression, facts that require an integrated, holistic approach to the care. There are also increased rates of frailty, cognitive dysfunction and geriatric syndromes such as falls and hospitalization involving elders undergoing dialysis.

Despite the fact that palliative care consultations for patients with cancer have shown decreases in symptoms and improved satisfaction, the authors note ESRD patients are less likely to receive comprehensive palliative care consultations. They recommend routine inclusion of palliative care specialists for these patients.

"In persons who will benefit, we must determine when we should initiate dialysis; this may differ substantially from initiation of dialysis in younger, healthier patients with ESRD," they note. "We must learn much more about how to ensure that we obtain truly informed consent from our patients, how to support them optimally in their therapeutic decisions and how to relieve their symptoms most effectively.

Source: Beth Israel Deaconess Medical Center