Revised dialysis clinical practice guideline promotes more informed decision-making

Area of Science:

• Nephrology
• Geriatrics
• Palliative Care

Background:

• A decade-old guideline on dialysis decision-making requires updating due to substantial new evidence.
• New evidence highlights poor prognosis in elderly CKD patients, cognitive impairment in dialysis patients, and undertreatment of symptoms.
• Underutilization of hospice and diverse treatment goals in ESRD patients necessitate updated guidance.

Purpose of the Study:

• To update the clinical practice guideline on shared decision-making for dialysis initiation and withdrawal.
• To incorporate recent evidence regarding prognosis, cognitive function, symptom management, and patient preferences.
• To provide practical strategies for clinicians, patients, and families in making informed dialysis-related decisions.

Main Methods:

• Review and synthesis of current evidence on the benefits and burdens of dialysis.
• Development of recommendations for quality decision-making in acute kidney injury, CKD, and ESRD.
• Inclusion of practical implementation strategies for guideline recommendations.

Main Results:

• Evidence indicates varied survival advantages of dialysis across patient populations.
• Cognitive impairment is prevalent in dialysis patients, requiring regular assessment for decision-making capacity.
• Pain and other symptoms are often under-recognized and undertreated; hospice utilization is low.

Conclusions:

• Updated guidelines provide current evidence on dialysis benefits and burdens for diverse patient conditions.
• Recommendations focus on quality decision-making for acute kidney injury, CKD, and ESRD.
• Practical strategies are offered to facilitate guideline implementation and improve patient care.