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Informing our elders about dialysis: is an age-attuned approach warranted?

Rebecca J Schmidt1

  • 1Section of Nephrology, West Virginia University School of Medicine, 1 Medical Center Drive, Box 9165, Morgantown, WV 26506, USA. rschmidt@hsc.wvu.edu

Clinical Journal of the American Society of Nephrology : CJASN
|December 17, 2011
PubMed

Insights

Older adults with chronic kidney disease (CKD) may not benefit from dialysis due to age and comorbidities. Informed consent should be age-sensitive, discussing risks, benefits, and potential loss of independence.

Area of Science:

  • Nephrology
  • Geriatrics
  • Bioethics

Background:

  • Older adults are the fastest-growing segment of the end-stage renal disease (ESRD) population.
  • These patients often have multiple comorbid conditions and unique needs impacting renal replacement therapy decisions.
  • Dialysis may offer limited survival benefits and increased risks for older individuals with impaired functional status.

Purpose of the Study:

  • To review medical evidence and guidelines for advance care planning in older CKD patients.
  • To present considerations for discussions with older adults considering dialysis.
  • To recommend an age-attuned approach to informed consent for dialysis in this population.

Main Methods:

  • Review of medical evidence and clinical practice guidelines.
  • Analysis of issues relevant to advance care planning and informed consent for older CKD patients.
  • Development of recommendations for an age-sensitive informed consent process.

Main Results:

  • Dialysis burdens and risks can be amplified in older patients, potentially negating survival benefits.
  • Dialysis withdrawal rates are highest among the oldest patients.
  • Standard informed consent may not adequately address the unique risk-benefit balance for older adults with comorbidities.

Conclusions:

  • Informed consent for dialysis in older CKD patients requires an age-sensitive approach.
  • Discussions should include age-specific prognosis, risks, benefits, burdens, and potential impact on independence and function.
  • An age-attuned informed consent process is crucial for appropriate advance care planning.

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