The Conversation: A Vital Element of Nephrology Care for Older Americans Who Are Medically Complex

The U.S. population is aging, supported in part by continued development of life-prolonging medical therapies and technologies. These innovations, including kidney replacement therapies, have been effective in providing additional options to patients facing serious illness, but they have also introduced a new level of complexity in the provider assessment of treatment for these patients. Health care providers are being tasked to decide if medical care is appropriate for an aging and medically complex population, a decision complicated by a variety of factors. Patient-focused conversations surrounding goals of care, prognosis, medical futility, and quality of life need to become part of the routine practice pattern for nephrology care in the United States.