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Dialysis Access Considerations in Kidney Palliative Care.
Samantha L Gelfand1, Dirk M Hentschel2
1Department of Medicine, Renal Division, Brigham and Women's Hospital, Boston MA; Department of Medicine, Division of Palliative Care, Brigham and Women's Hospital, Boston, MA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Department of Medicine, Interventional Nephrology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Seminars in Nephrology
|August 14, 2023
Summary
Planning dialysis access involves complex decisions for elderly or seriously ill patients. Understanding potential complications and benefits is crucial for informed choices about kidney replacement therapy versus conservative care.
Area of Science:
- Nephrology
- Medical Ethics
- Palliative Care
Background:
- Dialysis access planning requires careful consideration for patients with limited life expectancy.
- Central venous catheters, while immediately usable, carry higher risks than fistulas or grafts.
- The benefits of early access placement must be weighed against potential premature or unnecessary procedures.
Purpose of the Study:
- To review challenges in dialysis access planning, prognostication, and patient-centered decision-making.
- To highlight the importance of understanding dialysis complications for patients and families.
- To explore the role of kidney palliative care in complex end-of-life decisions.
Main Methods:
- Literature review of challenges in dialysis access planning.
- Discussion of prognostication factors influencing dialysis decisions.
- Analysis of patient-centered decision-making frameworks.
Main Results:
- Early access placement offers benefits but risks unnecessary surgery in some elderly/ill patients.
- Informed decision-making requires clear communication about access complications and prognosis.
- Kidney palliative care can facilitate goals-of-care discussions.
Conclusions:
- Shared decision-making is essential for dialysis access in vulnerable populations.
- Integrating palliative care improves navigation of complex treatment choices.
- Prognostication and patient values should guide dialysis access planning.
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