Supporting Shared Decision-Making in Life-Altering Kidney Therapy Decisions for Older Adults: A Review

Area of Science:

• Nephrology
• Geriatrics
• Public Health

Background:

• Older adults are the fastest-growing demographic initiating dialysis in the US.
• Dialysis is often the default, despite transplant ineligibility and misaligned patient goals prioritizing quality of life.
• Many older patients are not fully informed about all kidney therapy options.

Purpose of the Study:

• To guide primary care clinicians in collaborating with older adults, families, and nephrologists.
• To promote shared decision-making for advanced chronic kidney disease (CKD) therapy.
• To ensure patient-centered, goal-concordant CKD management.

Main Methods:

• This is a narrative review.
• It synthesizes current understanding of kidney therapy options for older adults.
• It focuses on the process of shared decision-making.

Main Results:

• Kidney therapy options include transplant, dialysis, and conservative kidney management.
• Shared decision-making involves joint planning based on evidence, patient goals, and risk-benefit analysis.
• Approaches like time-limited dialysis trials can address decisional uncertainty.

Conclusions:

• Shared decision-making is crucial for older adults with advanced CKD to understand options and make goal-concordant choices.
• Collaboration between primary care and nephrology is vital for coordinated, patient-centered care.
• This approach supports informed decisions aligning with patient priorities, such as quality of life.