Dialysis may not be the answer for older patients

Contrary to the assumption of many, dialysis added only 77 days of life, according to a recent study published in the Annals of Internal Medicine.

Researchers examined over 20,000 veterans (65 years or older) who were diagnosed with chronic kidney failure. They found that, over a three-year period of observation, patients on dialysis lived for an average of 770 days, which was 77 days longer than those who did not start dialysis.

Patients may live longer on dialysis, but will spend more time in hospitals and medical facilities as well (15 more days). The results show that, especially for older patients, alternatives to dialysis may be worth investigating.  

Conservative kidney management

Conservative Kidney Management (CKM) helps patients manage kidney disease with a focus on quality of life, symptom management, and living well without dialysis.

Researchers at the UW designed a patient decision aid to help older patients make informed decisions about managing their kidney disease. Of the patients and families who received the decision aid, about 26% had conversations with their provider about options to manage their disease. Only 3% of patients who did not receive the aid sought out these conversations.

Dr. Susan Wong, associate professor (Nephrology), and lead author of the study was pleased to see that patients and families felt empowered to initiate conversations with their providers about CKM after reviewing the aid.

“It can be intimidating for patients to bring up alternatives when a provider is pushing or recommending or positioning dialysis as the only right thing to do.”

In Wong’s clinic, about a third of patients who progress to kidney failure go on to hemodialysis centers, a third begin peritoneal dialysis at home and a third opt for conservative management without dialysis.