Shared Decision Making for Older Adults: Time to Move Beyond Dialysis as a Default

Abstract

For older adults facing kidney therapy decisions, more dialysis is not always better.Currently, dialysis is often the default option, even for older patients with end-stage kidney disease (1).Yet, older people with several comorbidities tend to incur substantial burdens due to dialysis, including loss of independence and increased hospitalizations, at times without a significant survival benefit.Data suggest that many people make life-altering decisions for dialysis without receiving full information about their choices or discussing their prognosis (2).Alternative treatment options exist for individuals with kidney disease, especially for those who are likely to incur more burdens than benefits from dialysis.Conservative kidney management (CKM) is a nondialytic treatment option that focuses on symptom management and quality of life.Although many older people with advanced kidney disease express goals that align with comfort-based options such as CKM, most patients remain uninformed about CKM as a treatment choice (3).Even when patients express a wish to forego dialysis, data suggest that they often face resistance from nephrologists and providers who generally promote dialysis (1).Improving shared decision making (SDM), a process that incorporates clinician and patient input and deliberation, for these vital kidney therapy decisions is imperative (4).

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