The ethics of chronic dialysis for the older patient

Time to reevaluate the norms

Bjoerg (Bjorg) Thorsteinsdottir, Keith M. Swetz, Robert C. Albright

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Recent research highlights the potential burdens of hemodialysis for older patients with significant comorbidities, for whom there is clinical equipoise regarding the net benefits.With the advent of accountable care and bundled payment, previous incentives to offer hemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. While this may offset the harm of overtreatment for some elderly patients, some voice concerns that the pendulum will swing too far back, with a return to ageist rationing of hemodialysis.Nephrologists should ensure that the patient’s rights to be informed about the potential benefits and burdens of hemodialysis are respected, particularly because age, functional status, nutritional status, and comorbidities affect the net balance between benefits and burdens. Nephrologists are also called on to help patients make a decision, for which the patient’s goals of care guide determination of potential benefit from hemodialysis. This article addresses concerns about present overtreatment and future risk of undertreatment of older adults with ESRD. It also discusses ways in which providers can ethically approach the question of initiation of hemodialysis in the elderly patient by including patient-specific estimates of prognosis, shared decision-making, and the use of specialist palliative care clinicians or ethics consultants for complex cases.

Original languageEnglish (US)
Pages (from-to)2094-2099
Number of pages6
JournalClinical Journal of the American Society of Nephrology
Volume10
Issue number11
DOIs
StatePublished - Nov 6 2015

Fingerprint

Ethics
Dialysis
Renal Dialysis
Comorbidity
Motivation
Patient Care Planning
Ethicists
Patient Rights
Nutritional Status
Palliative Care
Chronic Kidney Failure
Decision Making
Patient Care
Research

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

The ethics of chronic dialysis for the older patient : Time to reevaluate the norms. / Thorsteinsdottir, Bjoerg (Bjorg); Swetz, Keith M.; Albright, Robert C.

In: Clinical Journal of the American Society of Nephrology, Vol. 10, No. 11, 06.11.2015, p. 2094-2099.

Research output: Contribution to journalArticle

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