For elderly and frail patients, hours of quality life saved by starting dialysis may not stack up well when compared to medical management of chronic kidney disease.
Many studies show that for patients over 75, starting dialysis leads to poorer functional status and quality of life. Mortality rates after starting dialysis are high in patients with comorbidities such as heart disease, dementia, frailty or low albumen and for those who reside in nursing homes.
Data from Kurella et al., 2009, suggests that fewer than half of nursing home patients survived longer than 9 months after starting dialysis and pre-dialysis function was preserved in only 13% at one year.
The Renal Physician’s Association* recommends sharing prognostic information with patients before offering dialysis and considering alternatives like ongoing medical management or a time-limited trial of dialysis. Visit this link for details.