Dialysis for the elderly: New evidence to guide shared decision-making

New research from Mayo Clinic finds that half of elderly patients who start dialysis after age 75 will die within one year. The findings are being presented this week at the American Society of Nephrology's Kidney Week 2013 in Atlanta.

"Many and their families feel that they have no choice but to start dialysis, with several expressing regret from having initiated therapy," says Bjorg Thorsteinsdottir, M.D., lead study author and a scholar with the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. "The goal of our study was to develop evidence about dialysis outcomes to help guide shared decision-making among the patient, family members and care team."

Researchers reviewed four years of medical records for 379 patients who were at least 75 years old when they began at Mayo Clinic in Rochester. The majority (76 percent) started dialysis while in the hospital for a chronic illness or sudden medical event such as pneumonia.

Mortality was very high, with 40 percent of patients dying within six months. The highest mortality rates were seen in patients who started dialysis in the intensive care unit. Only 27 percent were alive after six months.

Patients who started dialysis in the hospital often were not able to return home. Of the patients admitted to the hospital from home, 28 percent died while in the hospital or were discharged to hospice, 28 percent were discharged to a nursing home, and only 37 percent were able to return home to independent living.

Age alone was not a good predictor of survival, and healthier elderly patients did better. Most deaths were preceded by a decision to withdraw life support, including dialysis.

"We hope that these study results will help inform the difficult decisions that patients and family members must make about whether or not to begin ," says Dr. Thorsteinsdottir. "We want to make sure that the treatment is congruent with our patients' goals and values."

add to favorites email to friend print save as pdf

Related Stories

New approaches to assessing and protecting kidney health

Nov 07, 2013

A variety of recent studies highlight new approaches to assessing and protecting kidney health. Below are the findings of some of these studies, which are being presented at ASN Kidney Week 2013 November 5-10 at the Georgia ...

Acute kidney injury increased for some over last decade

Nov 01, 2013

(HealthDay)—Over the last decade there has been an increase in the incidence of acute kidney injury (AKI), but a decrease in the incidence of AKI requiring dialysis, among elderly patients hospitalized ...

Recommended for you

Recorded Ebola deaths top 7,000

2 hours ago

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

6 hours ago

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

Bacteria in caramel apples kills at least four in US

Dec 19, 2014

A listeria outbreak believed to originate from commercially packaged caramel apples has killed at least four people in the United States and sickened 28 people since November, officials said Friday.

Steroid-based treatment may answer needs of pediatric EoE patients

Dec 19, 2014

A new formulation of oral budesonide suspension, a steroid-based treatment, is safe and effective in treating pediatric patients with eosinophilic esophagitis (EoE), according to a new study in Clinical Gastroenterology and Hepatology, the official clinical practice journal ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.