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."

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