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

Sierra Leone streets deserted as shutdown begins

5 hours ago

Sierra Leone's normally chaotic capital resembled a ghost town on Friday as residents were confined to their homes for the start of a three-day lockdown aimed at halting the deadly Ebola epidemic.

Sierra Leone launches controversial Ebola shutdown

6 hours ago

Sierra Leone on Friday launched a controversial three-day shutdown to contain the deadly spread of the Ebola virus, as the UN Security Council declared the deadly outbreak a threat to world peace.

Cooling of dialysis fluids protects against brain damage

19 hours ago

While dialysis can cause blood pressure changes that damage the brain, cooling dialysis fluids can protect against such effects. The findings come from a study appearing in an upcoming issue of the Journal of the American So ...

Two Ebola vaccines to be tested in Switzerland

20 hours ago

Clinical trials of two experimental vaccines against the deadly Ebola virus are due to begin soon in Switzerland, the country's Tropical and Public Health Institute said on Thursday.

User comments