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. 2022 Jun 1;51(6):afac111.
doi: 10.1093/ageing/afac111.

Kidney transplantation or dialysis in older adults-an interview study on the decision-making process

Tessa S Schoot  1   2 , Marieke Perry  3 , Luuk B Hilbrands  1 , Rob J van Marum  4   5   6 , Angèle P M Kerckhoffs  2   4
Affiliations

Kidney transplantation or dialysis in older adults-an interview study on the decision-making process

Tessa S Schoot et al. Age Ageing. .

Abstract

Background: In older patients with end-stage kidney disease (ESKD), the choice between kidney transplantation (KT) and dialysis may be more complex than in younger patients because of a higher prevalence of comorbidities and frailty. This study aims to provide greater insight into the current decision-making process by exploring the expectations, experiences and health outcome priorities of all stakeholders.

Methods: We performed semi-structured interviews with patients ≥65 years with ESKD (eGFR <15 ml/min/1.73m2, KT recipient or treated with dialysis), patients' relatives and healthcare professionals (nephrologists, nurses and medical social workers). Interviews were conducted until data saturation and thematically analysed.

Results: We performed 36 interviews (patients n = 18, relatives n = 5, healthcare professionals n = 13). Thematic analysis revealed five themes. Older patients' health outcome priorities were mostly related to quality of life (QOL). Individual older patients showed marked differences in the preferred level of engagement during the decision-making process (varying from 'wants to be in the lead' to 'follows the nephrologist') and in informational needs (varying from evidence-based to experience-based). On the contrary, healthcare professionals were quite unanimous on all aspects. They focused on determining eligibility for KT as start of the decision-making process, on clear and extensive information provision and on classical, medical outcomes.

Conclusions: The decision-making process could benefit from early identification of older patients' values, needs and health outcome priorities, in parallel with assessment of KT eligibility and before discussing the treatment options, and the explicit use of this information in further steps of the decision-making process.

Keywords: chronic kidney disease; dialysis; end-stage kidney disease; kidney replacement therapy; kidney transplantation; older people.

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Figures

Figure 1
Figure 1
Treatment options of an older patient with ESKD, scope of this study and people that are involved in the decision-making process. This study focuses on the decision between KT and dialysis. Blue = people that are involved in the decision-making process. Red = main question of the decision making process. Green = treatment options. * Nephrologists, nurses, medical social workers ** Beyond the scope of this study
See this image and copyright information in PMC

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