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. 2023 May;71(5):1378-1385.
doi: 10.1111/jgs.18256. Epub 2023 Feb 15.

Decision-making about dialysis: Beyond just dialysis or death

Christine Kee Liu  1   2 , Leah Taffel  3 , Matthew Russell  4 , Susan P Y Wong  5   6 , Howard Russell, Elizabeth K Vig  7   8
Affiliations

Decision-making about dialysis: Beyond just dialysis or death

Christine Kee Liu et al. J Am Geriatr Soc. 2023 May.

Abstract

Nearly half of the persons receiving dialysis in the United States are aged 65 years or older. Kidney failure occurs most frequently in older adults, and typically triggers a discussion regarding dialysis treatment. In this Special Article, we describe the journey of Mr. Howard Russell, an older adult who experienced kidney failure and underwent dialysis. Using the experience of Mr. Russell, we illustrate the complexity of dialysis decision-making, including how disease trajectory and health policy can potentially impede older adults from achieving "what matters." Our intent is to provide guidance regarding these barriers and support to clinicians who are sharing similar journeys with older adults making decisions about dialysis. Based on Mr. Russell's journey, we suggest that when discussing dialysis with an older adult, four points be considered: (1) recognize if dialysis is needed long-term; (2) understand what matters for the older adult; (3) sync the treatment plan when what matters changes; and (4) set up with resources for kidney failure, which is limited but evolving.

Keywords: advance directives; decision-making; dialysis; goals of care; hemodialysis; hospice; kidney failure; older adults; palliative care.

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Conflict of interest statement

None of the authors have potential conflicts per the ICMJE guidelines.

Conflicts of interest: All authors declare they do not have relevant financial or personal conflicts of interest.

Figures

Figure 1
Figure 1
Key points for dialysis decision-making, as illustrated by Mr. Howard Russell and his journey with dialysis
See this image and copyright information in PMC

References

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