A new study conducted by researchers at Stanford Medicine suggests that the decision of whether to start dialysis for kidney failure patients, especially older adults, requires careful consideration. The study found that for older adults who were not healthy enough for a kidney transplant, starting dialysis when their kidney function fell below a certain threshold provided them with roughly one more week of life. However, they spent an average of two more weeks in hospitals or care facilities in addition to the time spent on dialysis. This raises important questions about whether the benefits of dialysis outweigh the drawbacks for older patients with kidney failure.
The lead author of the study, Maria Montez Rath, emphasized the importance of understanding the trade-offs involved in starting dialysis, especially for older adults. With dialysis requiring a significant time commitment and having potential side effects, patients and their physicians should carefully consider whether and when to proceed with the treatment. While dialysis can effectively clean the blood and manage symptoms of kidney failure, such as fluid retention, itchiness, and nausea, it can also have a considerable impact on a patient’s quality of life.
The study focused on older adults who were ineligible for a kidney transplant and analyzed the impact of immediate dialysis initiation versus delayed or no dialysis. The findings revealed that patients who started dialysis immediately lived longer on average but spent more time in inpatient facilities. Age also played a role in the outcomes, with younger patients generally living fewer days but spending more time in facilities compared to older patients. The study highlights the need for individualized treatment decisions based on patient preferences, symptoms, and overall goals of care.
Physicians sometimes recommend dialysis to offer hope to patients, without fully considering the downsides of the treatment. However, the study suggests that physicians and patients should weigh the benefits and drawbacks of dialysis more carefully, taking into account patient symptoms and personal preferences. Framing dialysis as a palliative treatment intended to alleviate symptoms, rather than a choice between life and death, may help patients understand the potential trade-offs involved. This approach allows patients to make more informed decisions based on their goals and values.
Overall, the study underscores the importance of discussing the decision to start dialysis with older adults, especially those with multiple health conditions. By considering factors such as quality of life, symptom management, and the impact of dialysis on survival, physicians can work together with patients to make informed treatment decisions. Ultimately, the goal is to provide patients with the best possible care that aligns with their preferences and goals, ensuring that they receive treatment that maximizes their well-being and quality of life.