Deciding on dialysis is a significant decision for older adults facing kidney failure. A recent study from Stanford Medicine suggests that this choice, especially for those not eligible for a kidney transplant, may deserve more careful consideration. The findings reveal that starting dialysis immediately after kidney function declines below a certain level may not always offer the extended life or improved quality of life that patients might expect.
The study, published in the Annals of Internal Medicine, followed 20,440 adults from the Veterans Affairs who were 65 years or older and had chronic kidney failure and were not healthy enough for kidney transplantation. It found that starting dialysis early, as soon as kidney function dropped below a certain point, extended life by about one week, on average. However, this slight increase in lifespan came with a cost: these patients spent about two additional weeks in hospitals or care facilities, not to mention the time they spent undergoing dialysis treatments.
For older adults, this raises a critical question: Is the small extension of life worth the substantial time spent away from home and in a medical setting?
Dialysis: More Than Just a Treatment
Dialysis is an intensive therapy that requires significant lifestyle changes. It involves regular visits to a clinic, often three times a week, for three to four hours each time. This treatment process can be exhausting and comes with side effects like cramping, fatigue, and the emotional toll of frequent medical visits.
Dr. Manjula Tamura, a professor of nephrology and a senior author of the study, emphasizes the importance of understanding these trade-offs. “For all patients, but particularly for older adults, understanding the trade-offs is really essential,” she said. The decision to start dialysis shouldn’t be taken lightly, especially when the benefits might not align with a patient’s personal goals and quality of life.
Alternative Approaches and Considerations
Not all patients with kidney failure need to start dialysis right away. For some, medications can manage symptoms like fluid retention, itchiness, and nausea, providing relief without the burdens of dialysis. This approach might be more suitable for older adults who prefer to spend more time at home, maintaining as much independence and comfort as possible.
Interestingly, the study highlighted that older adults who delayed dialysis often lived just as long, if not longer, in some age groups, compared to those who started immediately. For example, patients aged 65 to 79 who began dialysis right away actually lived 17 fewer days on average than those who waited, while spending more days in medical facilities. For patients 80 and older, those who started dialysis right away lived longer, but they also spent more days in inpatient care, indicating a complex balance between longevity and quality of life.
Personalizing the Decision
Dr. Tamura points out that dialysis should be considered on a case-by-case basis, especially for older adults. “Different patients will have different goals,” she explains. “For some, it’s a blessing to have this option of dialysis, and for others, it might be a burden.”
When discussing treatment options, it’s vital for healthcare providers to frame dialysis not just as a choice between life and death but as a palliative option that can alleviate symptoms and improve comfort for some patients. This reframing allows for a more nuanced conversation, helping patients and their families to understand the potential benefits and drawbacks more clearly.
Making Informed Choices
Ultimately, the decision to start dialysis should be made with a full understanding of what it entails and how it aligns with a patient’s values and lifestyle. For many older adults, preserving quality of life and minimizing time spent in medical facilities might be more important than extending life by a few weeks or months.
Patients and their loved ones must engage in open, honest conversations with their healthcare providers about their preferences, goals, and what they hope to achieve with treatment. By doing so, they can make more informed decisions that truly reflect their values and priorities.
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