Many older patients with advanced kidney disease who decide to forgo dialysis still survive for several years after making their decision and have a good quality of life until their final days, a new systematic review of cohort studies suggests.
"Our findings challenge the common misconception that the only alternative to dialysis for many patients with advanced chronic kidney disease is no care or death," say Susan Wong, MD, Renal Dialysis Unit, Seattle, Washington, and colleagues in their review, published online March 14 in JAMA Network Open.
In an accompanying commentary, Christine Liu, MD, and Kurella Tamura, MD, MPH, note: "The decision to initiate dialysis or focus on active alleviation of symptoms, known as conservative care...is likely one of the consequential decisions [patients] will face."
"[But] in reality, dialysis is viewed as the default treatment for kidney failure and the option to forgo dialysis treatment is often not explicitly discussed," they add.
"We believe it is time to broaden the scope of kidney replacement therapy registries to include persons who receive conservative treatment of kidney failure…and we need to address the conservative care information gap so that lack of awareness is no longer a barrier to informed decision making," Liu and Tamura, both from the Stanford University School of Medicine, California, note.
