Learning to Say No to Dialysis

Paula Span has written a thoughtful and important Op-Ed piece on dialysis in the elderly for The New Old Age series in the NY Time (March 30, 2015).

Image from NY Times article

People over age 75 are the fastest-growing segment of patients on dialysis, and the treatment’s benefits and drawbacks add up differently for them than for younger patients. A growing number of nephrologists and researchers are pushing for more educated and deliberative decision making when seniors contemplate dialysis.

It is a choice, they say, not an imperative.  “Patients are not adequately informed about the burdens. All they’re told is, ‘You have to go on dialysis or you’ll die,’ ” said Dr. Alvin H. Moss, a nephrologist at West Virginia University School of Medicine and chairman of the Coalition for Supportive Care of Kidney Patients. “Nobody tells them, ‘You could have up to two years without the treatment, without the discomfort, with greater independence.’ ”

To weigh the pros and cons, however, kidney disease patients need better information. Among 99 patients at dialysis centers in North Carolina, for instance, two-thirds told researchers their doctors had not mentioned the treatment’s risks or burdens. The same proportion said they felt they had no choice.

Learning to Say No to Dialysis.

Editor's Note:  This is a choice for patients, not a mandate.  I have an 86 year-old patient who has been on hemodialysis for three years.  He is the main caregiver for his 83 year old wife who has mild dementia.  Dialysis allows them to keep living independently.