Elderly patients comprise the fastest growing population initiating dialysis and also experience the worst outcomes, including increased mortality, loss of functional status, and impaired quality of life. Nephrologists are often challenged with how best to engage in dialysis decision-making discussions within this population. Prognostication tools can assist nephrologists in engaging in these discussions, especially in patients for whom survival benefits may be outweighed by the burdens of treatment.
This review includes the latest research in the survival of elderly patients with and without dialysis; prognostic factors associated with renal progression and survival; and integrative prognostic models to predict both short-term and long-term prognosis. The concept of kidney illness disease trajectory is defined with important outcomes including survival, health-related quality of life, and symptoms with and without dialysis. This prognostic information will then be integrated into an individualized approach to shared decision-making regarding treatment decision-making.
Treatment decision-making for elderly patients with advanced kidney disease necessitates an active process between nephrologist and patient, incorporating medical information as well as patient preferences. Prognostic information and observational data can facilitate nephrologists’ ability to foresee and foretell the illness trajectory both with and without dialysis, further guiding these conversations.
aSection of Palliative Care and Medical Ethics
bRenal-Electrolyte Division, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania, USA
cLister Renal Unit, Stevenage, Herts, UK
dDivision of Nephrology, Baystate Medical Center, Springfield, Massachusetts, USA
Correspondence to Jane O. Schell, UPMC Montefiore, Suite 933W, 200 Lothrop Street, Pittsburgh, PA 15213, USA. Tel: +1 412 692 4315; fax: +1 412 692 4315; e-mail: firstname.lastname@example.org