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Kidney Week

Abstract: TH-PO647

Why Do Older Patients Choose Conservative Management?

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Saeed, Fahad, University of Rochester Medical Center, Pittsford, New York, United States
  • Adams, Hugh, Nephrology Division, Rochester, New York, United States
  • Epstein, Ronald M., University of Rochester, Rochester, New York, United States
Background

Although many older patients with end-stage renal disease and limited prognoses prefer conservative management (CM), it is not widely offered in the US. Moreover, there is a dearth of US-based literature reporting clinical experience with shared decision-making regarding CM of advanced chronic kidney disease (CKD).

Methods

We describe the experience of 13 patients who opted for CM at the University of Rochester Medical Center’s CKD clinic. Their reasons for choosing CM were categorized into four broad categories based on a review of their electronic medical records. A retrospective chart review conducted by two reviewers determined the status of advance care planning, hospice referral, and place of death.

Results

During the year 2016-2017, 13 patients opted for CM. The mean and median age of these patients was 81.8 years (standard deviation 7.3) and 83 years (interquartile range 11), respectively. Their reasons for choosing CM included: poor prognoses; a wish to maintain their quality of life; their desire for a dignified life closure; and the intention to protect family members from having to see them suffer, based on their own memory of having witnessed a relative on dialysis previously. A total of seven patients died: all received hospice services, five died at home, one at a nursing home and one at a hospital. Advance care planning was completed in 100% of the cases. Symptoms were managed in collaboration with primary care physicians.

Conclusion

Patients’ decisions to forego dialysis and engage in CM were influenced by their values and previous experience with dialysis, in addition to co-morbidities and limited prognoses. Promoting the choice of CM in the US will require training of clinicians in competencies, including communication and decision-making skills, as well as basic symptom management.