ArticleClinical journal of the American Society of Nephrology : CJASN2015
The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 34 citations in OpenAlex.
- Trial
- Logistical and Ethical Challenges in the Provision of Kidney Care to Immigrants.Journal of immigrant and minority health · 2026Article
- How do older patients with advanced kidney disease, and their family members, understand kidney function and failure? A qualitative study.BMC nephrology · 2025Article
- Frailty and dialysis initiation in the super-elderly.Clinical and experimental nephrology · 2024Article
- Decisional Regret Surrounding Dialysis Initiation: A Comparative Analysis.Kidney medicine · 2024Article
- Risk factors for short-term all-cause mortality in patients with end stage renal disease: a scoping review.BMC nephrology · 2024Article
- Asking the right questions: towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients.BMC medical ethics · 2022Article
- Older Patients with Advanced Chronic Kidney Disease and Their Perspectives on Prognostic Information: a Qualitative Study.Journal of general internal medicine · 2022Article
- Elderly Patients in a Large Nephrology Unit: Who Are Our Old, Old-Old and Oldest-Old Patients?Journal of clinical medicine · 2021Article
- Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75.PloS one · 2021Article
- Predictors of Health Deterioration Among Older New Zealanders Undergoing Dialysis: A Three-Year Accelerated Longitudinal Cohort Study.Canadian journal of kidney health and disease · 2021Article
- International variation in dialysis discontinuation in patients with advanced kidney disease.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Observational
- Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2018Review
- Burden of multimorbidity and outcome in ambulatory geriatric hemodialysis patients : Report from the QiN registry in Germany.Zeitschrift fur Gerontologie und Geriatrie · 2018Article
- The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions.BMC medical ethics · 2017Article
- Low renal replacement therapy incidence among slowly progressing elderly chronic kidney disease patients referred to nephrology care: an observational study.BMC nephrology · 2017Observational
- Palliation Versus Dialysis for End-Stage Renal Disease in the Oldest Old: What are the Considerations?Palliative care · 2017Article
- Choosing Wisely: The Canadian Society of Nephrology's List of 5 Items Physicians and Patients Should Question.Canadian journal of kidney health and disease · 2017Article
- Patient Survival and Costs on Moderately Restricted Low-Protein Diets in Advanced CKD: Equivalent Survival at Lower Costs?Nutrients · 2016Article
- Assessment of the geriatric competence and perceived needs of Italian nephrologists: an internet survey.Journal of nephrology · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Recent research highlights the potential burdens of hemodialysis for older patients with significant comorbidities, for whom there is clinical equipoise regarding the net benefits. With the advent of accountable care and bundled payment, previous incentives to offer hemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. While this may offset the harm of overtreatment for some elderly patients, some voice concerns that the pendulum will swing too far back, with a return to ageist rationing of hemodialysis. Nephrologists should ensure that the patient's rights to be informed about the potential benefits and burdens of hemodialysis are respected, particularly because age, functional status, nutritional status, and comorbidities affect the net balance between benefits and burdens. Nephrologists are also called on to help patients make a decision, for which the patient's goals of care guide determination of potential benefit from hemodialysis. This article addresses concerns about present overtreatment and future risk of undertreatment of older adults with ESRD. It also discusses ways in which providers can ethically approach the question of initiation of hemodialysis in the elderly patient by including patient-specific estimates of prognosis, shared decision-making, and the use of specialist palliative care clinicians or ethics consultants for complex cases.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.