Dialysis' Drawbacks Outweigh Benefits for Some Older Patients

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The study results can help both doctors and older nursing home patients make educated decisions about dialysis, she said. "These results will be surprising even for doctors who care for dialysis patients on a daily basis," Kurella Tamura said. "They can lead to more informed discussions with patients about the expected prognosis and options for palliative care. They can help patients make informed decisions about treatment options."

Even now, one-fourth to one-third of such elderly people who opt for dialysis choose to end it, she said.

The findings help build a case for appropriate expectations, another expert said.

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"There has been some earlier work that suggested that the course of frail elderly people was not very promising when they started dialysis," said Dr. Peter Aronson, professor in the nephrology section at Yale School of Medicine, who was familiar with the study. "This is the first to look at the subject in detail and document what happens when they start dialysis."

A weakness of the study was that it did not have a control group of elderly nursing home residents with a similar degree of kidney failure who did not receive dialysis, Aronson said. But there are obvious reasons why such a controlled study would be difficult to conduct, he said.

The study "does not make the case that if you are old, you shouldn't have dialysis," Aronson said. "And it should not be turned into an argument that we should ration dialysis, but it is important to have realistic expectations about whether dialysis will help you get better."

The issue of medical care for such old, frail people is "very difficult, both medically and ethically," Aronson said. "We should not ration it or withhold it from anybody, but it is important for doctors and patients to have realistic expectations about what to expect and to have appropriate discussions about end-of-life care."

More information

For more on dialysis, see the U.S. National Library of Medicine.

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