New Rutgers Study: Don't Rush Into Starting Dialysis

NEW BRUNSWICK, NJ — A new Rutgers study challenges the way kidney disease and dialysis is traditionally thought of in America.

People with chronic kidney disease over the age of 65 (who are not candidates for transplant) should be given the opportunity to decide not to begin dialysis, and they should actually be encouraged by their doctor to wait and monitor their symptoms.

This is according to a new Rutgers paper, published this February in the Journal of the American Society of Nephrology.

The paper discusses how physicians can improve care for older adults simply by taking more time to reflect and consider treatment options, rather than immediately defaulting to dialysis.

After all, more than 50 percent of those over 65 who are not candidates for a kidney transplant die within one year of starting treatment, according to studies.

Rutgers calls the movement "Deciding Not To Decide" (to begin dialysis) and it is a groundbreaking, radical change in how kidney disease and kidney failure is treated.

In modern American healthcare today, many doctors immediately push their patients to begin dialysis. However, the Rutgers researchers found evidence showing that kidney function does not decline as quickly in older adults.

Researchers say they are trying to combat a patient’s perceived lack of choice in treatment and increase patient autonomy to ensure ethical consent.

The Rutgers researchers also say active medical management without dialysis can be a viable option for many older adults.

“Advocacy for the ‘Deciding Not to Decide’ option in older patients is critically important to ensuring that patients and physicians have sufficient time to have conversations about treatment options that align with the quality-of-life patients seek,” said study author Paul Duberstein, chair of the Department of Health Behavior and Society at the Rutgers School of Public Health. "Patients can decide that they do not want to make a treatment decision at that time.”

Study co-authors include faculty from other collaborating institutions: Fahad Saeed and Kevin A. Fiscella (University of Rochester School of Medicine and Dentistry) and Alvin H. Moss (West Virginia University School of Medicine).

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