A national survey on the decision-making process of dialysis initiation in elderly patients

The decision-making process of dialysis initiation in the elderly involves different considerations compared with younger patients. Cognitive, functional and psychosocial issues are likely to be more important than standard prognostic factors. To assess the role of these issues in the decision-making process regarding dialysis initiation in the elderly, a survey was conducted among nephrologists in the Netherlands. An internet-based survey was sent to all members of the Netherlands Federation of Nephrology. Out of 298 invited, 94 Dutch nephrologists responded to the questionnaire. Reaching consensus with the patient and relatives and early withdrawal are difficult issues in the decision-making process in elderly end-stage renal disease patients. Geriatric impairments were considered (very) relevant issues (varying from 7- 0 on a scale from 1-10) in the context of dialysis initiation, with cognitive dysfunction being most relevant (median 10, range 6-10). The majority of nephrologists (56%) underlined the need for screening for geriatric problems when considering dialysis in the elderly. A total of 26% reported using some form of screening measurement for the determination of the presence of one or more geriatric impairments. Although cognitive, functional and psychosocial issues are considered relevant items in the context of dialysis initiation in the elderly, systematic assessment of these items is not standard of care in nephrology practice. Future research is needed to determine whether a more systematic screening for the presence of geriatric impairments can improve the decision-making process.