Advertisement

International Urology and Nephrology

, Volume 44, Issue 1, pp 295–300 | Cite as

Why did I start dialysis? A qualitative study on views and expectations from an elderly cohort of patients with end-stage renal failure starting haemodialysis in the United Kingdom

  • Stephanie Stringer
  • Jyoti BaharaniEmail author
Nephrology – Original Paper

Abstract

Background

It is now common for elderly patients with end-stage kidney disease to be offered treatment by dialysis. However, what these patients expect from dialysis is not known. Therefore, the purpose of this study was to elucidate the expectations of elderly patients starting dialysis and to investigate whether their views change after 6 months on this treatment.

Methods

This was a prospective observational qualitative study of patients commencing haemodialysis in our centre from 2006 to 2007. Data were collected by interview and review of case notes at the time of starting dialysis and after 6 months of treatment. Patients were asked about their expectations from dialysis, symptoms, and views on advance care planning.

Results

Data were collected from 22 patients (mean age 69.1 years) within a month from starting dialysis. Seventy per cent of these patients had attended a pre-dialysis clinic for at least 4 months previously; despite this, many of the patients complained about having had little choice in starting dialysis and seemed uncertain about what dialysis would involve. Even so, over 90% of those interviewed were optimistic about dialysis, had high expectations from treatment and were not keen to discuss advance care planning at first interview. Sixteen patients were re-interviewed at 6 months (four patients had died meanwhile and two had been transferred to other centres). After 6 months, there was a change in patients’ attitude, with only 45% of them still finding dialysis acceptable and more patients now keen to discuss advance care planning. Symptom burden was higher at 6 months than at initiation of dialysis treatment.

Conclusion

Most elderly patients have unrealistic expectations from dialysis at the start of treatment. There is a need for more specific counselling of these patients to ensure that they make informed decisions about treatment modality and have realistic expectations if they chose to receive RRT.

Keywords

Advance care planning Conservative management Elderly End-stage renal failure Expectations Knowledge Pre-dialysis counselling 

Notes

Acknowledgments

Many thanks to all the patients who participated in this study, the dialysis nurses, pre-dialysis team and the renal unit administrator who provided data support.

Conflict of interest

None declared.

References

  1. 1.
    Latos DL (1996) Chronic dialysis in patients over age 65. J Am Soc Nephrol 7(5):637–646PubMedGoogle Scholar
  2. 2.
    Malberti F, Conte F, Limido A, Marcelli D, Spotti D, Lonati F, Locatelli F (1997) Ten years of experience of renal replacement in the elderly. Geriatr Nephrol Urol 7(1):1–10PubMedCrossRefGoogle Scholar
  3. 3.
    Lamping DL et al (2000) Clinical outcomes, quality of life, and costs in the North Thames Dialysis Study of elderly people on dialysis: a prospective cohort study. Lancet 356(4):1543–1550PubMedCrossRefGoogle Scholar
  4. 4.
    Stevens LA, Levey AS (2005) Chronic kidney disease in the elderly—how to assess risk. N Engl J Med 352(20):2122–2124PubMedCrossRefGoogle Scholar
  5. 5.
    Khan S et al (2005) Does predialysis nephrology care influence patient survival after initiation of dialysis? Kidney Int 67:1038–1046PubMedCrossRefGoogle Scholar
  6. 6.
    Murtagh FEM, Marsh JE et al (2007) Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant 22(7):1955–1962PubMedCrossRefGoogle Scholar
  7. 7.
    Williams MA, Sklar AH, Burright RG, Donovick PJ (2004) Temporal effects of dialysis on cognitive functioning in patients with ESRD. Am J Kidney Dis 43:705–711PubMedCrossRefGoogle Scholar
  8. 8.
    Burns A, Carson R (2007) Maximum conservative management: a worthwhile treatment for elderly patients with renal failure who choose not to undergo dialysis. J Palliat Med 10(6):1245–1247PubMedCrossRefGoogle Scholar
  9. 9.
    Dasgupta I, Rayner HC (2007) Dialysis versus conservative management of elderly patients with advanced chronic kidney disease. Nat Clin Pract Nephrol 3(9):480–481PubMedCrossRefGoogle Scholar
  10. 10.
    Davison SN, Simpson C (2006) Hope and advance care planning in patients with end stage renal disease: qualitative interview study. Br Med J 333(7574):886–890CrossRefGoogle Scholar
  11. 11.
    UK Renal Registry: the 11th annual report (2008) Google Scholar
  12. 12.
    Hemmelgarn BR, Manns B, Zhang J, Tonelli M, Klarenbach S, Walsh M, Culleton BF (2007) Association between multidisciplinary care and survival for elderly patients with chronic kidney disease. J Am Soc Nephrol 18:993–999PubMedCrossRefGoogle Scholar
  13. 13.
    Murray AM, Tupper DE, Knopman DS et al (2006) Cognitive impairment in haemodialysis patients is common. Neurology 67:216–223PubMedCrossRefGoogle Scholar
  14. 14.
    Van Den Ende CHM, Hazes JMW, Cessie SLE, Breedveld FC, Dijikmans BAC (1995) Discordance between objective and subjective assessment of functional ablity of patients with rheumatoid arthritis. Rheumatology 34(10):951–955CrossRefGoogle Scholar
  15. 15.
    Sponsored supplement ‘Innovation in Renal Medicine Awards 2008’ (2008) Br J Ren MedGoogle Scholar
  16. 16.
    Jassal SV, Watson D (2009) Dialysis in late life: benefit or burden. Clin J Am Soc Nephrol 4:2008–2012PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2011

Authors and Affiliations

  1. 1.Department of Renal MedicineBirmingham Heartlands Hospital, Heart of England Foundation TrustBirminghamUK

Personalised recommendations