Skip to main content

Advertisement

SpringerLink
Log in

Patient-nephrologist prognostic awareness and discordance in end stage renal disease on renal replacement therapy

  • Nephrology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

The 1-year mortality rate of patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) is 20–25% comparable to many cancers. Studies have shown that cancer patients commonly overestimate their likelihood of survival relative to their physicians. It is unclear if this translates into other terminal illnesses.

Methods

Adult and elderly patients with ESRD on RRT without cognitive defect were interviewed to evaluate their prognostic estimates at 1 and 5 years. Past medical history and demographic data was abstracted from their medical charts. Each patient’s proper nephrologist was then interviewed regarding his proper prognostic estimate for this patient. Both the patient and the nephrologist’s estimates were compared and a difference of greater than 20% was defined as the threshold for prognostic concordance.

Results

77% of patients were found to be in prognostic discordance with their nephrologists. This group was older, had more comorbidities, a lower albumin level and a poorer prognosis. The majority of patients were in disagreement with their nephrologists regarding whether a discussion about prognosis had taken place. The choice of end of life care for 55% of patients was focused on relieving pain and discomfort.

Conclusion

Communication of prognosis and discussions related to life expectancy and end of life care are lacking in the routine care of ESRD patients. ESRD patients therefore tend to overestimate their prognosis which might lead to overutilization of invasive procedures with increased acute healthcare costs as well as a delay in instigation of palliative or hospice measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Saran R, Li Y, Robinson B et al (2016) US Renal Data System 2015 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis Off J Natl Kidney Found 67:S1–S305 (Svii)

    Article  Google Scholar 

  2. Kurella Tamura M, Covinsky KE, Chertow GM et al (2009) Functional status of elderly adults before and after initiation of dialysis. N Engl J Med 361:1539–1547

    Article  Google Scholar 

  3. Davison SN (2010) End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clin J Am Soc Nephrol 5:195–204

    Article  Google Scholar 

  4. Wong SPY, Kreuter W, O’Hare AM (2012) Treatment intensity at the end of life in older adults receiving long-term dialysis. Arch Intern Med 172:661–663 (discussion 663–664)

    Article  Google Scholar 

  5. Wachterman MW, Marcantonio ER, Davis RB et al (2013) Relationship between the prognostic expectations of seriously ill patients undergoing hemodialysis and their nephrologists. JAMA Intern Med 173:1206

    Article  Google Scholar 

  6. Thamer M, Kaufman JS, Zhang Y et al (2015) Predicting early death among elderly dialysis patients: development and validation of a risk score to assist shared decision making for dialysis initiation. Am J Kidney Dis 66:1024–1032

    Article  Google Scholar 

  7. Beddhu S, Bruns FJ, Saul M et al (2000) A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients. Am J Med 108:609–613

    Article  CAS  Google Scholar 

  8. Koncicki HM, Schell JO (2016) Communication skills and decision making for elderly patients with advanced kidney disease: a guide for nephrologists. Am J Kidney Dis 67:688–695

    Article  Google Scholar 

  9. Cohen RA, Jackson VA, Norwich D et al (2016) A nephrology fellows’ communication skills course: an educational quality improvement report. Am J Kidney Dis 68:203–211

    Article  Google Scholar 

Download references

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Hematology and Medical Oncology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA

    Sassine Ghanem

  2. Department of Pulmonary and Critical Care, Northwell Health - Staten Island University Hospital, Staten Island, NY, USA

    Sami Hossri

  3. Department of Nephrology, Mount Sinai, New York, NY, USA

    Nicholas Fuca

  4. Department of Hospice and Palliative Care Medicine, Virginia Commonwealth University, Richmond, VA, USA

    Evgenia Granina

  5. Department of Cardiology, Northwell Health - Staten Island University Hospital, Staten Island, NY, USA

    Samer Saouma

  6. Department of Hospice and Palliative Care Medicine, Northwell Health - Staten Island University Hospital, Staten Island, NY, USA

    Frank Forte

Authors
  1. Sassine Ghanem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sami Hossri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nicholas Fuca
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Evgenia Granina
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Samer Saouma
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Forte
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SG designed the study, helped in the acquisition of data, drafted the article, and analyzed the data; SH, NF, and SS helped in the acquisition of the data; EG helped analyze the data and helped complete the manuscript, FF helped with the design of the study and revised the manuscript; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Sassine Ghanem.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ghanem, S., Hossri, S., Fuca, N. et al. Patient-nephrologist prognostic awareness and discordance in end stage renal disease on renal replacement therapy. Int Urol Nephrol 52, 765–773 (2020). https://doi.org/10.1007/s11255-020-02420-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-020-02420-2

Keywords

Search

Navigation