Would you trade life expectancy to avoid dialysis?

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Many patients approaching end stage renal disease (ESRD) are willing to accept significant reductions in survival to avoid some of the burdens and limitations associated with dialysis, suggests a study in the Canadian Medical Association Journal.

The researchers performed a “discrete choice” experiment including 105 adult patients with stage 3 to 5 kidney disease at Australian renal clinics. The study looked at how various treatment characteristics affected patients’ preferences for dialysis versus conservative care for progressive kidney disease. Variables included life expectancy, number of visits to the hospital per week, ability to travel, time spent undergoing dialysis, and other factors.

Patients were more likely to opt for dialysis if it increased their average life expectancy: odds ratio (OR) 1.84. Other factors affecting the preference for dialysis were the availability of dialysis during the evening as well as during daytime hours, OR 8.95; and the availability of subsidized transportation, OR 1.55. By contrast, patients were less likely to choose dialysis if it involved more hospital visits, OR 0.70; or if it placed more limits on their ability to travel, OR 0.47.

Patients would accept a 7-month reduction in life expectancy to avoid one extra hospital visit per week, and a 15-month reduction to decrease their travel restrictions. Patient age was not a significant influencing factor.

The results suggest that, even if dialysis means longer survival, many patients with ESRD would prefer conservative care under certain circumstances. Patients are “willing to trade considerable life expectancy to reduce the burdens and restrictions of dialysis,” the researchers write. They call for further study of decision making in older patients with ESRD, and of patient preferences regarding the type and location of dialysis [Morton RL, et al. Factors influencing patient choice of dialysis versus conservative care to treated end-stage kidney disease. CMAJ 2012; 184:E277–E283].