What is it about?
This study tackles one of the most difficult medical decisions older adults face: whether starting dialysis will truly improve their lives—or whether a conservative, comfort-focused approach may be better aligned with their goals. We followed patients over 75 who participated in a structured “Welcome Meeting,” where nephrology and palliative care teams explained real options, risks, and expectations. After this conversation, each person chose between dialysis or conservative management, and we tracked how their health, symptoms, emotional well-being, and decisions evolved over time. The study reveals what older patients actually choose, why they choose it, and how guided decision-making changes their experience.
Featured Image
Photo by mali desha on Unsplash
Why is it important?
Because dialysis is often seen as the default—but for many older adults, it may not improve quality of life, independence, or dignity. Clear, honest conversations are rare, yet they dramatically change how confident patients feel about their choices. This research shows that structured, multidisciplinary counseling leads to more stable decisions and care that truly aligns with patient values. It provides essential evidence for clinicians, families, and health systems seeking a more humane, person-centered approach to advanced kidney disease.
Perspectives
As clinicians, we often see older adults making life-changing decisions under stress, fear, and limited understanding. Watching how a single, well-designed conversation can bring clarity, confidence, and peace is striking. This study reinforces a crucial idea: dialysis should not be an automatic response. Conservative care is not “doing less”—it is choosing care that respects a person’s priorities, limits, and hopes. My hope is that these findings encourage more centers to integrate early palliative care, improve communication, and place the patient—not the procedure—at the center of decision-making.
Juan Santacruz
Clínica de los Riñones Menydial
Read the Original
This page is a summary of: Outcomes and decision stability in older adults following structured counselling on dialysis vs conservative management for kidney failure: A Prospective Study., Nephron, November 2025, Karger Publishers,
DOI: 10.1159/000548248.
You can read the full text:
Contributors
The following have contributed to this page
