Work needed to support patients who initiate dialysis after choosing conservative care
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Research presented at the American Nephrology Nurses Association National Symposium revealed 14% of patients who chose conservative management went on to receive dialysis.
This according to Candice Halinski, MBA, MHCDS, MSN, NP-C, clinical director of the nephrology service line at Northwell Health, highlights the importance of developing formal approaches to support this treatment option.
“Historically, treatment options have focused on the prolongation of life [with] dialysis therapies as a universal approach to care,” Halinski said during her virtual presentation. “However, in the last 2 decades, conservative care has grown to be widely recognized and accepted in nephrology. Little research has been done to date to examine the actual treatment delivered for those patients chose conservative care. In fact, patients may receive dialysis despite choosing conservative care.”
To examine how actual treatment delivered might differ from patient choice, Halinski and colleagues conducted a retrospective chart review for 71 patients with late-stage chronic kidney disease or end-stage kidney disease who had chosen to forgo dialysis.
Despite that one patient documented the desire to pursue dialysis if necessary, researchers found nine patients went on to receive hemodialysis (a 14% conversion rate). Additional findings revealed 89% of these patients initiated hemodialysis acutely in an in-patient setting; all were older than 75 years.
According to Halinski, these results point to variability in treatment pathways despite patient choice.
“Active medical management without dialysis is widely recognized, yet no formal approaches exist to support this treatment,” she said. “The choice to forgo renal replacement therapies is complex. When decisions surrounding the reversal of conservative care management are made, the nephrology team should consider how conversations on how treatment options, goals and quality of life can serve to honor patient wishes. This is especially important in cases that are acute in origin.”
“Further research should focus on the psychosocial dynamics that surround medical treatment decisions and the supportive structure required to uphold medical management without dialysis,” Halinski concluded, adding that the goal should be to empower the patient and to support the provider.
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Halinski C. Poster #1. Presented at: American Nephrology Nurses Association National Symposium (virtual meeting); May 2-5, 2021.
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