American Society of Nephrology

View all recommendations from this society

Released April 4, 2012

Don’t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.

The decision to initiate chronic dialysis should be part of an individualized, shared decision-making process between patients, their families, and their physicians. This process includes eliciting individual patient goals and preferences and providing information on prognosis and expected benefits and harms of dialysis within the context of these goals and preferences. Limited observational data suggest that survival may not differ substantially for older adults with a high burden of comorbidity who initiate chronic dialysis versus those managed conservatively.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Nephrology (ASN) maintains a Quality and Patient Safety (QPS) Task Force that advances ASN’s commitment to providing high-quality care to patients and to raising awareness of patient safety issues for all professionals administering care to kidney patients. Each of ASN’s 10 advisory groups contributes expertise to the task force to ensure it addresses all areas of nephrology practice, and the society’s president, public policy board and council also provide insights. The QPS task force centered its focus on five items most likely to positively impact and influence optimal patient care. The final list of five items was unanimously approved by the ASN public policy board and council. ASN’s disclosure and conflict of interest policy can be found at www.asn-online.org.

Sources

Renal Physicians’ Association End-of-Life Care Guidelines, Pediatric Nephrology, Clinical Journal of the American Society of Nephrology, Journal of Pediatrics, Nephrology Dialysis Transplantation, Archives of Internal Medicine, Nephrology Dialysis and Transplant, New England Journal of Medicine, Palliative Medicin