Are there subsets of patients for whom the benefit of initiating dialysis is unclear?
There are two broad categories of patients for whom dialysis may be of unclear benefit. The first category is in the outpatient setting, where patients with advanced CKD and other comorbidities may be candidates for CCC. CCC is ideal for patients for whom dialysis is unlikely to add benefit and may cause substantial burdens. These characteristics include but are not limited to:
• Advanced age (>75 years) with frailty or ischemic heart disease with reduced ejection fraction
• Patients who have limited prognosis due to advanced coexisting conditions
• Patient goals that are consistent with maximizing quality of life and for whom dialysis would negatively impact quality of life
• Presence of geriatric syndromes such as cognitive or functional impairment.
The second category is in the inpatient setting , where critically ill patients with acute kidney injury prompt dialysis discussions. In these situations, in which the chances for meaningful recovery are very small or the burdens of the dialysis treatment itself are great, withholding dialysis or a time-limited trial may be suitable. These decisions often depend on the patient’s goals and preferences.
