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Study shows higher rates of untreated kidney failure among older adults

New research is showing age-related differences in whether patients are treated for kidney failure. In a study published today in the Journal of the American Medical Association, researcher Brenda Hemmelgarn, MD, PhD, and colleagues examined data from 1.8 million Canadian patients and found that the rate of progression to untreated kidney failure was considerably higher among the elderly when compared to younger patients.

The authors noted that the findings suggest the incidence of advanced kidney disease among older adults could be significantly underestimated by measuring rates of those who are receiving dialysis, waiting for a transplant or undergoing renal replacement therapy. And, they write:

These findings have important implications for clinical practice and decision making; coupled with the finding that many older adults with advanced chronic kidney disease [CKD] are not adequately prepared for dialysis, these results suggest a need to prioritize the assessment and recognition of CKD progression among older adults.

In an accompanying editorial, Stanford nephrologists Manjula Kurella Tamura, MD, and Wolfgang Winkelmayer, MD, discuss the findings, asking:

Does the magnitude of untreated kidney failure among older adults imply inappropriate withholding of treatment? Not necessarily. While the study describes the rates of untreated kidney failure for older adults, it does not provide information on the reasons these patients did not undergo dialysis or kidney transplantation or about alternative treatments they might have received. It is possible that older patients may have decided, after a shared decision-making process with their medical team and family, to forego dialysis and to opt for supportive care. In other situations, a patient's medical condition may have rendered dialysis unreasonable, such as among patients with terminal cancer or advanced dementia. However, for many patients both with treated and untreated kidney failure, it seems likely that an informed discussion about treatment options might not have taken place.

They conclude that the study "highlights a potentially sizeable unmeasured burden of untreated kidney failure among older adults." It also, they write, demonstrates the importance of refining "the current understanding of what constitutes appropriate treatment for kidney failure, which factors influence the decision-making process, and which methods are optimal for aligning treatment plans with patient goals and prognosis."

Previously: Potentially lethal clotting linked to blood pressure drop during dialysis, Study shows daily dialysis may boost patients’ heart function, physical health and Benefits of dialysis for frail elderly debated
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