Clinical Pearls
Advance Care Planning for End-Stage Renal Disease (ESRD)
Niharika Ganta, MD MPH; Amar Bansal, MD; Nina O’Connor, MD
Patients with end-stage renal disease (ESRD; advanced chronic kidney disease Stage V with an estimate glomerular filtration rate less than 15 mL/min) share several characteristics that make them an ideal population for increasing palliative care collaboration. ESRD patients have a high mortality rate, comparable to cancer, and high symptom burden with a majority of patients reporting at least three distressing symptoms such as pain, fatigue, and pruritus.1
When managing ESRD, it is important to recognize that not all patients will benefit from dialysis. One recent systematic review of elderly ESRD patients reported a 1-year survival of 73% with any dialysis modality (95% confidence interval 66.3%–79.7%) versus 70.6% with supportive care (95% CI 63.3%–78.0%).2 A recent retrospective cohort study of dialysis versus nondialytic management found no survival benefit with dialysis in patients ≥ 80 years of age or patients ≥ 70 years of age with multiple comorbidities.3 The same study found that elderly patients with cardiovascular disease are the least likely to derive survival benefit from dialysis.3