Dialysis' Drawbacks Outweigh Benefits for Some Older Patients

Oct. 15 -- WEDNESDAY, Oct. 14 (HealthDay News) -- Dialysis may not be worth undertaking for many older Americans in nursing homes who suffer kidney failure in addition to other ailments, a study finds.

The research, published in the Oct. 15 issue of the New England Journal of Medicine, found that this intervention failed to lengthen or improve most patients' lives.

"The hope was that even if dialysis [artificial kidney treatment] doesn't extend life, it might improve quality of life," said study lead author Dr. Manjula Kurella Tamura, assistant professor of nephrology at Stanford University School of Medicine. "We wanted to look at whether this might be true."

But the study of more than 3,700 nursing home residents found that few were better able to perform activities of daily living, such as eating, dressing and using the bathroom, following dialysis, and many actually suffered declines in those areas.

Indeed, only one of every eight of the people in the study was able to maintain pre-dialysis functional capacity, Kurella Tamura said.

In the 12 months after starting dialysis, 58 percent of the participants died.

Americans over the age of 80 are the fastest-growing segment of the 400,000-strong U.S. dialysis population, and at least a third of them have other chronic illnesses, such as heart disease or diabetes, she said.

"In these types of patients, kidney failure often occurs in the context of other serious conditions," Kurella Tamura noted. "The failure to show improvement may be a manifestation of these other conditions."

And dialysis itself can tax weak, elderly people, she added. "They have to travel to treatment centers, and treatment can take three to four hours three times a week," Kurella Tamura said. "That takes a lot of time and can be cumbersome. It also takes away time when patients might be in programs to improve functional capacity."

The study results can help both doctors and older nursing home patients make educated decisions about dialysis, she said. "These results will be surprising even for doctors who care for dialysis patients on a daily basis," Kurella Tamura said. "They can lead to more informed discussions with patients about the expected prognosis and options for palliative care. They can help patients make informed decisions about treatment options."