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While attending on an inpatient medical service recently, I cared for an older man with end-stage renal disease, dementia, severe aortic stenosis, and a heart failure exacerbation. He had been dialyzed for several years and was increasingly debilitated. When my team discussed goals of care and treatment options — including stopping dialysis — with the patient's daughter, she noted, “this is the first time anyone has ever told us we had that option,” and she thanked us for discussing that option.
To understand nephrologists' attitudes and perceptions on “conservative” (i.e., nondialytic) management of older patients with advanced kidney disease, researchers conducted structured interviews with 35 U.S. nephrologists, most of whom did not routi…