Results of studies will also allow health professionals to more accurately describe the benefits and harms of dialysis therapy on quality of life

and outcomes for patients. Assumptions are made that dialysis is appropriate for all individuals; however this may not be a valid assumption for everybody. Dialysis by the nature of the intervention has a large potential to influence the quality of life of the individual and immediate family. Dialysis may prolong life, however it also ‘remains an aggressive tertiary intervention Cisplatin that may challenge the priorities and attitudes of older patients in particular’.[8] Dialysis also has hazards, and in some patients it will shorten life. This is a particularly critical issue in the older age group. The patient’s preference and quality of life are central issues.[8] It has also been found that both dialysis patients and their partners are overwhelmed by the impact of dialysis on their lives.[4] In a patient survey conducted by Davison and colleagues,[9] 60.7% of patients regretted the decision to start dialysis. However, if patients opt for conservative therapy (no dialysis) it is unknown how much life expectancy, as well as the quality of life, is actually altered. It is possible Histone Methyltransferase inhibitor that the intervention

of dialysis may actually make the quality of life worse, particularly in the presence of significant comorbidity. Currently, there is a small amount of retrospective data only,[5] but no prospective scientific data to support either point of view to help clinicians, their patients and family/whanau to make a decision. A study from a large London dialysis centre looked at outcomes between two groups of older patients, one group that opted for dialysis therapy and the other that chose maximal conservative care. Those opting for conservative care were older (mean age 82 years vs 76 years). Although the dialysis group survived for a longer period (mean 2 Celecoxib years), the majority in the conservative group survived for over 13 months with substantially lower hospital days (16 days per patient per year) and the majority in

this group died at home.[10] The dialysis patients were dialysed in a hospital centre that meant they averaged 173 days per patient per year at the hospital. This study did not record any quality of life assessment, data related to patient satisfaction, cost-effectiveness or the socioeconomic impact of the hospital-based treatment.[10] 1. In a thematic analysis of the literature Morton and colleagues demonstrated that awareness of factors associated with decision-making related to the management of chronic kidney disease (CKD) can provide health professionals with evidence on how best to deliver education programmes for patients and their family, as well as enhancing the patient and their family’s capacity to share in that decision-making process.