Abstract Introduction In 2023, we introduced a new interdisciplinary clinic to raise awareness of the choices available for older patients with advancing, near end-stage kidney disease. Patients and their close family were invited to attend the clinic for assessment and discussion of future options. Rationale and Method Many older patients with advanced kidney disease are relatively asymptomatic and have not considered what might happen and what would be their preferred option when they do become symptomatic. A proportion of such patients develop end-stage kidney failure in the context of an intercurrent illness and may not be able to express their preferences at this time. Families are then left uncertain whether their older relative would want dialysis (RRT) or not. Frail, cognitively impaired patients may then undergo inappropriate treatments with prolonged hospital stay and poor quality of life in their final weeks. Results During 2023—early 2025, 81 patient-family groups attended the clinic. Patient medians: age 82 years. Clinical Frailty Scale 5. AMT 8. Barthel 87. eGFR 14 mL/min. Median follow- up 14 months. 57% female. After full discussion 25 (31%) patients opted for RRT, of which 6 are currently receiving RRT. 1 additional patient died on RRT. 4 additional patients died and 3 changed their choice to Supportive Care (SC). Another 11 patients are still free of RRT. 54 opted for SC with 2 remained undecided. 21 have since died. Of the other survivors, none have changed their decision or received RRT. A patient-family questionnaire in a subset showed strong satisfaction with the clinic. A high proportion were referred for Advanced Care Planning. Conclusions An interdisciplinary, one-off clinic for elderly patients with near end-stage renal failure has shown success in raising awareness with good concordance between patients and family. So far, there have been no clinical deviations from patient’s expressed wishes.
Wilkinson et al. (Sun,) studied this question.
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