Table 1.
An overview of clinical- and patient-related factors in decision making for CM and the subsequent end-of-life course
| Factors influencing decision-making | Clinical situation | Patients’/caregivers’ factors | Hospice referral | Place of death |
|---|---|---|---|---|
| Patient-1 (86-year-old Caucasian male) CKD-4 | End-stage CHF; difficulty with walking | Patient decided against dialysis due to low likelihood of improving functional status | Yes | Home |
| Patient-2 (67-year-old Caucasian male) CKD-4 | S/p liver transplant now decompensated liver cirrhosis; nursing-home resident; CHF inability to walk | Patient decided against dialysis because of low likelihood of improving already unsatisfactory QoL | Yes | Nursing home |
| Patient-3 (85-year-old Caucasian male) stage 4 CKD | Advanced CHF; cardiorenal syndrome | He was not content with his QoL and decided against dialysis for QoL reasons | Yes | Hospital, he was admitted for pneumonia; did not receive dialysis |
| Patient-4 (77-year-old Caucasian male) CKD-4 | Stage 4 chronic lymphocytic lymphoma; NASH cirrhosis; recurrent GI bleedings | Decided against dialysis for QoL reasons | No | Alive |
| Patient-5 (94-year-old Caucasian male) CKD-5 | CHF walks with a walker | He decided against dialysis because of its potential impact on functional status and QoL | No active palliative management | Alive |
| Patient-6 (83-year-old Caucasian male) CKD-4 | Cardiorenal syndrome; multiple myeloma; inability to walk | Decided against dialysis with the help of his wife, as it was unlikely to improve his functional status | Yes | Home |
| Patient-7 (73-year-old Caucasian female) CKD-4 | Lifelong ulcerative colitis status post multiple surgeries | Despite good renal prognosis, patient wanted to document decision against dialysis for peace of mind and a dignified life closure | No | Alive |
| Patient-8 (87-year-old Caucasian male) stage 3 CKD | Diabetic nephropathy | Patient chose a dignified closure of life without any artificial life support | No | Alive |
| Patient-9 (82-year-old Caucasian female) stage 4 CKD | Ulcerative colitis; sjogren syndrome | She made the decision against dialysis for QoL reasons and wished a dignified closure of life. Later she was diagnosed with cholangiocarcinoma | yes | Home |
| Patient-10 (79-year-old Caucasian female) stage 4 | Aortic stenosis; multiple myeloma | She wanted a dignified closure of life and had previously witnessed her husband suffer during his illness | Yes | Home |
| Patient-11 (88 years old Latino female) CKD-3 | Active breast cancer (on chemo) | She decided against dialysis based on her knowledge of her sister’s life on dialysis and for QoL reasons | Not yet | Alive |
| Patient-12 (87-year-old Caucasian male) CKD-5 | Severe dementia; wheelchair bound with very limited ability to walk; extremely limited ADL and IADL | Spouse made the decision based on her knowledge that the patient would not tolerate any dialysis catheter or AV fistula on his body | Yes | Home |
| Patient-13 (75-year-old Caucasian male) stage 4 CKD | Hepatorenal syndrome encephalopathy | Wife made the decision for CM because of husband’s poor prognosis | Yes | Home |
CM, conservative management; CKD, chronic kidney disease; QoL, quality of life; CHF, congestive heart failure; NASH, nonalcoholic steatohepatitis; ADL, activities of daily living; IADL, instrumental ADL.