Establishing Research Priorities in Geriatric Nephrology: A Delphi Study of Clinicians and Researchers

Abstract

Rationale & Objective:

Despite substantial growth in the population of older adults with kidney disease, there remains a lack of evidence to guide clinical care for this group. The Kidney Disease and Aging Research Collaborative (KDARC) conducted a Delphi study to build consensus on research priorities for clinical geriatric nephrology.

Study Design:

Asynchronous modified Delphi study.

Setting & Participants:

Clinicians and researchers in the US and Canada with clinical experience and/or research expertise in geriatric nephrology.

Outcome:

Research priorities in geriatric nephrology.

Analytical Approach:

In the first Delphi round, participants submitted free-text descriptions of research priorities considered important for improving the clinical care of older adults with kidney disease. Delphi moderators used inductive content analysis to group concepts into categories. In the second and third rounds, participants iteratively reviewed topics, selected their top 5 priorities, and offered comments used to revise categories.

Results:

Among 121 who were invited, 57 participants (47%) completed the first Delphi round and 48 (84% of enrolled participants) completed all rounds. After 3 rounds, the 5 priorities with the highest proportion of agreement were: 1) Communication and Decision-Making about Treatment Options for Older Adults with Kidney Failure (69% agreement), 2) Quality of Life, Symptom Management, and Palliative Care (67%), 3) Frailty and Physical Function (54%), 4) Tailoring Therapies for Kidney Disease to Specific Needs of Older Adults (42%), and 5) Caregiver and Social Support (35%). Health equity and person-centricity were identified as cross-cutting features that informed all topics.

Limitations.

Relatively low response rate and limited participation by private practitioners and older clinicians and researchers.

Conclusions:

Experts in geriatric nephrology identified clinical research priorities with the greatest potential to improve care for older adults with kidney disease. These findings provide a roadmap for the geriatric nephrology community to harmonize and maximize the impact of research efforts.

INTRODUCTION

Adults aged ≥65 years constitute 43% of the US population with kidney failure and make up a growing proportion of people with earlier stages of kidney disease.^1–8 These older adults, as well as younger people with kidney disease, more commonly experience geriatric syndromes such as frailty and cognitive impairment.^{9, 10} A growing body of work suggests that current clinical care practices may not be aligned with the needs of this population, which can lead to poor quality of care and life outcomes.^11–15 These concerning patterns can be partially explained by knowledge gaps and a paucity of evidence-based guidelines for the care of older people with kidney disease.^{16, 17} To encourage high-value and impactful work, leaders in the nephrology community have disseminated lists of research priorities for people with kidney disease.¹⁸ However, it is unclear if research priorities for the general population are aligned with the unique needs of older adults with kidney disease.¹⁹

The geriatric care model constitutes a paradigm shift from a disease-based to person-centered approach to care,²⁰ and may better support the unique needs of older adults with kidney disease. This model is based on the premise that older adults—whether age is defined chronologically or physiologically—often have multiple comorbid conditions and symptoms may not reflect a distinct disease state or pathophysiology. Life expectancy may be limited and values, goals, and preferences for medical care can vary widely.^{21, 22} The geriatric care model has implications for directing clinical research and geriatric professional societies have disseminated conceptual frameworks for centering future work on the needs of older adults.^{23, 24} However, these high-level guidelines are likely insufficiently specific to offer actionable guidance for researchers studying geriatric nephrology.^{23, 25}

There is a growing community of researchers focused on improving care for older adults with kidney disease. However, a road map to guide research in geriatric nephrology is needed to most effectively coordinate efforts and center work on what is most relevant to care for this patient population. To this end, we aimed to identify and rank research priorities from the perspective of clinicians and researchers with expertise in geriatric nephrology research.

METHODS

Study Design

We conducted an asynchronous, modified Delphi study to develop a list of research priorities in geriatric nephrology.^26–28 The Delphi is a technique for building consensus that involves gathering and synthesizing informed opinions from a group of experts through multiple rounds of open-ended and structured questioning.²⁹ For this study, common modifications to the classic Delphi technique were used to facilitate consensus including incorporating moderators to help synthesize and focus participant deliberation. To support feasibility and retain participants, the study was limited to 3 asynchronous rounds.²⁸

The Kidney Disease and Aging Research Collaborative (KDARC), established in 2023, is a cross-institutional, multinational network of investigators conducting interdisciplinary collaborative research that encompasses the study of both physiological and chronological aging and related concepts in persons with kidney disease. All members of KDARC were invited to meet and iteratively develop the study question and design. Members of the NYU Kidney Disease and Aging Community Advisory Board were invited to provide feedback on preliminary results and contributed to framing the discussion.

Study Population, Consent, and Recruitment

Participants for this study were selected for their knowledge of research in geriatric nephrology. We purposively sampled to recruit clinicians who provide care for adults with both kidney disease and geriatric conditions and academic researchers with content expertise in geriatric nephrology. Participation was limited to those who were English-speaking, aged ≥18 years, and working in the US or Canada. First, we recruited members of KDARC to participate. We then used a snowball sampling approach by asking KDARC members to invite colleagues who met eligibility criteria.³⁰ Lastly, we identified potential participants through a literature search using key words (e.g. frailty AND kidney) of authors who had published peer-reviewed geriatric nephrology research in the last 5 years and had current working email addresses.

Prior to beginning the first internet-based survey, participants were supplied with information on the study procedure, risks and benefits, and other information relevant to a decision about whether to participate. After reviewing this information, participants confirmed consent to participate by completing the first survey. The New York University Grossman School of Medicine Institutional Review Board (IRB i22-01046) approved the study and waived a requirement for written informed consent.

Data Collection

We collected data using secure Research Electronic Data Capture (REDCap) tools hosted at New York University.^{31, 32} The survey for each of 3 Delphi rounds was open to participants for up to 7 weeks and participants received several emails reminding them to complete the survey.

Moderator Role

Four authors (CRB, AN, RH, and MMD) designed, coordinated, and acted as moderators for the Delphi study but did not contribute as Delphi participants. Study moderators collated and synthesized data from each round and revised research topic titles and descriptions according to study participants’ comments and feedback. After the first Delphi round, inductive content analysis was used to identify concepts (codes) in participant free text and group these concepts into thematic categories.³³ One of the study moderators with training and experience in qualitative analysis (CRB) reviewed all free text and developed initial thematic categories and descriptions of research topics. All study moderators met to review categories and example quotes, deliberate, and iteratively develop a final list of research topics and descriptions to be returned to study participants. In the 2 subsequent Delphi rounds, existing research topics were revised, combined, split, or re-defined based on participant free text comments and feedback.

Round 1

The first online survey instrument included questions about participants’ backgrounds, including age, self-identified gender, self-identified race, and ethnicity. Participants answered questions to characterize their training background and discipline, the type and setting of the primary institution at which they worked, years in practice, their country of residence, and whether they were currently active in geriatric nephrology research.

Participants were presented with the following open-ended prompt: “What are the most important research priorities to improve the clinical care of older adults (>65 years) with kidney disease? Please offer at least three and up to five answers (in no particular order).” Participants were also given the opportunity to submit a description and justification for their answers.

Subsequent Delphi Rounds

In the round 2 survey, participants were presented with research topic categories and definitions ordered by frequency with which these were commented upon in participants’ responses to the first Delphi round. Participants were then asked to select the 5 most important research priorities for the care of older adults with kidney disease, to provide free text justification for these selections, and to provide feedback on other research topic titles and descriptions.

Results of the second round were collated and used to revise the list of research topics, which were then presented in the third (and final) Delphi round in order from most agreement to least agreement. Agreement was defined as the percentage of participants who indicated that a research topic was among the top 5 research priorities. Topics that did not meet a pre-determined threshold of 15% agreement in round 2 were dropped and not included in round 3.

RESULTS

Study Population

We sent invitations to 121 potential participants and 57 (47%) of these completed the first Delphi round (Figure 1). Among these 57 participants, 70% were women, 32% were Asian, 7% were Black, and 54% were White. The majority of participants reported having an MD/DO degree (79%) or PhD degree (12%). Most participants worked at academic institutions (93%) and practiced in urban settings (75%). Seventy-six percent of participants had at least 10 years of experience in their clinical or research roles which included adult nephrology (51%), geriatrics (25%), transplant nephrology (16%), internal medicine (9%), palliative care (11%), and social work (4%), as well as others. Sixty-seven percent of participants reported that they were directly active in geriatric nephrology research (Table 1).

Figure 1.

Recruitment for a Delphi study to identify priorities in geriatric nephrology research

Table 1.

Characteristics of participants in a Delphi study to identify priorities in geriatric nephrology research

Characteristics	Participants (N=57)
Age in years, %
30–39	11 (19.3)
40–49	27 (47.4)
50–59	14 (24.6)
60–69	3 (5.3)
≥ 70	2 (3.5)
Woman, %	40 (70.2)
Race, %
Asian	18 (31.6)
Black	4 (7.0)
Multi-Racial	3 (5.3)
White	31 (54.4)
Prefer Not To Say	1 (1.8)
Ethnicity, %
Hispanic	3 (5.3)
Training background, %
MD/DO	45 (79.0)
NP	1 (1.8)
RN	1 (1.8)
PhD	7 (12.3)
Other*	3 (5.3)
Disciplinary training, %**
Adult Nephrology	29 (50.9)
Geriatrics	14 (24.6)
Transplant Nephrology	9 (15.8)
Palliative Care and/or Hospice	6 (10.5)
Internal Medicine	5 (8.8)
Social Work	2 (3.5)
Other***	10 (17.5)
Primary Practice Setting, %
Urban	43 (75.4)
Rural	4 (7.0)
Suburban	7 (12.3)
N/A	3 (5.3)
Work Institution Type, %
Academic	53 (93.0)
VA	3 (5.3)
Other	1 (1.8)
Years in Practice, %
<10 Years	14 (24.6)
10–19 Years	27 (47.4)
≥ 20 Years	16 (28.1)
Country of residence, %
US	54 (94.7)
Canada	3 (5.3)
Currently active in geriatric nephrology research, %	38 (66.7)

^*2 participants reported having both MD and PhD degrees and one participant reported dietitian training

^**Participants could choose multiple.

^***Participants reported other areas of specialty including: living donor transplant, bioethics, clinical medical ethics, acute care, transplant surgery, infectious disease, and urology and sexual health.

Delphi Rounds

Fifty (88%) participants completed the second Delphi round and 48 (84%) completed the third round (Figure 1). In round 1, participants submitted research topics that were grouped into 17 categories to be included in round 2 (Tables S1–2). In round 2, one research topic (Cost-Effectiveness) received <15% agreement and was dropped. Participant comments suggested that two research topics (Risk/Benefit Profile of Treatments for Kidney Disease and Tailor Therapies for Kidney Disease to Specific Needs of Older Adults) were overlapping in content and could be combined into a single category (Tailor Therapies to Specific Needs of Older Adults with Kidney Disease). Fifteen research topics were presented to participants in round 3.

Research priorities

The top 5 research priorities identified in round 3 were: 1) Communication and Decision-Making about Treatment Options for Older Adults with Kidney Failure (69% agreement), 2) Quality of Life, Symptom Management, and Palliative Care (67% agreement), 3) Frailty and Physical Function (54% agreement), 4) Tailor Therapies for Kidney Disease to Specific Needs of Older Adults (42% agreement), and 5) Caregiver and Social Support (35% agreement) (Table 2).

Table 2.

Research Priorities in Geriatric Nephrology after the Final Delphi Round

Rank	Topic Title	Description	Agreement that topic is a top 5 research priority, (N=Votes) (%)
1	Communication and Decision-Making about Treatment Options for Older Adults with Kidney Failure	Develop interventions and models of care to better inform and support decision-making and communication about treatment for kidney failure in older adults.	33 (68.8%)
2	Quality of Life, Symptom Management, and Palliative Care	Develop an evidence base, measures, and interventions to provide palliative care that supports pain management, comfort, and quality of life for older adults with kidney disease.	32 (66.7%)
3	Frailty and Physical Function	Design measures and elucidate mechanisms of frailty and physical function and develop interventions that support physical function.	26 (54.2%)
4	Tailoring Therapies for Kidney Disease to Specific Needs of Older Adults	Design and implement trials of treatments to slow progression of kidney disease that are more inclusive of older adults to understand unique risk and benefit profile for this population and address system- and provider-level barriers to individualizing dialysis therapies to physiological needs, personal preferences, and goals of care for older adults.	20 (41.7%)
5	Caregiver and Social Support	Better understand and address caregiver burden and identify opportunities to reinforce social support for older adults.	17 (35.4%)
6	Health Equity for Older Adult Populations	Better understand and address age and racial/ethnic disparities in access to healthcare and health outcomes for older adults with kidney disease and transform all areas of research, education, and practice in nephrology to support equity.	16 (33.3%)
7	Conservative Kidney Management	Develop and implement models of care for conservative kidney management and investigate how new therapies may be integrated into a CKM approach.	14 (29.2%)
8	Medication Management and Deprescribing	Understand unique indications of medications, adjust dosing, deprescribe, and limit polypharmacy for older adults with kidney disease.	14 (29.2%)
9	Equitable and High-Value Healthcare Delivery for Older Adults	Develop models of high-value and equitable healthcare delivery to align with the needs of older adults.	12 (25.0%)
10	Access to Transplant for Older Adults	Understand and address barriers to access to transplant for older adults.	12 (25.0%)
11	Self-Management and Empowerment for Older Adults	Develop and implement effective strategies to support health behavioral change and patient engagement and empowerment among older adults with kidney disease.	12 (25.0%)
12	Cognitive Impairment	Develop and implement approaches to assess and manage cognitive impairment, slow cognitive decline, and support those with cognitive deficits.	12 (25.0%)
13	Access to Home Dialysis for Older Adults	Understand and address barriers to access to home dialysis modalities for older adults.	7 (14.6%)
14	Comorbidity	Develop models of care and care coordination for older adults with multiple comorbidities.	3 (6.3%)
15	Normal Aging	Elucidate the conceptual and biological foundations of normal aging and inform diagnosis of and communication about kidney disease.	3 (6.3%)

Research Priority 1: Communication and Decision-Making about Treatment Options for Older Adults with Kidney Failure

Participants underscored the need to develop interventions and models of care to better inform and support decision-making and communication about treatment for kidney failure in older adults. Studies should determine “the optimal communication strategies for kidney failure treatment options in diverse settings.” Future research in this area is “critical to identify[ing] information needs and optimal shared decision-making models to support…older people with kidney failure.”

Research Priority 2: Quality of Life, Symptom Management, and Palliative Care

Participants agreed on the need to develop an evidence base of measures and interventions to provide palliative care to support pain management, comfort, and quality of life for older adults with kidney disease. Participants noted that quality of life was a “top priority for patients and caregivers.” While they acknowledged that there were already existing measures of quality of life and symptoms, there was concern regarding the lack of research in how to improve these outcomes for older adults with kidney disease. Additionally, palliative care studies on “conservative management of advanced CKD [chronic kidney disease]… in the era of newer medical therapies for CKD and [their] complications” were of great importance.

Research Priority 3: Frailty and Physical Function

Participants agreed that there is a need to design measures and elucidate mechanisms of frailty and physical function and develop interventions that support physical function. Frailty and physical function were recognized as “major determinants of prognosis.” Participants underlined a need to design measures and elucidate mechanisms of frailty and called for clinicians and policymakers “to develop consensus around optimal frailty measures to improve patient evaluation, selection, and counseling.” Studies focused on interventions designed to improve physical function could also “change payment for rehab[ilitation] and [approach to] dialysis, delivery, environment, [and] workforce.”

Research Priority 4: Tailoring Therapies for Kidney Disease to Specific Needs of Older Adults

Participants agreed on the need to design and implement trials of treatments to slow progression of kidney disease that are more inclusive of older adults. They identified a need to understand unique risks and benefits for this population and address system- and provider-level barriers to individualizing kidney replacement therapies to address the physiological needs, personal preferences, and goals of care of older adults. Participants emphasized that older adults had “different needs than a younger patient with kidney disease” and faced unique challenges including frailty, cognitive impairment, and multiple comorbidities. Clinical trials for strategies to slow down progression of kidney disease in older adults are needed to determine “whether typical approaches to managing CKD [were] appropriate or helpful in older adults.” One participant noted that it was “an exciting time to be in nephrology…[with] medications like SGLT2 [inhibitors], endothelin antagonists, gut steroids, etc.”, but was concerned that emerging therapies for kidney disease are currently under-studied in older adults.

Research Priority 5: Caregiver and Social Support

Participants emphasized a need to better understand and address caregiver or care partner burden and identify opportunities to reinforce social support for older adults. Participants recognized caregivers to be an “informal workforce that [is] heavily relied on” and that these close persons are “paramount to [the] successful care of the older adult with [end-stage kidney disease] ESKD.” Further, participants emphasized the importance of studies aimed to quantify “the impact of disease and treatment on [a] patient’s caregivers/family members” and explore “strategies to alleviate caregiver burdens and to test interventions to increase social support for patients.” Additional exemplar quotations from participant deliberation is included in Table 3.

Table 3.

Participant Justification for Final Top 5 Research Priorities in Geriatric Nephrology

Rank	Topic Title	Participant Quotes on Justification for Research Priority
1	Communication and Decision-Making about Treatment Options for Older Adults with Kidney Failure	“The patient has to be a partner in the decision making-process. This is key to the success of any treatment.” “The evaluation and management of chronic kidney disease requires clear and compassionate communication around expectations and decision making. This requires research and education in communication and share[d] decision making…” “Medicine in general, not just nephrology, needs to prioritize shared decision making. That will lead us away from “default” therapies that can be (questionably) life extending and highly burdensome.” “Older adults have a range of health statuses. For some we should advocate for transplant, others would be more appropriately treated with palliative care. We need to better communicate what the options are and which ones might be more appropriate given circumstances.”
2	Quality of Life, Symptom Management, and Palliative Care	“Most patients report that quality of life is more important than quantity of life. Pain and symptom management improves patient quality of life.” “..novel therapeutic strategies, including psychedelic therapies, can produce robust improvements…in individuals with chronic disease or end of life care. To date, dialysis patients have been excluded from most or all of these trials. This is unfortunate, and should be considered.” “There is a growing interest on symptom burden as a better indicator of dialysis adequacy but more importantly, something that is important to patients.” “We are not always able to improve mortality for our patients - but we can help them live well, and thereby have better and more meaningful life participation.” “Quality of life becomes important when quantity of life has been limited.”
3	Frailty and Physical Function	“Frailty and Physical dysfunction are hallmarks of kidney failure. Finding novel strategies…are imperative for helping these patients return to a productive and enjoyable lifestyle.” “This is a looming issue in clinical transplantation and CKD management that is fraught with misunderstanding and misuse.” “Frailty and physical function are not only important predictors of mortality but also related to any number of other outcomes that influence patients’ ability to participate in life, as well as the potential burden for caregivers” “As a geriatrician, this is an area that we can contribute to interprofessional teams that care for older adults with CKD.” “Age is often misinterpreted as frailty. Transplant clinicians and policy makers need to develop consensus around optimal frailty measures to improve patient evaluation, selection, and counseling….”
4	Tailoring Therapies for Kidney Disease to Specific Needs of Older Adults	“Tailored therapy is also important to specific issues to avoid over burden with medications and treating symptoms or illnesses that are not important to the patient.” “Each older adult is unique and has different goals in life, yet we expect to broadly implement the same treatment for each” “This issue underlies most of the issues on this list - what is the best approach for individual older patients, and do we have the evidence to support it?” “Our dialysis [prescription] is based on CMS quality metrics that apply to all patients. Is there a role for palliative dialysis? I.e. older adults who decline medical management but have markers of poor prognosis and might benefit from a more nuanced scrip that focuses on quality of life rather than Kt/V, PTH, phos[phate], and other biomarkers.” “SGLT2i are the most exciting drugs we have had in a while to slow loss of GFR but the benefit is over time and there may be risks unique to older adults.”
5	Caregiver and Social Support	“Caregivers are woefully under resourced, and they are the linchpin of what make healthcare work for fragile individuals with kidney disease. They often do such basic, intimate tasks…. without financial compensation or support from the healthcare system.” “Caregiver and social support will be critical to ensuring adequate communication and decision making regarding treatment options.” “The ability to successfully navigate life on RRT especially home therapies is influenced by social supports.” “Having a care advocate and social support is critical to navigating healthcare in general and in advanced CKD in particular.” “The hidden work of patients and family is often not taken into account by health care systems and providers, or worse still, taken for granted, time to acknowledge the pivotal role often played by family and friends and give this the recognition, dignity and support that it deserves.” “Research is needed to on strategies to alleviate caregiver burdens and to test interventions to increase social support for patients”.

Abbreviations: CKD, chronic kidney disease; CMS, Centers for Medicare and Medicaid Services; PTH, Parathyroid hormone; GFR, glomerular filtration rate

Cross-cutting features of research priorities: Health equity and person-centricity

Content analysis suggested that several key research topics cut across all research areas in geriatric nephrology, rather than constituting entirely independent research topics in and of themselves. Participants commented on how all research topics should be understood through a lens of health equity and person-centricity (Figure 2).

Figure 2.

Research Priorities in Geriatric Nephrology

DISCUSSION

Deliberation among experts in geriatric nephrology clinical care and research resulted in a range of research topics that were considered to be highly relevant to the care of older adults with kidney disease. Participants prioritized research related to communication and decision-making, quality of life, frailty and physical functioning, tailoring therapies, and caregiver support. Health equity and person-centricity was seen to be important in framing all research topics.¹³

Establishing a set of agreed-upon research priorities is a key step needed to harmonize and maximize the impact of future research efforts. National Kidney Foundation (NKF) Research Priorities for Kidney-Related Research include expanding inclusivity of clinical trials, developing interventions to address health disparities, and working to implement evidence-based interventions.¹⁸ Results from this Delphi study identify research priorities in geriatric nephrology that overlap with those from the NKF, while emphasizing distinct needs to support the care of older adults. Delphi participants elaborated on the NKF’s focus on health disparities by emphasizing the intersectional nature of race and age in shaping individual experiences for older adults. Perhaps consistent with the nascent status of the field, research priorities for geriatric nephrology tended to be more “upstream” in the process of building a knowledge base compared with those for nephrology more broadly. Participants highlighted the need for foundational work to re-evaluate the underlying goals, design, and outcomes of clinical research around geriatric conditions through a lens of person-centricity. Participants also called for an expanded view of research to include not only older adults with kidney disease but their families and care partners who are often central to daily care and active participants in decision-making.^34,35 Results of this study—both the top research priorities as well as the range of other important research topics reported by experts in the field—point to a need to re-think and re-build the existing body of clinical evidence to support person-centered and equitable care for older adults with kidney disease.³⁶

Geriatric research communities, including the American Geriatrics Society and National Institute on Aging, have outlined high-level goals for research, including a need to understand aging in the context of function, social ties, and wellbeing.^{23, 25, 37} Results from this Delphi study ground these broad guidelines in the more granular challenges experienced by people with kidney disease and delineate the most urgent research priorities for this population from the perspective of those caring for and conducting research with older adults with kidney disease. Our results suggest that there is urgent need for research to support communication and treatment decision-making for older adults with kidney failure. Compared with the broader geriatric population, older adults with kidney disease, their families, and clinicians can face especially complex, consequential, and fraught care decisions. For example, these older adults may encounter complex questions of life extension versus quality of life³⁸ and what constitutes “normal lifespan” when deciding about receipt of intensive interventions such as dialysis³⁹ or transplant.⁴⁰ Older adults with kidney failure, many of whom have cognitive deficits, can be especially reliant on care partners for complex home care needs and decision-making. These complex clinical scenarios highlight the need for validated strategies to support treatment decision-making for this population. Top research priorities resulting from this Delphi study also highlight the relevance of quality of life and physical function in shaping treatment decisions. Collectively, top research priorities emphasize the need for research that advances how clinicians elicit underlying values and what matters most to older adults with advanced kidney disease.⁴¹

This study should be interpreted with several limitations in mind. Delphi participants were selected for their familiarity with geriatric nephrology practice and existing research in geriatric nephrology. However, to ensure that research priorities are grounded in the experiences of older adults with kidney disease, future work should elicit the perspectives of these patients and their care partners to help refine research priorities and focus work on what matters most to them.⁴² We also limited participation to clinicians and researchers in the US and Canada and the majority of participants were working in urban and academic settings, which may limit representation of those working in private practice or other healthcare settings. The majority of the participants were physicians and the perspectives of clinicians with other disciplinary backgrounds central to the care of older adults with kidney disease (e.g., dietetics, nursing, pharmacy, physical therapy, and social work) may have been under-represented. Only a small proportion of participants were themselves aged >60 years, so results may not represent the perspectives of older clinicians and researchers. Finally, while our sample size was consistent with or greater than comparable existing Delphi studies,^{29, 43} relatively low response rates for subsequent Delphi rounds may have limited diversity of perspectives.²⁸

The growing population of older adults with kidney disease has unique needs and there are notable gaps in knowledge to inform clinical practice. Priorities for research in geriatric nephrology center on communication and decision-making, quality of life, frailty and physical functioning, tailoring therapies, and caregiver support, but span multiple other domains. These themes harmonize with and are informed by existing work in geriatrics, palliative care, and health equity. These priorities help to establish a road map that may align the geriatric nephrology research community and funding agencies around common goals to improve care for older adults with kidney disease.

Supplementary Material

1

Table S1: Round 2 Agreement on Research Priorities in Geriatric Nephrology

Table S2: Participant Justification for Research Priorities 6–15 in Geriatric Nephrology.