Schoot Tessa S, Zuidema Marit G, Bok Edward, Perry Marieke, Lips Joy, Molenaar Femke, van Kuijk Willi, Logtenberg Susan J J, Reichert Louis J, Voorzaat Bram, van Marum Rob J, Hilbrands Luuk B, Kerckhoffs Angèle P M
Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands.
Department of Nephrology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
BMC Nephrol. 2025 Jul 17;26(1):400. doi: 10.1186/s12882-025-04325-7.
In older adults, decision-making about kidney failure treatments can be complex. Treatment choices should align with patient-centered goals and be guided by realistic expectations. However, limited knowledge exists regarding the goals and expectations of older patients for kidney transplantation (KT) and dialysis, as well as the extent to which these are met. This study aimed to identify the goals and expectations of older patients for KT and dialysis, to assess the achievement of these goals and expectations following KT and dialysis initiation, and to evaluate treatment satisfaction and decision regret.
This mixed-methods, prospective cohort study included KT recipients and dialysis patients aged ≥ 65 years who were suitable for KT. Qualitative data (semi-structured interviews) and quantitative data (questionnaires) were collected at baseline, and at six and 24 months after KT or dialysis initiation. Interviews were analyzed using quantitative content analyses and questionnaire data with nonparametric tests. Treatment goals and expectations for KT and dialysis were identified and categorized into medical, psychological, functional, and social domains.
A total of 33 patients KT recipients and 24 dialysis patients aged ≥ 65 years participated. Treatment goals for KT and dialysis were generally fully achieved by 50-60% of patients. Patients tended to overestimate the benefits of KT and dialysis, and to underestimate the risks associated with KT. However, some benefits of KT and dialysis were not expected by patients but did occur, such as less interference with their social activities than expected. Moreover, the percentage of KT recipients who fully achieved all their treatment goals increased from 50% at six months post-KT to 90% at 24 months post-KT. Overall, treatment satisfaction was high and decision regret was low in both groups.
This study identified which treatment goals and expectations are realistic for adults aged ≥ 65 years who are eligible for KT. These results can be used to improve patient education programs for kidney failure therapies, and to inform shared-decision making processes regarding the choice between KT and dialysis.
在老年人中，关于肾衰竭治疗的决策可能很复杂。治疗选择应符合以患者为中心的目标，并以现实的期望为指导。然而，关于老年患者对肾移植（KT）和透析的目标与期望，以及这些目标和期望在多大程度上得到满足，目前的了解有限。本研究旨在确定老年患者对KT和透析的目标与期望，评估KT和透析开始后这些目标与期望的实现情况，并评估治疗满意度和决策后悔程度。
这项混合方法的前瞻性队列研究纳入了年龄≥65岁、适合KT的KT受者和透析患者。在基线时以及KT或透析开始后的6个月和24个月收集定性数据（半结构化访谈）和定量数据（问卷）。使用定量内容分析法分析访谈内容，使用非参数检验分析问卷数据。确定KT和透析的治疗目标与期望，并将其分为医学、心理、功能和社会领域。
共有33例年龄≥65岁的KT受者和24例透析患者参与。KT和透析的治疗目标通常有50%-60%的患者完全实现。患者往往高估了KT和透析的益处，而低估了与KT相关的风险。然而，KT和透析的一些益处是患者未曾预期但确实出现的，例如对其社交活动的干扰比预期的要少。此外，完全实现所有治疗目标的KT受者比例从KT后6个月的50%增加到KT后24个月的90%。总体而言，两组的治疗满意度都很高，决策后悔程度都很低。
本研究确定了哪些治疗目标和期望对于符合KT条件的65岁及以上成年人是现实的。这些结果可用于改进肾衰竭治疗的患者教育项目，并为关于KT和透析选择的共同决策过程提供信息。
