Kidney transplantation and dialysis in older adults: goals, expectations, satisfaction, and regret - a mixed-methods prospective cohort study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.