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Original ArticlesGeriatric and Palliative Nephrology
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Dialysis Regret

Prevalence and Correlates

Fahad Saeed, Susan A. Ladwig, Ronald M. Epstein, Rebeca D. Monk and Paul R. Duberstein
CJASN July 2020, 15 (7) 957-963; DOI: https://doi.org/10.2215/CJN.13781119
Fahad Saeed
1Department of Medicine, School of Public Health, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Susan A. Ladwig
2Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Ronald M. Epstein
2Division of Palliative Care, University of Rochester School of Medicine and Dentistry, Rochester, New York
3Departments of Psychiatry and Family Medicine, and Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Rebeca D. Monk
1Department of Medicine, School of Public Health, Division of Nephrology, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Paul R. Duberstein
4Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Abstract

Background and objectives Although some patients regret the decision to start dialysis, modifiable factors associated with regret have rarely been studied. We aimed to identify factors associated with patients’ regret to initiate dialysis.

Design, setting, participants, & measurements A 41-item questionnaire was administered to adult patients receiving maintenance dialysis in seven dialysis units located in Cleveland, Ohio, and its suburbs. Of the 450 patients asked to participate in the study, 423 agreed and 397 provided data on decisional regret. We used multivariable logistic regression to identify predictors of regret, which was assessed using a single item, “Do you regret your decision to start dialysis?” We report adjusted odd ratios (ORs) and 95% confidence intervals (95% CIs) for the following candidate predictors: knowledge of CKD, attitudes toward CKD treatment, and preference for end-of-life care.

Results Eighty-two of 397 respondents (21%) reported decisional regret. There were no significant demographic correlates of regret. Regret was more common when patients reported choosing dialysis to please doctors or family members (OR, 2.34; 95% CI, 1.27 to 4.31; P<0.001). Patients who reported having a prognostic discussion about life expectancy with their doctors (OR, 0.42; 95% CI, 0.18 to 0.98; P=0.03) and those who had completed a living will (OR, 0.48; 95% CI, 0.25 to 0.95; P=0.03) were less likely to report regret with dialysis initiation.

Conclusions Dialysis regret was common in this sample. Demographic factors (age, sex, marital status, race, or educational attainment) were not significantly associated with regret, but modifiable care processes were.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_06_09_CJN13781119.mp3

  • regret
  • shared dialysis decision-making
  • decisional regret
  • aged
  • living wills
  • logistic models
  • life expectancy
  • renal dialysis
  • prognosis
  • terminal care
  • odds ratio
  • surveys and questionnaires
  • decision making
  • renal insufficiency, chronic
  • emotions
  • marital status
  • attitude
  • Received November 11, 2019.
  • Accepted April 9, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (7)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 7
July 01, 2020
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Dialysis Regret
Fahad Saeed, Susan A. Ladwig, Ronald M. Epstein, Rebeca D. Monk, Paul R. Duberstein
CJASN Jul 2020, 15 (7) 957-963; DOI: 10.2215/CJN.13781119

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Dialysis Regret
Fahad Saeed, Susan A. Ladwig, Ronald M. Epstein, Rebeca D. Monk, Paul R. Duberstein
CJASN Jul 2020, 15 (7) 957-963; DOI: 10.2215/CJN.13781119
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Keywords

  • regret
  • shared dialysis decision-making
  • decisional regret
  • aged
  • living wills
  • logistic models
  • life expectancy
  • renal dialysis
  • prognosis
  • terminal care
  • odds ratio
  • surveys and questionnaires
  • decision making
  • Renal Insufficiency, Chronic
  • emotions
  • marital status
  • attitude

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