Table 6.

Recommendations for providing informed consent to elderly patients contemplating dialysis

Initiate advanced care planning early on in the continuum of CKD.
Consider issues specific to age in informed consent discussions (Table 5).
Determine and agree on the patient’s goals for both short- and long-term care.
Integrate informed consent into ACP as part of the deliberation process when deciding whether to pursue RRT.
Assure decision-making capacity and cognitive capacity for comprehension.
Recognize the importance of life experience and tailor the discussion accordingly.
Engage the patient’s family in the decision-making process.
Distinguish informed consent for the option of dialysis from informed consent that is dedicated to the intradialytic symptoms associated with the dialysis procedure.
Present estimate of renal and overall prognosis with and without dialysis.
Present anticipated changes in functional status with and without dialysis.
Explain traditional burdens of dialysis, including potential for both intra-and interdialytic distress.
Explain risks of dialysis procedure, including those risks related to dialysis access.
Explain current requirements of vascular access in the case of hemodialysis.
Make plans for dealing with symptoms that could occur should renal failure progress faster than anticipated and/or faster than other comorbid conditions.
Discuss desires for acute symptom management and goals to avoid heat of the moment decisions.
For those patients choosing dialysis, discuss modality and dialysis access options, and explain the requirements and responsibilities associated with vascular access of hemodialysis or peritoneal catheter placement for peritoneal dialysis.
Respect and assure the integrity of the informed consent process.