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Dialysis Futility Shared Decision-Making — ESENeph MCQ

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ModerateHaemodialysisDialysis Futility Shared Decision-MakingESENeph

A 60-year-old man with CKD G5D has been on haemodialysis for 8 years. He is not a transplant candidate. He develops increasing frailty, recurrent hospitalisations, and progressive functional decline. His nephrologist discusses the concept of dialysis futility. What does this mean?

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Correct answer: B — When dialysis no longer provides net benefit (survival gain is offset by treatment burden and reduced quality of life), the concept of futility is considered – shared decision-making about transition to conservative/palliative care should be explored sensitively

Dialysis futility is considered when the burdens of treatment (time on dialysis, vascular access procedures, hospitalisations, symptoms, reduced quality of life) outweigh the benefits (life prolongation). This is particularly relevant in elderly, frail patients with multiple comorbidities and functional decline. UKKA and RCP guidelines emphasise: this is a shared decision (not unilateral); the patient's values and goals must guide discussions; PROMs (patient-reported outcome measures) help quantify quality of life; advance care planning should be integrated; and transition to conservative management with palliative support is the alternative pathway.

Reference: UKKA 2021 – Conservative Management; RCP 2018 – End-of-Life Dialysis