Kidney Week 2025 Annual Meeting-Decision-Making at Transitions Along the Dialysis Pathway

Video Transcription

Video Summary

The session focuses on decision-making during key transitions along the dialysis pathway: when to start dialysis, staying on home modalities, pediatric-to-adult transfer, and shifting to palliative/end-of-life care.<br /><br />Dr. Susan Wong argues U.S. dialysis decision-making is often poor, with many patients “crashing” into dialysis unprepared and later regretting it. She recommends (1) uncoupling dialysis planning from eGFR and kidney failure risk estimates, which miss many clinical and personal factors and can mis-time preparation; (2) investing in patient education as an ongoing process, noting common pamphlet/video approaches have limited reach and decision-aid benefits may fade; and (3) redefining “instability” as lacking a plan despite foreseeable kidney failure, emphasizing proactive planning, better communication tools, and aligning clinician roles with patient decision preferences. She suggests acknowledging denial using a “Pandora’s box” metaphor and notes “trials of dialysis” are conceptually helpful but hard to operationalize due to fragmented care.<br /><br />Dr. Edwina Brown discusses keeping patients on home dialysis through person-centered care and shared decision-making, emphasizing incremental peritoneal dialysis to reduce burden early and increase as residual kidney function declines. Case examples illustrate flexible switching between CAPD and APD, transitions from PD to home hemodialysis, and use of assisted PD to avoid in-center HD for frail patients.<br /><br />Ms. Jessica Geer outlines pediatric-to-adult transition as a multi-year process starting around ages 11–12, tailored to development and stability (medical and social). Barriers include family attachment, trust, adult-system unfamiliarity, and limited institutional support. She highlights transition “champions,” structured education bundles, and joint pediatric-adult clinics to improve outcomes.<br /><br />Dr. Samantha Gelfman reviews dialysis discontinuation as ethical, common, yet stigmatized. She describes typical triggers (acute events, frailty), survival after stopping (often days to ~2 weeks), communication strategies to explore suffering and goals, assessing depression and capacity, considering “palliative” or reduced dialysis, and ensuring symptom management and hospice handoffs.

Asset Subtitle

Moderator(s): Manisha Jhamb, Isaac Teitelbaum

Presentation(s):

Deciding When to Start Dialysis: Why Now? - Susan Wong
Dialysis Lifetime at Home: Incremental Peritoneal Dialysis to Home Hemodialysis - Edwina Brown
Decisions for Youngsters Moving from Pediatric to Adult Kidney Care - Jessica Geer
Enabling "Living Well" at the Same Time as "Dying Well" - Samantha Gelfand

Meta Tag

Date 11/7/2025

Pathway 1 Dialysis

Pathway 2 Pediatric Nephrology

Session ID 506797

Keywords

dialysis initiation decision-making

unplanned dialysis start

shared decision-making in nephrology

dialysis patient education

eGFR limitations for dialysis planning

proactive kidney failure planning

trial of dialysis

home dialysis retention

incremental peritoneal dialysis

assisted peritoneal dialysis

pediatric-to-adult transition in nephrology

dialysis discontinuation ethics

palliative and end-of-life dialysis care