Background

In Germany, approximately 80,000 people live with chronic kidney failure at an advanced stage (CKD-5), the majority of whom are over 70 years old. Those affected undergo blood purification through dialysis several times a week. This treatment removes toxins that are normally filtered by the kidneys. However, studies suggest that for very elderly, multimorbid patients, this form of therapy does not necessarily improve life expectancy or quality of life. In such cases, a "conservative" (i.e., dialysis-free) treatment approach may be a more appropriate option. Currently, this option is rarely chosen, and affected individuals are often not sufficiently involved in the decision-making process regarding dialysis.

Project Objective

The aim of the project is to develop a decision aid that supports older patients with advanced kidney disease in choosing a suitable treatment. The decision aid will provide structured, needs-oriented information about the various treatment options and facilitate decision-making for or against dialysis therapy.

Study Design

First, qualitative interviews and focus group discussions will be conducted to identify the care needs and preferences from the perspectives of patients, relatives, and experts involved in their care. Additionally, nationwide routine data from AOK on early mortality after the start of dialysis will be analyzed. Based on these findings, a statistical model will be developed to assess the mortality risk of older dialysis patients. In the next step, the decision aid will be developed using the interim results. Together with those affected, their relatives, and the treatment team, we will determine which information is useful for decision-making and how it can be communicated in an understandable way. In the final step, the decision aid will be tested and evaluated in nephrological practices as part of a feasibility study, ensuring that all relevant groups are involved in its development. The goal of the decision aid is to improve the health literacy of older patients with end-stage chronic kidney disease, thereby contributing to greater self-determination and quality of life in their final phase of life.
 

Research Consortium, Funding, and Duration

The research consortium consists of the Institute for Public Health at Charité – Universitätsmedizin Berlin (consortium lead), the Institute for Social Medicine and Health Systems Research at Otto von Guericke University Magdeburg, AOK Nordost, the Scientific Institute of the AOK Federal Association (WIdO), and the German Kidney Association (Bundesverband Niere e.V.). The project is funded by the Innovation Committee of the Federal Joint Committee (G-BA) and has a duration of 3.5 years.