Prevalence and contents of advance directives of patients with ESRD receiving dialysis

Molly A. Feely, Daniel Hildebrandt, Jithinraj Edakkanambeth Varayil, Paul S. Mueller

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background and objectives ESRD requiring dialysis is associated with increased morbidity and mortality rates, including increased rates of cognitive impairment, compared with the general population. About one quarter of patients receiving dialysis choose to discontinue dialysis at the end of life.Advance directives are intended to give providers and surrogates instruction onmanagingmedical decision making, including end of life situations. The prevalence of advance directives is low among patients receiving dialysis. Little is known about the contents of advance directives among these patients with advance directives. Design, setting, participants, & measurements We retrospectively reviewed the medical records of all patients receivingmaintenance in-center hemodialysis at a tertiary academicmedical center between January 1, 2007 and January 1, 2012. We collected demographic data, the prevalence of advance directives, and a content analysis of these advance directives. We specifically examined the advance directives for instructions on management of interventions at end of life, including dialysis. ResultsAmong 808 patients (mean age of 68.6 years old;men =61.2%), 49%had advance directives, ofwhich only 10.6% mentioned dialysis and only 3% specifically addressed dialysis management at end of life. Patients who had advance directives were more likely to be older (74.5 versus 65.4 years old; P<0.001) and have died during the study period (64.4% versus 46.6%; P<0.001) than patients who did not have advance directives. Notably, for patients receiving dialysis who had advance directives, more of the advance directives addressed cardiopulmonary resuscitation (44.2%),mechanical ventilation (37.1%), artificial nutrition and hydration (34.3%), and pain management (43.4%) than dialysis (10.6%). Conclusions Although one-half of the patients receiving dialysis in our study had advance directives, end of life management of dialysis was rarely addressed. Future research should focus on improving discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives, among these patients.

Original languageEnglish (US)
Pages (from-to)2204-2209
Number of pages6
JournalClinical Journal of the American Society of Nephrology
Issue number12
StatePublished - 2016


  • Academic Medical Centers
  • Advance Directives
  • Advance care planning
  • Advance directives
  • Cardiopulmonary Resuscitation
  • Clinical Decision-Making
  • Cognition Disorders
  • Death
  • Dialysis
  • Documentation
  • Goals
  • Humans
  • Kidney Failure, Chronic
  • Kidney failure, chronic
  • Male
  • Medical Records
  • Pain Management
  • Prevalence
  • Renal dialysis
  • Respiration, Artificial
  • Retrospective Studies
  • Terminal Care
  • Terminal care

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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