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Invited Commentary
February 2016

Honoring Patient Preferences in Initiation of DialysisProblems, Proposals, and a Path Forward

Author Affiliations
  • 1Department of Internal Medicine, Lankenau Medical Center, Wynnewood, Pennsylvania
  • 2Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia
  • 3Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia
JAMA Intern Med. 2016;176(2):236-237. doi:10.1001/jamainternmed.2015.7796

Why are nephrologists initiating dialysis treatments for patients with end-stage renal disease (ESRD) at an earlier stage of disease than in the past? Aggressive early treatment with maintenance dialysis drives up health care costs and does not usually provide a clinical benefit.1 Few data are available to answer the question of how clinician and patient preferences influence the decision to begin dialysis.

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