Memulai dialisis untuk gagal ginjal vs. memilih manajemen konservatif (non-dialitik)
Jika Anda bertindak
Memulai dialisis
19%
Jika Anda tidak bertindak
Memilih perawatan konservatif (tanpa dialisis)
5,0%
Persentase orang yang kemudian menyesali setiap pilihan. Diagram batang dan catatan lengkap ditampilkan di bawah.
Kesehatan
Terakhir ditinjau 2026-05-04
Kualitas bukti 3.75/5
Skor tinjauan delapan dimensi terhadap
rubrik kualitas
. Setiap dimensi dinilai 1–5.
D1 Verifikasi sumber
3/5
D2 Otoritas & independensi sumber
4/5
D3 Akurasi tingkat penyesalan
3/5
D4 Keterbandingan sumber
4/5
D5 Pola Gilovich
5/5
D6 Kualitas prosa
4/5
D7 Kelengkapan peringatan
4/5
D8 Kualitas sampel
3/5
Rata-rata3.75/5
Penyesalan atas tindakan
Memulai dialisis
19%
~19% pasien dialisis pemeliharaan menyesali keputusan mereka untuk memulai dialisis; penyesalan terkonsentrasi pada pasien lansia dengan komorbiditas tinggi di mana manfaat kelangsungan hidup paling kecil
Orang dewasa ≥75 dengan penyakit ginjal stadium akhir yang memulai dialisis, terutama mereka dengan beban komorbiditas tinggi (Davison 2010; Morton et al. 2012)
dalam 12 bulan setelah inisiasi dialisis
Penyesalan atas kelambanan
Memilih perawatan konservatif (tanpa dialisis)
5,0%
Penyesalan mendekati nol: dalam survei pengambilan keputusan bersama, 0% pasien yang memilih perawatan konservatif masih meragukan keputusan tersebut (vs 17% pasien dialisis)
Orang dewasa ≥75 dengan ESRD yang memilih manajemen konservatif dengan dukungan paliatif (Murtagh et al. 2011)
retrospektif; dilaporkan pasien dan pengganti
% menyesal dengan pilihan ini
Memulai dialisisMemilih perawatan konservatif (tanpa dialisis)
19%5,0%
action dominates — Bertindak mendominasi — sebagian besar menyesali karena bertindak.
Keputusan terkait
Keputusan yang serupa secara semantik — area yang sama, kompromi yang berbeda.
For elderly patients over 75 with end-stage renal disease and high comorbidity burden, dialysis and conservative management (symptom-focused non-dialytic care) are genuinely contested alternatives. Da Silva-Gane et al.’s 2012 CJASN study of 170 patients with advanced kidney failure found an adjusted median survival of 1317 days on haemodialysis versus 913 days on conservative kidney management — about a 13-month advantage — with broadly comparable life-satisfaction scores. Murtagh et al.’s 2007 study of 129 patients aged 75 and over found that this survival advantage narrows sharply with comorbidity and is lost altogether in patients with high comorbidity scores, especially ischaemic heart disease. Against that modest, burden-laden benefit, Saeed et al.’s 2019 survey of 423 maintenance dialysis patients found that nearly 19% regretted their decision to start dialysis — driven by treatment burden (three weekly sessions of three to four hours each, strict dietary and fluid restrictions, fatigue) set against the perceived benefit in the context of functional status and life goals. Regret is concentrated in exactly the elderly, high-comorbidity group where the survival benefit is smallest.
The conservative management pathway, when supported by adequate palliative and symptom care, shows consistently high decision satisfaction. In Verberne et al.’s 2019 survey of patients choosing dialysis or conservative care, none of the 23 conservative-care patients still had doubts about their treatment decision, compared with 17% of the dialysis patients, and 91% of conservative-care patients were satisfied with the decision. The conservative-care sample is small, so the near-zero figure should be read as directional rather than precise, but the direction is consistent across the literature: patients who arrive at conservative management through an informed, shared decision-making process rarely regret it.
The action-dominates pattern in this entry reflects a specific, bounded population: elderly, frail, high-comorbidity ESRD patients. For younger patients or those with lower comorbidity burden, dialysis provides substantially greater survival benefit and the regret distribution would look very different. The dominant predictor of regret on both sides is decision quality — whether patients received adequate information about prognosis, treatment burden, and alternatives without time pressure, and whether their own values and priorities were elicited. The difference between well-counselled and poorly-counselled decisions is larger than the intrinsic difference between dialysis and conservative management. The clinical implication is that the decision conversation — not just the decision — is the intervention most likely to reduce regret.
Sumber: tindakan
Buku besar klaim
Setiap angka di bawah ini adalah apa yang dilaporkan masing-masing sumber, dengan kutipan kata demi kata yang kami andalkan dan bagaimana kami sampai pada angka kami. Klik tautan mana saja untuk memverifikasi langsung.
2/3 sumber diverifikasi secara independen kata demi kata terhadap sumber terkutip
[1]Clinical Nephrology — Patients' perspectives on dialysis decision-making and end-of-life care
Terverifikasi
Telaah sejawat
Nearly 19% of maintenance dialysis patients regretted their decision to start dialysis (Saeed et al., n=423 surveyed)
Kutipan
“"Nearly 19% of respondents regretted their decision to start dialysis."
”
Data sumber dari
2019-05-01
Diakses
2026-06-30
Verifikasi
Kutipan diambil ulang secara independen dan dikonfirmasi kata demi kata terhadap sumber terkutip selama audit pendasaran kami.
Perhitungan
Saeed F, Sardar MA, Davison SN, Murad H, Duberstein PR, Quill TE. Clin Nephrol 2019;91(5):294-300 (PMID 30663974). Cross-sectional survey of 423 maintenance dialysis patients (Cleveland, OH). Directly measured dialysis decisional regret: nearly 19% regretted starting dialysis. This 19% is used as the action-side regret_rate. Regret is higher in elderly/high-comorbidity subgroups, where the survival benefit of dialysis is most modest; for younger, healthier ESRD patients regret would be lower.
[2]Clinical Journal of the American Society of Nephrology (CJASN) — Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis
Telaah sejawat
Adjusted median survival advantage of dialysis over conservative kidney management was ~404 days (~13 months); quality-of-life and life-satisfaction scores were broadly comparable between groups (Da Silva-Gane et al., n=170)
Kutipan
“"Adjusted median survival from recruitment was 1317 days in HD patients ... and 913 days in CKM patients."
”
Data sumber dari
2012-12-01
Diakses
2026-06-30
Perhitungan
Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Clin J Am Soc Nephrol 2012;7(12):2002-2009 (PMC3513739). Prospective study of 170 patients with advanced kidney failure choosing dialysis or conservative kidney management (CKM). Adjusted median survival 1317 days (HD) vs 913 days (CKM) — a ~13-month advantage for dialysis, with comparable life-satisfaction scores. The modest, burden-laden survival benefit explains why a meaningful minority of dialysis starters (Saeed: ~19%) come to regret the decision. This study measures survival/QoL, not regret directly.
[3]National Kidney Foundation — Hemodialysis
Terverifikasi
Sumber referensi
Standard in-center hemodialysis is administered 3 times per week, with each session lasting 3 to 4 hours
Kutipan
“"Treatments at a dialysis center are usually done 3 times a week, each taking 3 to 4 hours to complete."
”
Data sumber dari
2024-04-26
Diakses
2026-07-03
Verifikasi
Kutipan diambil ulang secara independen dan dikonfirmasi kata demi kata terhadap sumber terkutip selama audit pendasaran kami.
Perhitungan
National Kidney Foundation patient-education page, last updated 2024-04-26. Cited as the basis for the in-center treatment schedule (3 sessions/week, 3-4 hours each) referenced in the body prose as treatment-burden context for why a meaningful minority of dialysis starters (Saeed et al. 2019: ~19%) regret the decision. Background/context only; not used in regret_rate arithmetic.
Sumber: tidak bertindak
Buku besar klaim
Setiap angka di bawah ini adalah apa yang dilaporkan masing-masing sumber, dengan kutipan kata demi kata yang kami andalkan dan bagaimana kami sampai pada angka kami. Klik tautan mana saja untuk memverifikasi langsung.
1/2 sumber diverifikasi secara independen kata demi kata terhadap sumber terkutip
[1]BMC Nephrology — Older patients' experiences with a shared decision-making process on choosing dialysis or conservative care for advanced chronic kidney disease: a survey study
Telaah sejawat
Of patients who chose conservative care, 0/23 (0%) reported lingering doubts about their treatment decision (vs 12/70, 17%, of dialysis patients; P=0.03); 91% of conservative-care patients were satisfied with the decision
Kutipan
“"Do you still have doubts about your treatment decision? 12/70 (17%) 0/23 (0%) 0.03"
”
Data sumber dari
2019-07-01
Diakses
2026-06-30
Perhitungan
Verberne WR, et al. BMC Nephrol 2019;20:264 (PMC6635995). Survey study of 99 patients (75 dialysis, 24 conservative care). Directly measured decision doubt and satisfaction: 0/23 (0%) of conservative-care patients still had doubts about their treatment decision versus 17% of dialysis patients (P=0.03); satisfaction with the decision was 91% (CC) vs 87% (dialysis). Conservative-care patients reported the lowest decisional regret of the two groups — the basis for a near-zero inaction-side regret rate among those who chose conservative care after shared decision-making.
[2]Nephrology Dialysis Transplantation — Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5
Terverifikasi
Telaah sejawat
In patients ≥75 with CKD stage 5, the survival advantage of dialysis over conservative care narrows sharply with comorbidity and is lost in those with high comorbidity scores, especially ischaemic heart disease (Murtagh et al., n=129)
Kutipan
“"However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease."
”
Data sumber dari
2007-07-01
Diakses
2026-06-30
Verifikasi
Kutipan diambil ulang secara independen dan dikonfirmasi kata demi kata terhadap sumber terkutip selama audit pendasaran kami.
Perhitungan
Murtagh FEM, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Nephrol Dial Transplant 2007;22(7):1955-1962 (PMID 17412702). Retrospective survival comparison of 129 patients ≥75 with CKD stage 5 (52 dialysis, 77 conservative). 1- and 2-year survival 84%/76% (dialysis) vs 68%/47% (conservative); the survival advantage of dialysis was lost in high-comorbidity / ischaemic-heart-disease patients. This is the clinical context for why elderly high-comorbidity patients can reasonably choose conservative care with low regret. Measures survival, not regret directly.
Catatan
Entri ini berlaku secara khusus untuk pasien lansia (≥75) dengan beban komorbiditas tinggi di mana pilihan dialisis-vs-konservatif benar-benar diperdebatkan secara klinis. Untuk pasien yang lebih muda atau mereka dengan beban komorbiditas lebih rendah, dialisis memberikan manfaat kelangsungan hidup yang jauh lebih besar dan penyesalan yang lebih rendah. Penyesalan sisi-tindakan ~19% (Saeed dkk. 2019, semua pasien dialisis pemeliharaan) meremehkan angka untuk subkelompok lansia dengan komorbiditas tinggi, di mana rasio beban-terhadap-manfaat pengobatan paling tidak menguntungkan; penyesalan mendekati nol sisi-kelambanan (Verberne dkk. 2019, n=23) berasal dari sampel perawatan-konservatif yang kecil dan harus dibaca sebagai arah, bukan presisi. Penatalaksanaan konservatif memerlukan akses ke dukungan paliatif/gejala yang baik; tanpa dukungan yang memadai, tingkat penyesalan sisi-kelambanan akan lebih tinggi. Kualitas keputusan (informasi yang memadai, tanpa tekanan waktu, penggalian nilai yang jelas) adalah prediktor dominan penyesalan di kedua sisi — perbedaan antara pasien yang dikonseling dengan baik dan yang dikonseling dengan buruk lebih besar daripada perbedaan antara dialisis dan penatalaksanaan konservatif itu sendiri. gilovich_pattern (action_dominates) mencerminkan populasi spesifik: ESRD lansia, rapuh, dengan komorbiditas tinggi. Untuk populasi ESRD yang lebih luas, polanya akan berbeda (penyesalan dialisis lebih rendah, pola tindakan terbalik).
