Iniciar diálise para insuficiência renal vs. optar pelo manejo conservador (não dialítico)
Se você agir
Iniciar diálise
19%
Se você não agir
Optar por tratamento conservador (sem diálise)
5,0%
Porcentagem de quem mais tarde se arrepende de cada escolha. As barras e o registro completo aparecem abaixo.
Saúde
Última revisão 2026-05-04
Qualidade das evidências 3.75/5
Pontuação de revisão em oito dimensões segundo a
grelha de qualidade
. Cada dimensão pontuada de 1 a 5.
D1 Verificação das fontes
3/5
D2 Autoridade e independência das fontes
4/5
D3 Precisão da taxa de arrependimento
3/5
D4 Comparabilidade das fontes
4/5
D5 Padrão de Gilovich
5/5
D6 Qualidade da prosa
4/5
D7 Completude das ressalvas
4/5
D8 Qualidade da amostra
3/5
Média3.75/5
Arrependimento por ação
Iniciar diálise
19%
~19% dos pacientes em diálise de manutenção se arrependem da decisão de iniciar a diálise; o arrependimento se concentra em pacientes idosos e com alta carga de comorbidades, nos quais o benefício de sobrevida é mais modesto
Adultos ≥75 com doença renal em estágio terminal que iniciaram diálise, particularmente aqueles com alta carga de comorbidades (Davison 2010; Morton et al. 2012)
dentro de 12 meses do início da diálise
Arrependimento por omissão
Optar por tratamento conservador (sem diálise)
5,0%
Arrependimento próximo de zero: em uma pesquisa de tomada de decisão compartilhada, 0% dos pacientes que optaram pelos cuidados conservadores ainda tinham dúvidas sobre a decisão (contra 17% dos pacientes em diálise)
Adultos ≥75 com DRT que escolheram tratamento conservador com apoio paliativo (Murtagh et al. 2011; Davison et al. estudos qualitativos)
retrospectivo; relatado pelo paciente e pelo substituto
% se arrependem desta escolha
Iniciar diáliseOptar por tratamento conservador (sem diálise)
19%5,0%
action dominates — A acção domina — a maioria arrepende-se de ter agido.
Decisões relacionadas
Decisões semanticamente semelhantes — mesmo terreno, compromissos diferentes.
Recusar o tratamento oncológico convencional; recorrer apenas à medicina alternativa (sem cirurgia, quimioterapia, radioterapia ou hormonoterapia)Aceitar o tratamento oncológico convencional (cirurgia, quimioterapia, radioterapia, hormonoterapia conforme o estágio)
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.
Fontes: acção
Registro de evidências
Cada número abaixo é o que cada fonte relatou, com a citação literal em que nos baseamos e como chegamos ao nosso valor. Clique em qualquer link para verificar diretamente.
2/3 fontes verificadas de forma independente palavra por palavra em relação à fonte citada
[1]Clinical Nephrology — Patients' perspectives on dialysis decision-making and end-of-life care
Verificado
Revisado por pares
Nearly 19% of maintenance dialysis patients regretted their decision to start dialysis (Saeed et al., n=423 surveyed)
Trecho
“"Nearly 19% of respondents regretted their decision to start dialysis."
”
Dados da fonte de
2019-05-01
Acessado
2026-06-30
Verificação
Trecho obtido novamente de forma independente e confirmado palavra por palavra em relação à fonte citada durante nossa auditoria de fundamentação.
Cálculo
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
Revisado por pares
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)
Trecho
“"Adjusted median survival from recruitment was 1317 days in HD patients ... and 913 days in CKM patients."
”
Dados da fonte de
2012-12-01
Acessado
2026-06-30
Cálculo
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
Verificado
Fonte de referência
Standard in-center hemodialysis is administered 3 times per week, with each session lasting 3 to 4 hours
Trecho
“"Treatments at a dialysis center are usually done 3 times a week, each taking 3 to 4 hours to complete."
”
Dados da fonte de
2024-04-26
Acessado
2026-07-03
Verificação
Trecho obtido novamente de forma independente e confirmado palavra por palavra em relação à fonte citada durante nossa auditoria de fundamentação.
Cálculo
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.
Fontes: inacção
Registro de evidências
Cada número abaixo é o que cada fonte relatou, com a citação literal em que nos baseamos e como chegamos ao nosso valor. Clique em qualquer link para verificar diretamente.
1/2 fontes verificadas de forma independente palavra por palavra em relação à fonte citada
[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
Revisado por pares
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
Trecho
“"Do you still have doubts about your treatment decision? 12/70 (17%) 0/23 (0%) 0.03"
”
Dados da fonte de
2019-07-01
Acessado
2026-06-30
Cálculo
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
Verificado
Revisado por pares
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)
Trecho
“"However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease."
”
Dados da fonte de
2007-07-01
Acessado
2026-06-30
Verificação
Trecho obtido novamente de forma independente e confirmado palavra por palavra em relação à fonte citada durante nossa auditoria de fundamentação.
Cálculo
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.
Ressalvas
This entry applies specifically to elderly patients (≥75) with high comorbidity burden where the dialysis-vs-conservative choice is genuinely contested clinically. For younger patients or those with lower comorbidity burden, dialysis provides substantially greater survival benefit and lower regret. The action-side ~19% regret (Saeed et al. 2019, all maintenance dialysis patients) understates the figure for the elderly high-comorbidity subgroup, where the treatment burden-to-benefit ratio is least favourable; the inaction-side near-zero regret (Verberne et al. 2019, n=23) comes from a small conservative-care sample and should be read as directional, not precise. Conservative management requires access to good palliative/symptom support; without adequate support, the inaction-side regret rate would be higher. Decision quality (adequate information, no time pressure, clear values elicitation) is the dominant predictor of regret on both sides — the difference between well-counselled and poorly-counselled patients is larger than the difference between dialysis and conservative management per se. The gilovich_pattern (action_dominates) reflects the specific population: elderly, frail, high-comorbidity ESRD. For the broader ESRD population, the pattern would be different (dialysis regret lower, action pattern reversed).
