Surreal illustration of medical decision-making in critical care

Dialysis Decisions: Are Hospitalized Patients Truly in Control?

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Reese Marlowe in Health & Wellness July 2025 • 4 min read.

"A pilot study reveals surprising insights into the perceptions of patients and their surrogates regarding dialysis initiation during critical illness."


When faced with acute kidney injury (AKI) and critical illness, the decision to start dialysis often happens quickly within a hospital setting. While dialysis is a life-saving treatment, how do patients (or their designated decision-makers) feel about this process when it occurs during a hospitalization? Understanding their perceptions is essential for improving the quality of care and ensuring patient-centered decisions.

A new study dives into this important question, exploring the experiences of hospitalized patients and their surrogate decision-makers (SDMs) concerning dialysis initiation. The research sheds light on decisional satisfaction, the extent of shared decision-making, and the level of patient involvement in this critical treatment choice.

This article breaks down the key findings of this pilot study, revealing potential gaps in communication and informed consent. Learn about the challenges of making dialysis decisions during acute illness and the importance of revisiting treatment options for those who continue to need dialysis long-term.

The Reality of Dialysis Decisions in the Hospital

Surreal illustration of medical decision-making in critical care

The study, conducted at a large academic center, involved patients who started dialysis for AKI during a specific period. Researchers assessed decisional satisfaction and shared decision-making using validated scales and structured interviews. Here's what they found:

A significant portion of patients couldn't actively participate in the dialysis decision. In the study, 62% of patients relied on a surrogate decision-maker (SDM) to provide consent for dialysis initiation. This often reflected the severity of their illness, particularly among those in the ICU.

  • Continuous Dialysis is Common: Continuous renal replacement therapy (CRRT) was used in 67% of cases, reflecting the critical care setting.
  • High Mortality: The in-hospital mortality rate was 33%, highlighting the serious nature of the underlying conditions.
  • Choice Perception: Despite the difficult circumstances, 90% of participants felt they had a choice in making the dialysis decision.
  • Limited Awareness of Alternatives: However, a concerning 81% were unable to name any alternatives to dialysis initiation.
While most participants reported feeling satisfied with the decision-making process, the lack of awareness regarding alternatives raises concerns about the completeness of informed consent. It suggests that the urgency of the situation may overshadow the exploration of all available options.

Empowering Patients and Families in Critical Care

This study underscores the need to enhance communication and shared decision-making for hospitalized patients facing dialysis initiation. When patients lack the capacity to participate, it becomes even more crucial for healthcare providers to engage SDMs in thorough discussions about treatment options, potential outcomes, and the patient's values and preferences.

For those who survive critical illness and remain dialysis-dependent, revisiting the initial decision is essential. This allows patients to better understand the rationale for dialysis, weigh the risks and benefits, and align their treatment plan with their long-term goals. It may also be helpful to explore alternative modalities such as conservative care.

By prioritizing patient-centered communication and shared decision-making, we can empower individuals and families to make informed choices that reflect their values, even in the face of critical illness. This ultimately leads to better care and improved quality of life.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

Who makes the decision about dialysis when a patient is too sick to participate?

In many cases, hospitalized patients are unable to actively participate in decisions regarding dialysis due to the severity of their illness. This study found that 62% of patients relied on a Surrogate Decision-Maker (SDM) to make these critical choices. This high percentage underscores the importance of involving SDMs in the decision-making process, ensuring that treatment aligns with the patient's values and preferences.

2

What is Acute Kidney Injury (AKI) and why is it relevant to this topic?

Acute Kidney Injury (AKI) is a sudden decline in kidney function that can occur in hospitalized patients. When AKI occurs, the need for dialysis, a life-saving treatment, arises rapidly. The article explores the challenges of making dialysis decisions in this urgent context and highlights the need for enhanced communication and shared decision-making to ensure patient-centered care.

3

What is a Surrogate Decision-Maker (SDM) and what is their role in the context of dialysis?

A Surrogate Decision-Maker (SDM) is a person designated to make healthcare decisions for a patient who cannot make them for themselves, often due to critical illness. In this context, the SDM's role is crucial when patients are unable to participate in decisions about dialysis. The study emphasizes the importance of healthcare providers engaging SDMs in discussions about treatment options, potential outcomes, and the patient's wishes.

4

What is Continuous Renal Replacement Therapy (CRRT) and why is it mentioned?

Continuous Renal Replacement Therapy (CRRT) is a type of dialysis commonly used in critical care settings. The article mentions that CRRT was employed in 67% of the cases within the study, reflecting the critical nature of the patients' conditions. The high prevalence of CRRT highlights the severity of the illnesses and the intensity of the treatments required.

5

What are the implications of patients feeling they have a choice in dialysis decisions?

In this study, while 90% of participants reported feeling they had a choice in the decision to initiate dialysis, a concerning 81% were unable to identify any alternatives to dialysis. This disparity highlights the need for improved communication and ensuring complete informed consent, including the exploration of all available options, during critical illness.

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