# Developing Tools for Dialysis Decision Support in Older Adults

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Background: Each year, more than 25,000 patients over the age of 75 start maintenance dialysis treatment in
the United States. Although dialysis may prolong life, it entails profound and sometimes burdensome changes
in lifestyle, substantial risks for complications, and for older adults, a high likelihood of permanent disability.
The quality of dialysis decision making is often poor; few patients receive prognostic information or discuss the
option to receive medical management without dialysis. Rather, patients perceive these decisions as a choice
between dialysis or death.
Significance/Impact: Our overarching goal is to support informed, goal-concordant dialysis decisions by
developing decision support tools, addressing HSRD Priority Domain `Healthcare Informatics'. This project will
address the information needs of patients and clinicians by generating new tools to support informed decision-
making and goal-concordant care for Veterans with advanced chronic kidney disease and end-stage renal
disease.
Innovation: The project is innovative in several ways. First, it applies causal inference models to estimate
treatment effects of dialysis to address an important clinical question for which a clinical trial is not feasible.
Second, it incorporates patient-centered outcomes to evaluate the effectiveness of dialysis. Third, it uses
novel scenario planning frameworks to address uncertainty with decision support.
Specific Aims and Methods: To accomplish this goal, we will (1) compare survival, hospital-free survival, time
to nursing home placement and number of dialysis access procedures using causal inference models to
illustrate trade-offs from dialysis versus medical management among older Veterans with end-stage renal
disease; (2) develop a web-based risk benefit calculator and decision aid based on the framework of scenario
planning that incorporates estimates of survival and treatment complications with dialysis initiation compared to
medical management; and (3) using mixed methods, evaluate the tools' usability, acceptability and effects on
patient knowledge and decisional conflict.
Implementation/Next Steps: We will work with operational partners to ensure the tools meet the needs of the
end-users, and develop plans for broader testing and dissemination. By the end of the project period, we
expect to submit a proposal to test a dialysis decision support intervention incorporating these tools in older
Veterans.

## Key facts

- **NIH application ID:** 10213136
- **Project number:** 5I01HX002763-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** MANJULA KURELLA TAMURA
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-07-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10213136

## Citation

> US National Institutes of Health, RePORTER application 10213136, Developing Tools for Dialysis Decision Support in Older Adults (5I01HX002763-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10213136. Licensed CC0.

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