Background
Chronic kidney disease (CKD) is a growing public health concern that overwhelmingly affects older adults. National guidelines
have called for earlier referral of CKD patients, but it is unclear how these should apply to older adults.
Objective
This scholarly review aims to explore the current literature about upstream referral decisions for CKD within the context
of decisions about initiation of dialysis and general referral decisions. The authors propose a model for understanding the
referral process and discuss future directions for research to guide decision making for older patients with CKD.
Results
While age has been shown to be influential in decisions to refer patients for dialysis and other medical therapies, the role
of other patient factors such as competing medical co-morbidities, functional loss, or cognitive impairment in the decision
making of physicians has been less well elucidated, particularly for CKD.
Conclusions
More information is needed on the decision-making behavior of physicians for upstream referral decisions like those being
advocated for CKD. Exploring the role of geriatric factors like cognitive and functional status may help facilitate more appropriate
use of resources and improve patient outcomes.
KEY WORDS chronic kidney disease - decision making - older adults