The Role of Estimating and Communicating Prognosis in Kidney Supportive Care

Most patients with advanced chronic kidney disease and end-stage kidney disease want to know their prognosis. Nephrologists report discomfort in communicating prognostic information to their patients and tend to avoid these discussions. This contributes to prognostic misperceptions among patients and overtreatment for patients for whom treatment benefit is questionable. Decisional regret and withdrawal rates are very high, especially among elderly dialysis patients. Prognosis lies at the center of good discussions about treatment goals that, in turn, facilitate shared decision-making. Good prognostic discussions thus have the potential to promote patient autonomy and facilitate goal concordant care. Several validated tools and frameworks are available to guide clinicians in these important conversations.