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The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

Overview of attention for article published in BMC Medical Ethics, November 2017
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  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (72nd percentile)
  • Average Attention Score compared to outputs of the same age and source

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12 tweeters

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42 Mendeley
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Title
The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions
Published in
BMC Medical Ethics, November 2017
DOI 10.1186/s12910-017-0219-4
Pubmed ID
Authors

Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre

Abstract

Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at "extreme" ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions. Mr. H is a ninety-year-old patient with end-stage kidney disease that is no longer manageable with conservative care, in spite of optimal nutritional management, good blood pressure control and strict clinical and metabolic evaluations; dialysis is the next step, but its morbidity is challenging. The case is analysed according to principlism (beneficence, non-maleficence, justice and respect for autonomy). In the setting of care, dialysis is available without restriction; therefore the principle of justice only partially applied, in the absence of restraints on health-care expenditure. The final decision on whether or not to start dialysis rested with Mr. H (respect for autonomy). However, his choice depended on the balance between beneficence and non-maleficence. The advantages of dialysis in restoring metabolic equilibrium were clear, and the expected negative effects of dialysis were therefore decisive. Mr. H has a contraindication to peritoneal dialysis (severe arthritis impairing self-performance) and felt performing it with nursing help would be intrusive. Post dialysis fatigue, poor tolerance, hypotension and intrusiveness in daily life of haemodialysis patients are closely linked to the classic thrice-weekly, four-hour schedule. A personalized incremental dialysis approach, starting with one session per week, adapting the timing to the patient's daily life, can limit side effects and "dialysis shock". An individualized approach to complex decisions such as dialysis start can alter the delicate benefit/side-effect balance, ultimately affecting the patient's choice, and points to a narrative, tailor-made approach as an alternative to therapeutic nihilism, in very old and fragile patients.

Twitter Demographics

The data shown below were collected from the profiles of 12 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 42 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 42 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 9 21%
Student > Bachelor 7 17%
Student > Doctoral Student 7 17%
Researcher 5 12%
Librarian 2 5%
Other 4 10%
Unknown 8 19%
Readers by discipline Count As %
Nursing and Health Professions 15 36%
Social Sciences 5 12%
Medicine and Dentistry 5 12%
Biochemistry, Genetics and Molecular Biology 3 7%
Psychology 1 2%
Other 2 5%
Unknown 11 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 6. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 03 July 2018.
All research outputs
#3,331,016
of 14,155,545 outputs
Outputs from BMC Medical Ethics
#301
of 621 outputs
Outputs of similar age
#87,428
of 317,244 outputs
Outputs of similar age from BMC Medical Ethics
#38
of 70 outputs
Altmetric has tracked 14,155,545 research outputs across all sources so far. Compared to these this one has done well and is in the 76th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 621 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 10.9. This one has gotten more attention than average, scoring higher than 51% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 317,244 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 72% of its contemporaries.
We're also able to compare this research output to 70 others from the same source and published within six weeks on either side of this one. This one is in the 45th percentile – i.e., 45% of its contemporaries scored the same or lower than it.