"Why Is This Patient on Dialysis?" - A Survey of Nephrology Nurses' Perspectives on Dialysis Appropriateness and Their Related Moral Distress.

In a 1996 national survey, nephrology registered nurses believed that 15.0% of patients aged 65 years and older should not be dialyzed. In 2025, we replicated the survey and additionally asked nephrology nurses to rate their moral distress using the Moral Distress Thermometer (MDT). The 315 respondents believed that 19.4% of patients aged 65 years and older should not be dialyzed; 100 nurses (31.7% of respondents) reported high moral distress (MDT 6 or higher) and that 26.7% of older patients should not be dialyzed. In comparison, 215 nurses (68.3%) reported low moral distress (26.7% vs. 16.0%, p = 0.0002) and that 16.0% or older patients should not be dialyzed. High moral distress is present among many nephrology registered nurses, underscoring the need for interdisciplinary dialogue about the appropriateness of dialysis for some older patients.