Coalition Bibliography

Clinical Practice Guideline

Renal Physicians Association. Shared Decision-Making in the Appropriate Initiation of and Withdrawal from Dialysis, 2nd ed. Rockville, MD: Renal Physicians Association, 2010.

Moss AH. Revised Dialysis Clinical Practice Guideline Promotes More Informed Decision-Making. Clin J Am Soc Nephrol 2010;5(12):2380-2383

RPA/ASN Position Statement

Renal Physicians Association. American Society of Nephrology: Position Paper on Quality Care at the End of Life. Rockville, MD: Renal Physicians Association, 2002.


Chambers EJ, Germain M, Brown E, eds. Supportive Care for the Renal Patient, 2nd ed. Oxford: Oxford University Press, 2010.

Core Curriculum

Moss AH, Holley JL, Davison SN, Dart RA, Germain MJ, Cohen LM, Swartz RD. Core Curriculum in Nephrology: Palliative Care. Am J Kidney Dis 2004;43:172-185.

Fellows Training

Holley JL, Carmody SS, Moss AH, Sullivan AM, Cohen LM, Block SD, Arnold RM. The Need for End-of-Life Care Training in Nephrology: National Survey Results of Nephrology Fellows. Am J Kidney Dis 2003;42:813-820.

Acute Kidney Injury (AKI)

Akbar S, Moss AH. The Ethics of Offering Dialysis for AKI to the Older Patient: Time to Reevaluate? Clin J Am Soc Nephrol. 2014; 9(9): 1652-6.

Moss AH. To dialyze or not: The Patient with Metastatic Cancer and AKI in the ICU. Clin J Am Soc Nephrol 2012; 7: 1507-1512.

Advance Care Planning

Davison SN, Simpson C. Hope and Advance Care Planning in Patients with End Stage Renal Disease: Qualitative Interview Study. BMJ. 2006; 333 (7574):886.

Davison SN. Facilitating Advance Care Planning for Patients with End Stage Renal Disease: the Patient Perspective. Clin J Am Soc Nephrol. 2006; 1:1023-1028.

Davison SN, Torgunrud C. The Creation of an Advance Care Planning Process for Patients with ESRD. Am J Kidney Dis. 2007;49:27-36.

Goff SL, Eneanya ND, Feinberg R, et al. Advance Care Planning: A Qualitative Study of Dialysis Patients and Families. Clin J Am Soc Nephrol. 2015. Qualitative ACP study in CJASN 2015.pdf

Hines SC, Glover JJ, Holley JL, Babrow AS, Badzek LA, Moss AH. Dialysis Patients’ Preferences for Family-Based Advance Care Planning. Ann Intern Med. 1999;130:825-828.

Hines SC, Glover JJ, Babrow AS, Holley JL, Badzek LA, Moss AH. Improving advance care planning by accommodating family preferences. J Palliat Med. 2001; 4:481-489.

Holley JL. Advance Care Planning in CKD/ESRD: An Evolving Process. Clin J Am Soc Nephrol. 2012;7(6):1033-1038

Holley JL. Palliative Care in End-Stage Renal Disease: Focus on Advance Care Planning, Hospice Referral, and Bereavement. Sem Dial. 2005;18:154-156.

Holley JL. Advance Directives and Advance Care Planning in Patients with End-Stage Renal Disease. In: Chambers J, Germain M, Brown E, eds. Supportive Care for the Renal Patient. Oxford: Oxford University Press 2004: 35-43.

Holley JL, Davison SN. Advance Care Planning for Patients with Advanced CKD: A Need to Move Forward. Clin J Am Soc Nephrol. 2015: 10. Holley Davison editorial on CJASN 2015 article on ACP.pdf

Holley JL, Hines SC, Glover JJ, Babrow AS, Badzek LA, Moss AH. Failure of Advance Care Planning to Elicit Patients’ Preferences for Withdrawal from Dialysis. Am J Kidney Dis. 1999;33:688-693.

Sanders J. Finding the Right Words at the Right Time – High-Value Advance Care Planning. NEJM. 2015; 372 (7): 598-599.

Schmidt RJ. Informing Our Elders About Dialysis: Is an Age-Attuned Approach Warranted? Clin J Am Soc Nephrol. 2012;7:185-189.

Chronic Kidney Disease

Bear RA, Stockie S. Patient engagement and patient-centered care in the management of advanced chronic kidney disease and chronic kidney failure. Can J Kidney Health Dis. 2014;1:24.

Bowling CB, O’Hare AM. Managing Older Adults with CKD: Individualized Versus Disease-Based Approaches. Am J Kidney Dis. 2012;59(2):293-302.

Carson R. Deny Dialysis or “D-NI” Dialysis? The Case for “Do Not Initiate; Do Not Ignore” Orders. Clin J Am Soc Nephrol. 2012; 7: 1924–1926.

Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis. Clin J Am Soc Nephrol 2012;7: 2002–2009.

Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, Murtagh FE, Naicker S, Germain MJ, O’Donoghue DJ, Morton RL, Obrador GT. Executive Summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int. 2015.

Murtagh FEM, Addington-Hall JM, Higginson IJ. End-Stage Renal Disease: A New Trajectory of Functional Decline in the Last Year of Life. J Am Geriatr Soc. 2011;59:304-308.


Schell JO, Bova-Collis R, Deziel S, Moss AH. The patient wants to stop dialysis: the latest evidence on how to respond. Nephrol News Issues 2012; 26(4): 22-28.

Schell JO, Germain MJ, Finkelstein FO, Tulsky JA, Cohen LM. An integrative approach to advanced kidney disease in the elderly. Adv Chronic Kidney Dis. 2010;17(4): 368-77.

Schell JO, Patel UD, Steinhauser KE, Ammarell N, Tulksy JA. Discussions of the kidney disease trajectory by elderly patients and nephrologists: a qualitative study. Am J Kidney Dis. 2012;59(4): 495-503.

Schell JO, Green JA, Tulsky JA, Arnold RM. Communication skills training for dialysis decision-making and end-of-life care in nephrology. Clin J Am Soc Nephrol. 2013 Apr;8(4):675-80.

Schell JO, Bova-Collis R, Eneanya ND. An Interdisciplinary Approach to Dialysis Decision-Making in the CKD Patient with Depression. Adv Chronic Kidney Dis 2014; 21(4): 385-391.


Hijazi F, Holley JL. Cardiopulmonary Resuscitation and Dialysis: Outcome and Patients’ Views. Sem Dial 2003;16:51-53.

Karnik JA, Young BS, Lew NL, Herget M, Dubinsky C, Lazarus JM, Chertow CM. Cardiac Arrest and Sudden Death in Dialysis Units. Kidney Int. 2001;60:350-57.

Lehrich RW, Pun PH, Tanenbaum ND, Smith SR, Middleton JP. Automated External Defibrillators and Survival from Cardiac Arrest in the Outpatient Hemodialysis Clinic. J Am Soc Nephrol. 2007;18:312-320.

Moss AH, Holley JL, Upton MB. Outcomes of Cardiopulmonary Resuscitation in Dialysis Patients. J Am Soc Nephrol. 1992; 3:238-43.

Moss AH, Hozayen O, King K, Holley JL, Schmidt RJ. Attitudes of Patients Toward Cardiopulmonary Resuscitation in the Dialysis Unit. Am J Kidney Dis. 2001;38:847-852.

Wong PYW, Kreuter W, Curtis JR, Hall YN. Trends in In-Hospital Cardiopulmonary Resuscitation and Survival in Adults Receiving Maintenance Dialysis. JAMA. 2015; 0406.


Murray AM, Arko C, Chen S-C, Gilbertson DT, Moss AH. Use of Hospice in the United States Dialysis Population. Clin J Am Soc Nephrol. 2006;1:1248-1255.

O’Connor NR, Dougherty M, Harris PS, Casarett DJ. Survival after dialysis discontinuation and hospice enrollment for ESRD. Clin J Am Soc Nephrol. December 2013; 8(12): 2117-22. doi: 10.2215/CJN.04110413.

Managing the Disruptive Patient

Allon M, Harbert G, Bova-Collis R, Roberts SV, Moss AH. The demented patient who declines to be dialyzed and the unhappy armed police officer son: what should be done? Clin J Am Soc Nephrol 2014; 9(4): 804-8.

Feely MA, Albright RC, Thorsteinsdottir B, Moss AH, Swetz KM. Ethical Challenges with Hemodialysis Patients who Lack Decision-making Capacity: Behavioral issues, Surrogate decision-makers, and End-of-life Situations. Kidney Int. 2014; 86: 475-480.

Pain and Symptoms

Barakzoy AS, Moss AH. Efficacy of the World Health Organization Analgesic Ladder to Treat Pain in End-Stage Renal Disease. J Am Soc Nephrol. 2006; 17:3198-3203.

Cohen LM, Tessier EG, Germain MJ, Levy NB. Update on Psychotropic Medication Use in Renal Disease. Psychosomatics. 2004;45:34-48.

Davison SN, Jhangri G, Johnson J. Longitudinal Validation of a Modified Edmonton Symptom Assessment System (ESAS) in Hemodialysis Patients. Nephrol Dial Transplant. November 2006; 21(11): 3189-95.

Davison SN, Jhangri G, Johnson JA. Cross Sectional Validity of a Modified Edmonton Symptom Assessment System in Dialysis Patients: A Simple Assessment of a Symptom Burden. Kidney Int. May 2006, 69(9):1621-1625.

Davison SN, Jhangri G. The impact of Chronic Pain on Depression, Sleep and the Desire to Withdraw from Dialysis in Hemodialysis Patients. J Pain Symptom Manage. November 2005;30(5):465-73.

Davison SN. Chronic Pain in End-Stage Renal Disease. Adv Chronic Kidney Dis. 2005;12(3):326-334.

Davison SN. Pain in Hemodialysis Patients: Prevalence, Cause, Severity, and Management. Am J Kidney Dis. 2003;42:1239-1247.

Davison SN. The prevalence and management of chronic pain in end-stage renal disease. J Palliat Med. 2007;10:1277-1287.

Dean M. Opioids in Renal Failure and Dialysis Patients. J Pain Symptom Manage. 2004;28:497-504.

Kimmel PL, Emont SL, Newmann JM, Danko H, Moss AH. ESRD Patient Quality of Life: Symptoms, Spiritual Beliefs, Psychological Factors, and Ethnicity. Am J Kidney Dis. 2003;42:713-721.

Murphy EJ. Acute Pain Management Pharmacology for the Patient with Concurrent Renal or Hepatic Disease. Anaesth Intensive Care. 2005;33:311-322.

Murtagh FEM, Addington-Hall JM, Edmonds PM, et al. Symptoms in advanced renal disease: A cross-sectional survey of symptom prevalence in stage 5 chronic kidney disease managed without dialysis. J Palliat Med. 2007;10:1266-1276.

Pasero C, McCaffery M. Ketamine. Am J Nursing. 2005;105:60-64.

Weisbord SD, Fried LF, Arnold RM, Fine MJ, Leveson DJ, Peterson RA, Switzer GE. Prevalence, Severity, Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients. J Am Soc Nephrol. 2005; 16:2487-2494.

Weisbord SD, Fried LF, Mor MK, Resnick AL, Unruh ML, Palevsky PM, Levenson DJ, Cooksey SH, Fine MJ, Kimmel PL, Arnold RM. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007; 2:960-967.

Palliative Care Overview

Cohen LM, Germain MJ. Palliative and Supportive Care. In: Brady HR, Wilcox CS, eds. Therapy of Nephrology and Hypertension: A Companion to Brenner’s The Kidney, 2nd Edition. Philadelphia: W. B. Saunders, Co, 2003: 753-756.

Davison SN. The ethics of end-of-life care for patients with ESRD. Clin J Am Soc Nephrol 2012; 7(12):2049-2057.

Germain MJ, Kurella Tamura M, Davison SN. Palliative Care in CKD: The Earlier the Better. Am J Kidney Dis. 2011; 57(3):378-380.

Grubbs V, Moss AH, Cohen LM, Fischer MJ, Germain MJ, Jassal SV, Perl J, Weiner DE, Mehrotra R. A Palliative Approach to Dialysis Care: A Patient-Centered Transition to the End of Life. Clin J Am Soc Nephrol. 2014. doi: 10.2215/CJN.00650114.

Holley JL. Palliative Care in End-Stage Renal Disease: Illness Trajectories, Communication, and Hospice Use. Adv Chronic Kidney Dis 2007;14 (4):402-408.

Cohen LM, Moss AH, Weisbord SD, Germain MJ. Renal palliative care. J Palliat Med. 2006; 9: 977-992.

Moss AH. Kidney Failure. In: Emanuel L, Librach SL, eds. Palliative Care: Core Skills and Clinical Competencies. Philadelphia: W.B. Saunders, 2007, pp. 354-368. 

Brown EA. Epidemiology of renal palliative care. J Palliat Med. 2007; 10:1248-1252.

Rosen D, Moss AH, Dower J, Parker J. Measuring ICU Palliative Care: Have we set the bar too low? [editorial] Crit Care Med 2012; 40(4): 1343-4.

Vandecasteele, SJ, Tamura MK. A Patient-Centered Vision of Care for ESRD: Dialysis as a Bridging Treatment or as a Final Destination? J Am Soc Nephrol. 2014; 25(8): 1647-51.

Wolf SM, Berlinger N, Jennings B. Forty Years of Work on End-of-Life Care – From Patients’ Rights to Systemic Reform. NEJM. 2015; 372 (7): 678-682.

Wong SPY, Kreuter W, O’Hare AM. Treatment Intensity at the End of Life in Older Adults Receiving Long-term Dialysis. Arch Intern Med. 2012;172:661-663.


Callanan M, Kelley P. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. New York: Bantam; 1993.Last updated: 5/4/15 9

Dunn H. Hard Choices For Loving People: CPR, Artificial Feeding, Comfort Care, and the Patient with a Life-Threatening Illness; 2001.

Okun B, Nowinski J. Saying Goodbye: How Families Can Find Renewal Through Loss. New York: The Berkley Publishing Group; 2011.

Webb M. The Good Death: The New American Search to Reshape the End of Life. New York: Bantam; 1997.

Patient Perspectives

Davison SN. End-of-Life Care Preferences and Needs: Perceptions of Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol. 2010;5(2):195-204.

Manns B, Hemmelgarn B, Lillie E, Dip SC, Cyr A, Gladish M, Large C, Silverman H, Toth B, Wolfs W, Laupacis A. Setting Research Priorities for Patients on or Nearing Dialysis. Clin J Am Soc Nephrol May 2014. doi: 10.2215/CJN.01610214

Morton RL, Tong A, Howard K, Snelling P, Webster AC. The views of patients and carers in treatment decision making for chronic kidney disease: systematic review and thematic synthesis of qualitative studies. BMJ. 2010; 340: c112.

Tamura MK, Periyakoil VS. The patient perspective and physician’s role in making decisions on instituting dialysis. Nephrol Dial Transplant. November 2013; 28(11): 2663-2666.

Tong A, Cheung KL, Nair SS, Tamura KM, Craig JC, Winkelmayer WC. Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD.” Am J Kidney Dis. June 2014; 63(6): 913-27.


O’Hare AM, Armistead N, Schrag WL, Diamond L, Moss AH. Patient-Centered Care: An Opportunity to Accomplish the “Three Aims” of the National Quality Strategy in the Medicare ESRD Program. Clin J Am Soc Nephrol 2014; 9: 2189-2194.

Ozar DT, Kristensen C, Fadem SZ, Blaser R, Singer D, Moss AH. Nephrologists’ professional ethics in dialysis practices. Clin J Am Soc Nephrol. 2013; 8: 840-844.

Tamura MK, Meier, DE. Five policies to promote palliative care for patients with ESRD. Clin J Am Soc Nephrol October 2014; 8(10): 1783-90. doi: 10.2215/CJN.02180213.

Vandecasteele SJ, Tamura MK. A Patient-Centered Vision of Care for ESRD: Dialysis as a Bridging Treatment or as a Final Destination? J Am Soc Nephrol 2014; 25: 1647-51.



Cohen LM, Ruthazer R, Moss AH, Germain MJ. Predicting six-month mortality in patients maintained with hemodialysis. Clin J Am Soc Nephrol. 2010; 5(1):72-79.

Kurella M, Covinsky KE, Collins AJ, et al. Octogenarians and Nonagenarians Starting Dialysis in the United States. Ann Intern Med. 2007;146:177–183.

Kurella Tamura M, Covinsky KE, Chertow GM, et al. Functional Status of Elderly Adults Before and After Initiation of Dialysis. N Engl J Med. 2009; 361:1539–1547.

Moss AH, Ganjoo J, Sharma S, et al. Utility of the “Surprise” Question to Identify Dialysis Patients with High Mortality. Clin J Am Soc Nephrol. 2008;3(5):1379-1384.

Vascular Access Considerations

Drew DA, Lok CE, Cohen JT, Wagner M, Tangri N, Weiner DE. Vascular Access Choice in Incident Hemodialysis Patients: A Decision Analysis. J Am Soc Nephrol 2014; 4. doi: 10.1681/ASN.2013111236.

Kaufman SR, Shim JK, Russ AJ: Old age, life extension, and the character of medical choice. The journals of gerontology. Series B, Psychological sciences and social sciences 2006; 61:S175-184.

Moist LM, Lok CE, Vachharajani TJ, et al: Optimal hemodialysis vascular access in the elderly patient. Semin Dial. 2012; 25:640-648.

Richardson AI, 2nd, Leake A, Schmieder GC, et al: Should fistulas really be first in the elderly patient? J Vasc Access. 2009; 10:199-202.

Tamura MK, Tan JC, O’Hare AM: Optimizing renal replacement therapy in older adults: a framework for making individualized decisions. Kidney Int. 2012; 82:261-269.

Vachharajani TJ, Moossavi S, Jordan JR, et al: Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis. Clin J Am Soc Nephrol. 2011; 6:1663-1667.

Xi W, Harwood L, Diamant MJ, et al: Patient attitudes towards the arteriovenous fistula: a qualitative study on vascular access decision making. Nephrol Dial Transplant. 2011; 26:3302-3308.

Withdrawal of Dialysis and End-of-Life Decision-Making

Cohen LM, Germain MJ, Woods AL, Mirot A, Burleson JA. The Family Perspective of ESRD Deaths. Am J Kidney Dis. 2005;45(1):154-161.

Cohen LM, Germain M, Poppel DM, Pekow PS, Woods A, Kjellstrand CM. Dying Well After Discontinuing the Life-Support Treatment of Dialysis. Arch Intern Med. 2000;160:2513-2518.

Cohen LM, Germain MJ, Poppel DM. Practical Considerations in Dialysis Withdrawal: “To have that option is a blessing.” JAMA. 2003;289:2113-2119.

Cohen LM, Bostwick JM, Mirot A, Garb J, Braden G, Germain M. A Psychiatric Perspective of Dialysis Discontinuation. J Palliat Med. 2007;10:1262-1265.

Davison SN, Jhangri GS, Holley JL, Moss AH. Nephrologists’ Comfort with End-of-Life Decision-Making. Clin J Am Soc Neph. 2006;1:1256-1262.

Footel C, Morton RL, Jardine M, Gallagher M, Brown M, Howard K, Cass A. Considerations of Nephrologists when Suggesting Dialysis in Elderly patients with Renal Failure (CONSIDER): a discrete choice experiment. Nephrol Dial Transplant. 2014: 1-8.

Germain MJ, Davison SN, Moss AH. When Enough Is Enough: The Nephrologist’s Responsibility in Ordering Dialysis Treatment. Am J Kidney Dis. 2011; 58 (1): 135-143.

Hickman SE, Nelson CA, Moss AH, Tolle SW, Perrin NA, Hammes BJ. The Consistency Between Treatments Provided to Nursing Facility Residents and Orders on the Physician Orders for Life-sustaining Treatment (POLST) Form. J Am Geriatr Soc 2011: 2091-2099.

Holley JL, Davison SN, Moss AH. Nephrologists’ Changing Practices in Reported End-of-Life Decision-Making. Clin J Am Soc Nephrol. 2007;2:107-111.

Moss AH. Ethical Principles and Processes Guiding Dialysis Decision-Making. Clin J Am Soc Nephrol 2011;6(9);2313-2317.

Moss AH. Patient Selection for Dialysis, the Decision to Withdraw Dialysis, and Palliative Care. In: Brady HR, Wilcox CS, eds. Therapy in Nephrology and Hypertension, 2nd edition. Philadelphia: W. B. Saunders, Co., 2003:875-882.

Muthalagappan S, Johansson L, Kong WM, Brown E. Dialysis or Conservative care for Frail Older Patients: Ethics of Shared Decision-making. Nephrol Dial Transplant. November 2013; 28(11): 2717-22.

Schmidt RJ, Moss AH. Dying on Dialysis: The Case for a Dignified Withdrawal. Clin J Am Soc Nephrol. January 2014; 9(1): 174-80.

Sekkarie, MA, Moss, AH. Withholding and Withdrawing Dialysis: The Role of Physician Specialty and Education and Patient Functional Status. Am J Kidney Dis. 1998;31:464-472.

Vandecasteele SJ, Tamura MK. A Patient-Centered Vision of Care for ESRD: Dialysis as a Bridging Treatment or as a Final Destination? J Am Soc Nephrol. August 2014; 25(8): 1647-51.