Dialysis May Not Be Optimal for All Older Adults with Kidney Failure, Study Reveals - Video

A recent study published in the journal Annals of Internal Medicine found that older adults who were not healthy enough for a kidney transplant, starting dialysis when their kidney function fell below a certain threshold — rather than waiting — afforded them roughly one more week of life.

Patients with kidney failure who are in good enough health to undergo transplantation can benefit from a donated kidney, which helps remove toxins and excess fluid from their blood. However, this option is not available to many older adults who have additional health issues such as heart disease, lung disease, or cancer.

For patients who cannot undergo a kidney transplant, physicians frequently recommend dialysis, a treatment that performs the blood-cleaning functions of healthy kidneys. Kidney failure is diagnosed when a patient’s estimated glomerular filtration rate (eGFR), an indicator of kidney function, drops below 15.

The researchers aimed to assess the impact of dialysis on older adults who are not eligible for a kidney transplant, focusing on its effects on life extension and the number of days spent in inpatient settings such as hospitals, nursing homes, or rehabilitation centers.

The team analyzed health records from 2010 to 2018 for 20,440 patients (98% of whom were men). These patients, aged 65 and older, had chronic kidney failure, were not under evaluation for a transplant, and had an eGFR below 12.

They divided patients into two groups: those who began dialysis immediately and those who postponed it for at least a month. Over three years, approximately half of those who delayed dialysis never eventually started it.

Patients who began dialysis right away lived, on average, nine days longer than those who waited, but they spent 13 more days in an inpatient facility. Age played a role in the outcomes: patients aged 65 to 79 who started dialysis immediately lived 17 fewer days on average and spent 14 more days in an inpatient facility, while patients aged 80 and older who started dialysis immediately lived 60 more days on average but spent 13 additional days in an inpatient setting.

Patients who never started dialysis, on average, died 77 days sooner than those who began dialysis right away but spent 14 more days at home.

Researchers concluded that older adults who began dialysis when their eGFR dropped below 12 mL/min/1.73 m² and were not considered for a transplant experienced only modest increases in life expectancy and spent less time at home.

Reference: Montez-Rath, M. E., Thomas, I.-C., Charu, V., Odden, M. C., Seib, C. D., Arya, S., Fung, E., O’Hare, A. M., Wong, S. P. Y., & Kurella Tamura, M. (2024). Effect of starting dialysis versus continuing medical management on survival and home time in older adults with kidney failure: A target trial emulation study. Annals of Internal Medicine. https://doi.org/10.7326/M23-3028