Conservative Kidney Management Can Offer Meaningful Survival in Dialysis-Suitable Older Adults: Study
A new study published in the journal of Kidney Medicine found that survival with conservative kidney management (CKM) in older adults with kidney failure was longer than previously reported, particularly among patients considered medically suitable for dialysis. Median survival was approximately 53 months with dialysis, 32 months with CKM among dialysis-suitable patients, and 18 months with CKM among those less suitable for dialysis. These findings emphasize the importance of considering dialysis suitability when comparing treatment strategies and support individualized shared decision-making for older adults with advanced kidney disease.
Previous studies may have underestimated survival in CKM because they grouped together all patients choosing conservative care, regardless of whether they were medically eligible for dialysis. By separating these groups, the current findings provide a more realistic estimate of survival for patients considering CKM as a viable alternative.
This study examined survival outcomes among patients aged 65 years and older who made a documented treatment decision between dialysis and CKM from 2017 to 2024. This research distinguished between patients who chose CKM despite being suitable for dialysis and those considered less suitable for the treatment. The single-center cohort study found that patients who chose dialysis had a median survival of 53 months after making their treatment decision. Patients who opted for CKM while still considered suitable candidates for dialysis had a median survival of 32 months, while those deemed less suitable for dialysis survived a median of 18 months.
When compared with patients receiving dialysis, the unadjusted risk of death was more than twice as high among CKM patients who were suitable for dialysis and more than three times higher among those less suitable for dialysis. However, among patients aged 80 years and older, the survival difference between dialysis and CKM for those suitable for dialysis was less pronounced, suggesting that the survival advantage of dialysis diminishes in very elderly patients.
Around 13% of patients who initially chose dialysis later transitioned to conservative kidney management, while only 1% of patients who initially selected CKM eventually switched to dialysis, which showed that treatment preferences remained largely stable. Overall, the findings highlight the importance of individualized shared decision making for older adults with advanced kidney disease. Rather than relying solely on age or treatment type, clinicians are encouraged to consider a patient's overall health, dialysis suitability, and personal preferences when discussing care options.
Source:
Jongejan, M., van Buren, M., Verberne, W. R., Ocak, G., & Bos, W. J. W. (2026). Survival of older adults choosing dialysis or conservative kidney management, stratified by suitability for dialysis. Kidney Medicine, 8(8), 101430. https://doi.org/10.1016/j.xkme.2026.101430
