Survival of Older Adults Choosing Dialysis or Conservative Kidney Management, Stratified by Suitability for Dialysis.
Patients suitable for dialysis choosing conservative management had a higher mortality hazard.
Survival of Older Adults Choosing Dialysis or Conservative Kidney Management, Stratified by Suitability for Dialysis.
Previous studies indicate survival benefit for dialysis over conservative kidney management (conservative kidney management), which attenuates in patients ≥80 years or with high comorbidity.
We aimed to describe survival outcomes in patients choosing dialysis, patients suitable for dialysis who chose conservative kidney management, and patients less suitable for dialysis who chose conservative kidney management.
We included patients aged ≥65 years with a documented treatment decision for dialysis or conservative kidney management between 2017 and 2024.
Among patients aged ≥80 years, hazard ratios were 1.89 (0.99-1.74) for conservative kidney management suitable for dialysis versus dialysis and 2.35 (1.31-4.64) for conservative kidney management less suitable for dialysis versus dialysis.
Thirteen percent of patients who initially chose dialysis switched to conservative kidney management, whereas 1% transitioned from conservative kidney management to dialysis.
LIMITATIONS: Subjectivity in dialysis suitability assessment.
In this cohort of older patients with kidney failure, survival outcomes in patients choosing conservative kidney management suitable for dialysis were longer than previously reported.
These findings highlight the importance of distinguishing dialysis suitability when evaluating survival outcomes in conservative kidney management and dialysis.
This supports more individualized shared decision making in older adults with advanced kidney disease.