A Stanford-led study found that frail older adults who delayed starting dialysis lived only nine days less on average but spent more time at home than those who began treatment right away.
For older adults with complex health issues, starting dialysis immediately when kidney function drops slightly extends life by about a week. However, it adds two more weeks in a hospital or care home.
The study suggests that whether to start dialysis right away for kidney failure might need more careful thought, especially for those not healthy enough for a kidney transplant.
Older adults who start dialysis right away spend about two extra weeks in hospitals or care facilities in addition to dialysis time. Maria Montez Rath, PhD, a lead researcher, questions whether older patients want this.
Her study, published in Annals of Internal Medicine, emphasizes the need for older patients and their doctors to carefully weigh the benefits and drawbacks of starting dialysis. Understanding these trade-offs is crucial for those not fit for a kidney transplant, which removes toxins from the blood.
Doctors often recommend dialysis for kidney failure when the eGFR drops below 15. Many patients think dialysis is their only option. They will greatly extend their life, but other treatments, like medications, can manage symptoms.
Dialysis can cause side effects like cramping and fatigue and requires regular clinic visits. It also involves significant lifestyle changes.
A study analyzed the health records of 20,440 older patients who weren’t eligible for kidney transplants.
It found that starting dialysis immediately added about nine days to life and increased time spent in hospitals or care facilities by 13 days. The impact varied by age: those 65-79 lived 17 fewer days but spent 14 more days in facilities. In comparison, those 80 and older lived 60 more days but spent 13 additional days in facilities.
Patients who didn’t start dialysis lived 77 days less on average but spent 14 more days at home. The study shows that starting dialysis right away can extend life but often means more dialysis time and hospital stays.
Doctors sometimes recommend dialysis to give hope or because the downsides aren’t always clear. The study suggests that waiting until the eGFR drops further and considering symptoms and personal preferences might be better.
Dialysis should be seen as a way to relieve symptoms, not just a choice between life and death, which helps patients understand its trade-offs better.
Journal reference :
- Maria E. Montez-Rath, Chun Thomas et al., 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. DOI: 10.7326/M23-3028.