A Stanford Medicine-led study has provided new insights into the decision-making process for starting dialysis in frail, older patients. The research suggests that initiating dialysis immediately when kidney function declines offers minimal life extension, but at the cost of increased time spent in hospitals or care facilities. A new study emphasizes the need to carefully weigh the benefits and burdens of dialysis, particularly for older adults with complex health issues.*

Dialysis Timing and Life Expectancy

The study evaluated the health records of over 20,000 patients (98% men) aged 65 and older with chronic kidney failure, focusing on those not eligible for kidney transplants. All had eGFRs below 12. 

Researchers found that patients who started dialysis immediately after their kidney function dropped below a certain threshold lived only nine days longer on average than those who delayed treatment. 

This small gain in life expectancy came with a significant cost, however. Those patients spent an average of 13 more days in hospitals or care facilities compared to patients who delayed dialysis.

Impact of Age on Outcomes

The findings also revealed that age significantly affects the outcomes of immediate dialysis. 

• For patients aged 65 to 79, starting dialysis immediately actually reduced life expectancy by 17 days, while increasing the time spent in inpatient facilities by 14 days.
• Patients aged 80 and above who began dialysis immediately lived an average of 60 days longer, though they still spent 13 additional days in care facilities. 

These findings highlight the complexity of deciding when to start dialysis, particularly for older adults.

“Different patients will have different goals,” said Manjula Tamura, MD, senior author of the study. “For some, it’s a blessing to have this option of dialysis, and for others, it might be a burden.”

Consideration of Patient Goals

The researchers stressed the importance of a more nuanced approach to dialysis for older adults. Dialysis is often framed as a life-saving treatment, but this study suggests it might be more appropriate to view it as a palliative option. 

“When treatment is framed as symptom-alleviating,” Tamura said, “patients can more readily understand that there are trade-offs.”

By presenting dialysis in this way, patients and their families can better grasp the complexities involved and make treatment decisions that align with their personal goals, preferences, and quality of life. 

*Stanford University. (2024, August 19). Study Finds Dialysis May Not Be the Best Option for Older Adults With Kidney Failure. Stanford Report.

https://news.stanford.edu/stories/2024/08/for-some-older-adults-with-kidney-failure-dialysis-may-not-be-the-best-option 

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