Dialysis versus conservative kidney management in older adults: why one size does not fit all.
Dragos Scripcariu, Andreea Covic, Loredana-Mariana Agavriloaei et al.
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In 30 seconds
This narrative review synthesized observational, cohort, and systematic review evidence comparing dialysis with conservative kidney management (CKM) in adults aged ≥70 years with stage 4–5 chronic kidney disease. Across the included studies, dialysis was associated with longer survival mainly among younger and less comorbid patients; its advantage diminished with greater frailty and multimorbidity. CKM was associated with comparable or better health-related quality of life and fewer hospitalizations. The review also considered prognostic factors and models, noting that patient characteristics were more influential than treatment modality and that CKM-specific prognostic tools remain limited.
Key findings
- Dialysis-associated survival advantage was concentrated in younger, less comorbid patients and diminished with frailty and multimorbidity.
- CKM was associated with comparable or superior health-related quality of life and fewer hospitalizations.
- Conservatively managed patients were more likely to die at home, consistent with closer alignment to end-of-life preferences.
- Age, frailty, and eGFR decline were identified as key prognostic factors; CKM-specific prognostic models remain limited.
Why it matters
The review highlights that dialysis may not offer the same survival benefit to all older adults with advanced CKD, while treatment burden and quality of life are important outcomes. Considering frailty, comorbidity, prognosis, and patient goals alongside survival can support more individualized discussions of kidney care options.
What to keep in mind
The review searched only PubMed and synthesized evidence from observational, cohort, and systematic review studies, limiting the breadth and certainty of its conclusions.