Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5
Open accessAbstract
BACKGROUND: The number of elderly patients with chronic kidney disease (CKD) stage 5 is steadily increasing. Evidence is needed to inform decision-making for or against dialysis, especially in those patients with multiple comorbid conditions for whom dialysis may not increase survival. We therefore compared survival of elderly patients with CKD stage 5, managed either with dialysis or conservatively (without dialysis), after the management decision had been made, and explored which of several key variables were independently associated with survival. METHODS: A retrospective analysis of the survival of all over 75 years with CKD stage 5 attending dedicated multidisciplinary pre-dialysis care clinics (n=129) was performed. Demographic and comorbidity data were collected on all patients. Survival was defined as the time from estimated GFR<15 ml/min to either death or study endpoint. RESULTS: One- and two-year survival rates were 84% and 76% in the dialysis group (n=52) and 68% and 47% in the conservative group (n=77), respectively, with significantly different cumulative survival (log rank 13.6, P<0.001). However, this survival advantage was lost in those patients with high comorbidity scores, especially when the comorbidity included ischaemic heart disease. CONCLUSIONS: In CKD stage 5 patients over 75 years, who receive specialist nephrological care early, and who follow a planned management pathway, the survival advantage of dialysis is substantially reduced by comorbidity and ischaemic heart disease in particular. Comorbidity should be a major consideration when advising elderly patients for or against dialysis.
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As many as one third of older ESRD patients have at least four other chronic conditions when they reach ESRD.
“Up to one third of elderly patients with ESRD have four or more chronic health conditions when they reach ESRD [5]”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [5]
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- Authors
- Murtagh, F. E. M., Marsh, J. E., Donohoe, P., Ekbal, N. J., Sheerin, N. S., & Harris, F. E.
- Affiliations
- St George's Hospital (GB)
- Venue
- Nephrology Dialysis Transplantation
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-04-20
- Volume
- 22
- Issue
- 7
- Pages
- 1955-1962
- ISSN
- 0931-0509 (ISSN-L)
- 1460-2385
- OpenAlex
- W2157260213
- Cited by
- 643
- References
- 30
- Citations by year
- 2026: 19 · 2025: 13 · 2024: 18 · 2023: 22 · 2022: 17 · 2021: 21 · 2020: 22 · 2019: 39 · 2018: 29 · 2017: 32 · 2016: 45 · 2015: 54 · 2014: 62 · 2013: 55 · 2012: 58
- FWCI
- 23.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Nephrology Dialysis Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- dialysis, conservative treatment, end-stage renal disease, elderly patients, survival, comorbidities, ischemic heart disease, pre-dialysis care, treatment decision-making
- MeSH terms
- Aged, Aged, 80 and over, Chronic Disease, Female, Glomerular Filtration Rate, Renal Dialysis, Humans, Kidney Diseases, Male, Retrospective Studies, Severity of Illness Index, Myocardial Ischemia, Kaplan-Meier Estimate
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