A new study suggests that for older adults with kidney failure who aren’t eligible for a transplant, starting dialysis early may not always be the best option.
The research, led by Stanford Medicine and the University of California, shows that starting dialysis right away added just a few extra days of life—while also increasing the time spent in hospitals or care facilities.
Dialysis is often recommended when kidney function drops to very low levels, measured by a test called eGFR (estimated glomerular filtration rate). When eGFR falls below 15, doctors typically suggest dialysis, which removes waste from the blood like healthy kidneys would.
But for many older patients—especially those with other health issues like heart or lung disease—a kidney transplant isn’t an option, and dialysis may not provide the benefits they expect.
Many patients and families believe dialysis is the only choice or that it will greatly extend life.
However, the study found that patients who started dialysis right away lived only about nine days longer on average than those who delayed it—but spent 13 more days in hospitals or nursing homes. That means they had less time at home, and more time receiving intensive care.
For people aged 65 to 79, those who started dialysis immediately actually lived 17 fewer days and spent more time in care facilities. For those aged 80 and older, early dialysis led to a slightly longer life—about 60 more days—but still added time in inpatient care. People who never started dialysis lived 77 fewer days than those who did but had more time at home.
The researchers used health records from over 20,000 veterans, all 65 or older, with advanced kidney disease. These patients had low eGFR levels (below 12) and weren’t being considered for transplants. About half of those who delayed dialysis ended up never starting it at all.
The study’s lead author, Maria Montez Rath, PhD, said the goal was to better understand what dialysis really means for older patients. Senior author Dr. Manjula Tamura added that the decision to start dialysis should be based on personal preferences, not just test results.
Dialysis is a serious treatment. It usually requires visiting a clinic three times a week for three to four hours at a time. It can also cause side effects like cramping and fatigue. In contrast, some people with kidney failure can manage symptoms like swelling or nausea with medication.
Tamura said that doctors often recommend dialysis with good intentions—to give patients hope—but may not fully explain the trade-offs. Framing dialysis as a symptom-relief option, especially for frail older adults, could help patients make more informed decisions.
This way, patients understand that it’s not just a choice between life and death but a treatment with pros and cons.
Ultimately, each patient has different goals. For some, dialysis may be a helpful tool. For others, it could be a burden that reduces quality of life. The study encourages doctors and patients to discuss these options more openly and carefully.
If you care about kidney health, please read studies about pesticide linked to chronic kidney disease, and this drug may prevent kidney failure in people with diabetes.
For more health information, please see recent studies about drug duo that may treat kidney failure, and results showing these vegetables may protect against kidney damage.
The study is published in Annals of Internal Medicine.
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