When people hear that their kidneys are failing, one of the first treatments they think about is dialysis. This treatment helps clean the blood when the kidneys can no longer do their job. For many patients, it is seen as a life-saving option.
However, new research suggests that for some older adults, especially those who cannot get a kidney transplant, starting dialysis early may not always lead to better outcomes.
The study was led by researchers from Stanford Medicine and the University of California. It looked at how early dialysis affects older patients with advanced kidney disease. These are patients whose kidneys are no longer working well, and their ability to remove waste from the body is very limited.
Doctors often use a test called the estimated glomerular filtration rate, or eGFR, to measure kidney function. When this number drops below 15, it usually means the kidneys are close to failing, and dialysis is often recommended. The idea is that starting dialysis early can help remove waste and extend life.
But this new study shows that the situation may not be so simple, especially for older adults with other health problems such as heart or lung disease. Many of these patients are not candidates for a kidney transplant, which is usually the best long-term treatment for kidney failure.
The researchers studied health records from more than 20,000 patients aged 65 and older. All of these patients had very low kidney function and were not being considered for transplant. The team compared patients who started dialysis right away with those who delayed it.
The results were surprising. On average, patients who started dialysis immediately lived only about nine days longer than those who delayed the treatment. However, they spent about 13 more days in hospitals or care facilities. This means that although they lived slightly longer, they spent more time receiving medical care and less time at home.
For patients aged 65 to 79, the results were even more unexpected. Those who started dialysis early actually lived about 17 days less than those who delayed it. They also spent more time in hospitals and nursing homes.
For patients aged 80 and older, starting dialysis early did lead to a longer life, about 60 extra days on average, but this also came with more time spent in inpatient care.
Interestingly, some patients who delayed dialysis never started it at all. These patients lived about 77 days less than those who received dialysis, but they had more time at home instead of in medical settings. This shows that there is a trade-off between living longer and the quality of that time.
Dialysis itself is not an easy treatment. It usually requires going to a clinic three times a week, with each session lasting three to four hours. It can also cause side effects such as muscle cramps, tiredness, and low energy. For older patients who are already dealing with other health issues, this can be physically and emotionally challenging.
In some cases, patients can manage symptoms of kidney failure, such as swelling or nausea, with medications and supportive care instead of dialysis. This approach focuses more on comfort and quality of life rather than extending life at all costs.
The researchers say that many patients and families believe dialysis is the only option or that it will greatly extend life. However, this study shows that the benefits may be limited for certain groups, especially older adults with complex health conditions.
The lead author, Maria Montez Rath, explained that the goal of the study was to give patients and doctors a clearer understanding of what dialysis really offers. Senior author Dr. Manjula Tamura emphasized that the decision to start dialysis should not be based only on test results, but also on the patient’s personal goals and preferences.
Doctors often recommend dialysis because they want to help patients live longer. However, they may not always fully explain the downsides, such as frequent hospital visits and the physical burden of treatment. Presenting dialysis as one option among many, rather than the only choice, may help patients make better decisions.
This study highlights the importance of open and honest conversations between patients, families, and doctors. Every person is different, and what works for one patient may not be right for another. Some people may choose dialysis to extend their life, while others may prefer to focus on comfort and spending more time at home.
In the end, the decision is deeply personal. It depends on how a patient values time, quality of life, and medical care. By understanding the full picture, patients can make choices that match their own priorities and live in a way that feels right for them.
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.
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The study was published in the journal Annals of Internal Medicine.
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