A new study suggests that for many older adults with kidney failure who cannot get a transplant, starting dialysis right away may not always be the best decision.
The research was done by Stanford Medicine and the University of California. It found that early dialysis only added a few extra days of life, while also leading to more time spent in hospitals or nursing homes.
Dialysis is a treatment that removes waste and extra fluid from the blood when the kidneys are no longer working well. It is often suggested when a person’s eGFR (estimated glomerular filtration rate) drops below 15.
But for older people who have other health problems—like heart or lung disease—and who cannot get a kidney transplant, the benefits of dialysis may be smaller than expected.
Many patients and their families believe that dialysis is the only option or that it will help them live much longer. But this study shows that is not always true.
On average, people who started dialysis early lived only about nine days longer than those who delayed it—but they also spent 13 more days in hospitals or care homes. That means they had less time at home and more time receiving medical care.
For patients aged 65 to 79, early dialysis actually led to a shorter life—17 fewer days—and more time in care facilities. For people aged 80 and older, early dialysis added about 60 more days of life, but also more time spent away from home.
Some people who never started dialysis lived about 77 days less than those who did, but they had more time in their own homes.
The researchers looked at health records from more than 20,000 U.S. veterans aged 65 or older with serious kidney disease. All of them had low kidney function (eGFR below 12) and were not being considered for kidney transplants. About half of the people who delayed dialysis never ended up needing it.
Dr. Maria Montez Rath, the lead author of the study, said the goal was to help patients better understand what dialysis really means. Dr. Manjula Tamura, the senior author, added that the decision to start dialysis should be based on what each person wants, not just on lab numbers.
Dialysis is a big commitment. Most people go to a clinic three times a week, and each visit takes three to four hours. It can also cause side effects like cramps, tiredness, and dizziness. In some cases, symptoms like swelling or nausea can be managed with medicine instead of dialysis.
Dr. Tamura explained that doctors often recommend dialysis because they want to help patients, but they may not always explain the downsides clearly. Talking about dialysis as a way to manage symptoms—not just as a way to extend life—could help patients make better choices, especially older and frail ones.
In the end, each person has different goals. For some, dialysis can help. For others, it may feel like a burden. The study encourages patients and doctors to have honest conversations about what matters most to the patient’s life and health.
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This research was published in the journal Annals of Internal Medicine.
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