(2024-09-01) Dialysis May Prolong Life For Older Patients But Not By Much

Dialysis May Prolong Life for Older Patients. But Not by Much. ...a simulated trial involving records from more than 20,000 older patients (average age: about 78) in the Veterans Health Administration system. (simulated?)

Over three years, older patients with kidney failure who started dialysis right away lived for an average of 770 days — just 77 days longer than those who never started it.

Moreover, those patients spent less time at home; they were in a hospital, a nursing home or a rehab center for about 15 more days than those who never started dialysis.

Another group didn’t begin dialysis early but continued with “medical management” (which could help alleviate symptoms if needed), though half of them started dialysis at some later point. They lived for about the same amount of time as those who started dialysis right away.

About a third of the population over age 65 have chronic kidney disease.

Among older adults who progress to kidney failure, most also have diabetes and many have heart failure, pulmonary disease or other serious chronic illnesses.

About 13 percent of the patients with kidney failure who register with the Renal Data System begin peritoneal dialysis at home

But a great majority, almost 84 percent in 2021, still turn to dialysis centers

Hemodialysis, the treatment offered in centers, requires a catheter, graft or fistula to allow access to a patient’s blood vessels, and it can cause side effects like infections, fatigue and itching.

The alternative to dialysis goes by various names — medical management, conservative kidney management, supportive kidney care. In this scenario, nephrologists monitor their patients’ health, educating them about behavioral approaches, prescribing anti-nausea drugs like Zofran and diuretics like Lasix to reduce fluid retention, and adjusting their doses as needed.

“They’re more complicated — we have to pay a lot more attention,” she said. “But they sleep in their own beds. They’re not in the hospital a lot. They have a better quality of life.”

Researchers at the University of Washington developed a “decision aid” — a booklet explaining conservative kidney management and its pros and cons — and tried it out on patients 75 and older with advanced kidney disease and their families. The goal: to prompt discussion of conservative management with a health care provider.

In the groups that received the booklet, about a quarter of patients and their relatives had such conversations. But among those who didn’t get the booklet, only 3 percent of patients discussed

the use of peritoneal dialysis at home more than doubled from 2008 to 2021; the proportion of patients traveling to dialysis centers declined.

Several things in the kidney world appear to be getting better,”

The proportion of older Americans with kidney disease has fallen, in part reflecting the wider use of more effective blood pressure drugs in recent decades, he said. The new (GLP-1) diabetes drugs that help reduce weight and blood sugar also show promise for treating kidney disease.