Effect of Starting Dialysis Versus Continuing Medical Management on Survival and Home Time in Older Adults With Kidney Failure
Maria E. Montez‐Rath, I‐Chun Thomas, Vivek Charu, Michelle C. Odden, Carolyn D. Seib, Shipra Arya, Enrica Fung, Ann M. O’Hare, Susan Wong, Manjula Kurella Tamura
Abstract
BACKGROUND: For older adults with kidney failure who are not referred for transplant, medical management is an alternative to dialysis. OBJECTIVE: and those who continued medical management. DESIGN: Observational cohort study using target trial emulation. SETTING: U.S. Department of Veterans Affairs, 2010 to 2018. PARTICIPANTS: who were not referred for transplant. INTERVENTION: Starting dialysis within 30 days versus continuing medical management. MEASUREMENTS: Mean survival and number of days at home. RESULTS: Among 20 440 adults (mean age, 77.9 years [SD, 8.8]), the median time to dialysis start was 8.0 days in the group starting dialysis and 3.0 years in the group continuing medical management. Over a 3-year horizon, the group starting dialysis survived 770 days and the group continuing medical management survived 761 days (difference, 9.3 days [95% CI, -17.4 to 30.1 days]). Compared with the group continuing medical management, the group starting dialysis had 13.6 fewer days at home (CI, 7.7 to 20.5 fewer days at home). Compared with the group continuing medical management and forgoing dialysis completely, the group starting dialysis had longer survival by 77.6 days (CI, 62.8 to 91.1 days) and 14.7 fewer days at home (CI, 11.2 to 16.5 fewer days at home). LIMITATION: Potential for unmeasured confounding due to lack of symptom assessments at eligibility; limited generalizability to women and nonveterans. CONCLUSION: who were not referred for transplant had modest gains in life expectancy and less time at home. PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and National Institutes of Health.