Abstract: SA-PO1121
Decisions About Kidney Replacement Therapy in a Large US Health System
Session Information
- Geriatric Nephrology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Wong, Susan P.Y., University of Washington, Seattle, Washington, United States
- Kornowske, Lindsey M., Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
- Jones, Cami R., Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
- Reynolds, Christina, Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
- Laundry, Ryan, VA Puget Sound Health Care, Seattle, Washington, United States
- Daratha, Kenn B., Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
- Tuttle, Katherine R., Providence Medical Research Center, Providence Inland Northwest Health, Spokane, Washington, United States
Background
Clinical equipoise exists regarding whether initiating maintenance dialysis offers greater benefit than conservative management in older patients with significant comorbidity and frailty. This uncertainty should be carefully considered in decisions about kidney replacement therapy (KRT).
Methods
We conducted a retrospective cohort study of adults with advanced kidney disease receiving care in the Providence Health System to determine the treatment decision made for kidney failure. Advanced kidney disease was defined as ≥2 outpatient measures of estimated glomerular filtration rate (eGFR) ≤15 mL/min/1.73m2 for ≥90 days between 2006-2020. The index date was the second eGFR ≤15 mL/min/1.73m2. Patients were followed through death or December 31, 2022. We used procedure code search of administrative files to identify patients who received KRT. For the remaining patients, we reviewed documentation in their clinical progress notes to determine the treatment decision made closest to the end of follow-up. Baseline demographic and clinical data were abstracted from electronic health records for the year prior to entry.
Results
Among patients with advanced kidney disease (n=16,181), 90.7% (n=14,679) received KRT based on either procedure code search or documentation in chart notes, 3.7% (n=592) were discussing/preparing for KRT, and 5.6% (n=910) decided against KRT. Most patients who had forgone KRT were women (64.6%) and non-Hispanic white (71.5%). Decisions to forgo dialysis were most common among patients with dementia (41.4%) and those aged ≥85 years (26.1%), though the majority in both groups were still treated with KRT (Figure).
Conclusion
Most patients approaching kidney failure receive or are preparing for KRT irrespective of age or underlying comorbidities, highlighting the need for a more nuanced, patient-centered approach to decision-making about treatment of kidney failure.
Funding
- Private Foundation Support