Abstract: SA-PO1117
Representation of Adults Older Than 75 Years in Dialysis Outcome Studies: Implications for Generalizability
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Thakkar, Anand, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, United States
- Thakkar, Priyesh T., Northeast Kidney Care, Northfield, New Jersey, United States
Background
End-stage renal disease disproportionately affects older adults, with the incidence rate of patients aged ≥75 increasing and representing a growing segment of the dialysis population. However, many trials and cohort studies underrepresent very elderly patients, particularly those with multiple comorbidities or who do not explicitly analyze outcomes in this age group. This raises questions about the applicability of research evidence to the patients most commonly encountered in clinical practice.
Methods
A narrative review was conducted of peer-reviewed studies, meta-analyses, and registry data examining clinical outcomes in older adults receiving dialysis or conservative management.
Results
Older adults constitute a large proportion of ESRD patients starting dialysis, with an incident rate rising to approximately 1744 per million population in those aged ≥75.1 Observational data indicate 1-year mortality rates of ~46% among patients aged ≥80 after dialysis initiation, significantly higher than in younger cohorts.2 Among maintenance peritoneal dialysis patients, survival rates for those ≥75 were 76.8% at 1 year, 37.5% at 3 years, and 17.6% at 5 years, compared with 91.2%, 68.0%, and 51.3% for those aged 65-74.3
Comparative survival studies demonstrate that elderly patients ≥75 managed with dialysis have higher 1- and 2-year survival rates (84% and 76%) compared with conservative care (68% and 47%), though this advantage diminishes in the context of significant comorbidity.4 Systematic reviews report median survival times of 8–67 months with dialysis versus 6–30 months with conservative care, but heterogeneity and comorbidity burden limit definitive conclusions.5 Frailty is prevalent (up to 46%) in older haemodialysis populations and is associated with increased hospitalization, dependency, and mortality.6 Notably, many interventional dialysis studies exclude patients with significant comorbidities or functional impairment, limiting the external validity of outcomes for those ≥75.
Conclusion
While dialysis may confer a survival benefit for some older adults, evidence suggests diminishing advantage with increasing age and comorbidity burden. High mortality, frequent hospitalization, and frailty challenges highlight the need for dedicated research in patients ≥75. Underrepresentation in clinical trials and cohort studies complicates shared decision-making and may bias treatment recommendations.