Location
Philadelphia, PA
Start Date
17-4-2026 1:30 PM
End Date
17-4-2026 2:30 PM
Description
Background: End-stage renal disease (ESRD) 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 either underrepresent very elderly patients, particularly those with frailty or multiple comorbidities, or 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.
Objective: To evaluate how adults aged 75 and older are represented in dialysis outcome studies and to summarize survival and quality-of-life evidence relevant to this group.
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. Articles reporting survival, hospitalization, and comorbidity effects in patients aged ≥75 were included.
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.
Discussion: 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.
Conclusion: Adults aged ≥75 are underrepresented in dialysis outcome research despite being a significant portion of the ESRD population. Current evidence indicates high early mortality and variable survival benefit, particularly in the presence of frailty and comorbidities. Future studies should prioritize inclusion of very elderly patients to improve generalizability and inform individualized care decisions.
Embargo Period
6-3-2026
Included in
Representation of Adults Over 75 years old in Dialysis Outcome Studies: Implications for Generalizability
Philadelphia, PA
Background: End-stage renal disease (ESRD) 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 either underrepresent very elderly patients, particularly those with frailty or multiple comorbidities, or 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.
Objective: To evaluate how adults aged 75 and older are represented in dialysis outcome studies and to summarize survival and quality-of-life evidence relevant to this group.
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. Articles reporting survival, hospitalization, and comorbidity effects in patients aged ≥75 were included.
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.
Discussion: 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.
Conclusion: Adults aged ≥75 are underrepresented in dialysis outcome research despite being a significant portion of the ESRD population. Current evidence indicates high early mortality and variable survival benefit, particularly in the presence of frailty and comorbidities. Future studies should prioritize inclusion of very elderly patients to improve generalizability and inform individualized care decisions.