Observational studyAnnals of internal medicine2024
Effect of Starting Dialysis Versus Continuing Medical Management on Survival and Home Time in Older Adults With Kidney Failure : A Target Trial Emulation Study.
Observational study in Annals of internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- ASN Kidney Health Guidance on Conservative Management in People with Kidney Failure.Journal of the American Society of Nephrology : JASN · 2026Guideline
- Recommendations for the management of frailty in chronic kidney disease: a consensus report.Nature reviews. Nephrology · 2026Review
- Temporal Trends in Decisions to Forgo KRT.Kidney360 · 2026Article
- Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review.Clinical kidney journal · 2026Review
- Balancing Days at Home and Major Adverse Limb Events After Surgical Versus Endovascular Lower-Extremity Revascularization in Chronic Kidney Disease.Journal of the American Heart Association · 2026Article
- Optimal patient care in advanced chronic kidney disease progressing to kidney failure.Nature reviews. Nephrology · 2026Review
- Days at Home After Hip Fracture Among Older Adults With and Without Dementia.JAMA network open · 2026Article
- An Initiative to Improve Nephrology Clinician Confidence in Shared Decision Making.Kidney medicine · 2026Article
- Kidney-therapy decision-making among older adults and caregivers: treatment beliefs, prognostic information, and health priorities.BMC nephrology · 2025Article
- Supporting Shared Decision-Making in Life-Altering Kidney Therapy Decisions for Older Adults: A Review.JAMA internal medicine · 2025Review
- Importance of age and timing of referral when initiating dialysis.Journal of nephrology · 2025Article
- Prognostic Preferences of Older Adults on Maintenance Hemodialysis and Their Care Partners: A Qualitative Study.Clinical journal of the American Society of Nephrology : CJASN · 2025Article
- Predicting mortality in elderly chronic kidney disease patients using algorithmic risk assessment: a Southeast Asian perspective.BMC nephrology · 2025Article
- Article
- Pausing before Surgery Referral in Patients with ESKD on Hemodialysis to Ensure Patient-Centered Care.Kidney360 · 2025Article
- Kidney replacement therapies in the older person: challenges to decide the best option.Clinical kidney journal · 2025Review
- Improving Integration of Palliative Care and Nephrology.Kidney360 · 2025Article
- Anemia as a mediator: bridging the frailty index and hip fractures in older Chinese populations.Frontiers in public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
Abstract
backgroundFor older adults with kidney failure who are not referred for transplant, medical management is an alternative to dialysis.
objectiveTo compare survival and home time between older adults who started dialysis at an estimated glomerular filtration rate (eGFR) less than 12 mL/min/1.73 m
designObservational cohort study using target trial emulation.
settingU.S. Department of Veterans Affairs, 2010 to 2018.
participantsAdults aged 65 years or older with chronic kidney failure and eGFR below 12 mL/min/1.73 m
interventionStarting dialysis within 30 days versus continuing medical management. MEASUREMENTS: Mean survival and number of days at home.
resultsAmong 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.
conclusionOlder adults starting dialysis when their eGFR fell below 12 mL/min/1.73 m PRIMARY FUNDING SOURCE: U.S. Department of Veterans Affairs and National Institutes of Health.
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Registered trials
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