ReviewInternational urology and nephrology2026
Dialysis versus conservative kidney management in older adults: why one size does not fit all.
Review in International urology and nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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
5 citing papers in PubMed.
- From "one size" to "right-fit": making goal-concordant dialysis vs. conservative kidney management operational for older adults worldwide.International urology and nephrology · 2026Article
- "One Size Does Not Fit All" is only the beginning: the need for proportional, patient-level decisions in elderly CKD.International urology and nephrology · 2026Article
- Navigating prognostic uncertainty with H.O.P.E.: Caring for elderly patients with chronic kidney disease.Patient education and counseling · 2026Article
- Prediction is not decision: why frailty must guide clinical choices in hemodialysis.International urology and nephrology · 2026Article
- Comment on "Dialysis versus conservative kidney management in older adults: why one size does not fit all".International urology and nephrology · 2026Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundAs the global population ages, an increasing number of older adults progress to end-stage kidney disease (ESKD). In this population, frailty, multimorbidity, and functional decline often limit the survival benefit of dialysis, challenging the conventional approach to renal replacement therapy. PURPOSE: To summarize current evidence comparing dialysis with conservative kidney management (CKM) in older adults with advanced chronic kidney disease (CKD), focusing on survival, quality of life, hospitalization, and prognostic tools.
methodsA narrative synthesis was conducted based on observational, cohort, and systematic review studies including adults aged ≥ 70 years with stage 4-5 CKD. The literature search was performed exclusively in the PubMed database, which represents a methodological limitation of this review. Search terms included: end-stage renal disease, chronic kidney disease, kidney failure, dialysis, conservative management, frailty, geriatric patients, and elderly patients. Outcomes were grouped into four domains: survival, quality of life, healthcare utilization, and prognostic models.
resultsAcross studies, dialysis prolonged survival mainly in younger and less comorbid patients, but this advantage diminished with increasing frailty and multimorbidity. CKM provided comparable or superior health-related quality of life (HRQoL) and was associated with fewer hospitalizations. Patients managed conservatively were more likely to die at home, reflecting closer alignment with end-of-life preferences. Prognosis was primarily determined by patient-level factors-age, frailty, and eGFR decline-rather than by treatment modality. CKM-specific prognostic models remain limited.
conclusionIn older adults with advanced CKD, survival gains from dialysis are modest and frequently offset by higher treatment burden. CKM offers a patient-centered alternative focused on quality of life, comfort, and goal-concordant care. The development of validated CKM-specific prognostic tools is essential to support individualized, evidence-informed decision-making.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.