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Research Letter
April 22, 2019

One-Year Mortality After Dialysis Initiation Among Older Adults

Author Affiliations
  • 1Section of General Internal Medicine, Veterans Affairs Boston Health Care System, Boston, Massachusetts
  • 2Hospital and Specialty Medicine Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
  • 3Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
  • 4Section of Palliative Care, Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California
  • 5Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 6Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. Published online April 22, 2019. doi:10.1001/jamainternmed.2019.0125

Shared decision making about dialysis, a potentially burdensome or harmful treatment for older adults, requires accurate estimates of prognosis.1 More than 120 000 people in the United States initiated chronic dialysis in 2015, half of whom were older than 65 years.2 The 1-year mortality rate after dialysis initiation for these older adults, based on the United States Renal Data System (USRDS) registry, is currently approximately 30%.2 However, the USRDS does not include all patients who start dialysis—most notably omitting those who die before an outpatient dialysis provider enters them into the registry. Therefore, USRDS-based mortality estimates are not generalizable to all patients who initiate dialysis. Registry data also lack detailed information on functional and cognitive status, which can significantly affect treatment decisions and outcomes. Thus, existing data2,3 may not provide optimal support for real-time decision making about dialysis initiation in older adults. To address these knowledge gaps, we used data from the Health and Retirement Study, a nationally representative, longitudinal survey of older adults, to describe mortality within the first year after dialysis initiation.

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