TUESDAY, Nov. 10, 2026 (HealthDay News) -- For older adults living with kidney failure and frailty or multimorbidity, neither preparing for responsive management nor preparing for renal dialysis is superior in terms of quality-adjusted life-years (QALYs), according to a study published online Nov. 4 in The Lancet.
Fergus J. Caskey, M.D., from the University of Bristol in the United Kingdom, and colleagues examined the relative effectiveness of preparing for responsive management (a protocolized version of conservative kidney management) and preparing for renal dialysis among older people living with kidney failure in a superiority, open-label, individually randomized controlled trial. Eligible patients had an estimated glomerular filtration rate below 15 mL/min/1.73 m2 and were either aged 80 years or older, regardless of frailty, or aged 65 to 69 years with frailty or multimorbidity. Participants were randomly assigned to prepare for responsive management or to prepare for renal dialysis (228 and 217, respectively).
The researchers found that the mean QALYs were 1.354 and 1.472 in the group that underwent preparation for responsive management and the group that prepared for renal dialysis, respectively (adjusted mean difference, −0.147) after a mean follow-up duration of 4.5 years. Hospital admission rates were similar in the two groups, while the group that prepared for responsive management had significantly lower dialysis access complications.
"If you are an older person with failing kidneys and other health problems, both preparing for dialysis and conservative kidney management are worth considering," Caskey said in a statement. "Both have pros and cons. They result in similar overall length and quality of life. Neither should be the default."
Several authors disclosed ties to the biopharmaceutical industry.
