Kidney failure, also known as End-Stage Renal Disease (ESRD), occurs when kidneys can no longer effectively filter waste and excess fluid from the blood. For individuals aged 90, the implications of kidney failure are particularly complex. This article explores the prognosis for 90-year-olds facing kidney failure who choose not to undergo dialysis.
Understanding Kidney Failure in the Elderly
Kidney function naturally diminishes with age, a process known as renal senescence, contributing to kidney failure in older individuals. This decline means kidneys may not adapt as readily to stress or disease. Kidney failure in a 90-year-old often presents with distinct considerations compared to younger patients.
Common causes include long-standing conditions like high blood pressure and diabetes, which progressively damage the kidney’s filtering units. Other contributing factors can include heart disease or acute kidney injuries. The reduced physiological reserve in older adults means their bodies are less resilient to the metabolic disturbances caused by failing kidneys.
Key Factors Influencing Life Expectancy
Several individual factors significantly impact how long a 90-year-old with kidney failure might live without dialysis. The presence and severity of other health conditions, known as comorbidities, play a substantial role. Conditions like heart disease, lung disease, or cancer can greatly affect survival, as any survival benefit from dialysis often decreases with increasing comorbidities, particularly ischemic heart disease.
The degree of remaining kidney function, often measured by the estimated Glomerular Filtration Rate (eGFR), also influences prognosis. Even small amounts of residual function can make a difference in how quickly symptoms progress. A lower eGFR is associated with poorer survival outcomes for these patients.
A person’s overall health and level of frailty are also important considerations. This includes their general physical condition, mobility, nutritional status, and ability to perform daily activities independently. Studies indicate that frail older patients may not experience a survival advantage from dialysis compared to those managed conservatively.
Typical Survival Timeframes Without Dialysis
Predicting an exact survival timeframe for a 90-year-old with kidney failure who does not receive dialysis is challenging due to individual variability. Without kidney replacement therapy, toxin accumulation can quickly lead to severe symptoms. Generally, survival is limited to days or weeks, rarely extending to months.
Median survival for elderly patients choosing not to undergo dialysis has been reported around 16 months, with approximately one-third surviving longer than 12 months. Other research indicates a median survival ranging from 6.3 to 23.4 months for patients managed conservatively.
For frail older patients, a study found that those who waited to start dialysis died on average only nine days earlier than those who began treatment immediately. Another study noted that patients who never underwent dialysis lived approximately 77 fewer days on average than those who did.
Prioritizing Comfort and Quality of Life
When dialysis is not pursued, prioritizing comfort and maintaining a good quality of life become the central goals of care. Palliative care and hospice services are important for managing symptoms and providing support. Palliative care focuses on alleviating pain and other symptoms, and can be provided at any stage of illness, even alongside other treatments.
Individuals with kidney failure who do not receive dialysis may experience symptoms such as fatigue, nausea, shortness of breath, swelling, and itching. Muscle cramps, loss of appetite, and confusion are also common as waste products build up. Medical teams focus on managing these symptoms with medications and other supportive measures to ensure the patient’s comfort and dignity.
Fluid management and treatment of anemia are often part of supportive care to alleviate discomfort. The aim is to enhance the patient’s remaining time, focusing on their well-being rather than aggressive life-prolonging measures. This approach helps patients and their families navigate the illness with compassion.
Making Informed Treatment Decisions
The decision not to pursue dialysis for a 90-year-old with kidney failure is a complex process involving the patient, their family, and the medical team. Patient preference and personal values are central to this choice. Some individuals may decide against dialysis if they perceive it will not significantly improve their quality of life or might impose an undue burden.
Medical considerations, such as the likelihood of dialysis providing benefit or potentially causing more suffering due to severe comorbidities, also play a role. For very elderly patients, advanced age often correlates with increased frailty and multiple health issues that can make dialysis less effective or more risky. Studies suggest dialysis can carry a high symptom burden for elderly patients.
Open communication with healthcare providers, known as shared decision-making, is essential for exploring all available options and understanding the potential outcomes of each. This process includes discussing the goals of care and aligning treatment choices with the patient’s wishes for their remaining life. Advance care planning helps ensure these preferences are respected.