How long someone lives with kidney failure, also known as End-Stage Renal Disease (ESRD), has no single answer. Kidney failure is defined as the stage where kidney function has fallen below 10 to 15% of normal. At this stage, the kidneys can no longer sustain life because the body cannot adequately remove waste products and excess fluid. A patient’s prognosis depends entirely on the treatment path chosen—dialysis, transplantation, or conservative management—and individual health factors.
Survival on Dialysis
Dialysis is the most common immediate treatment for kidney failure, filtering the blood to take over the work of the failed kidneys. Patients typically undergo either hemodialysis, which filters the blood externally using a machine, or peritoneal dialysis, which uses the patient’s abdominal lining as a filter. Survival rates are generally comparable between these two methods, though the choice depends on lifestyle, medical suitability, and preference.
The average life expectancy after starting dialysis is approximately five to ten years, but this is heavily influenced by age and other health conditions. The mean survival time is about three years, reflecting that the average patient starting treatment is often over 65. The overall five-year survival rate for patients on dialysis is around 35–40%.
Younger patients have a much better prognosis; people under the age of 45 who start dialysis have a five-year survival rate of approximately 85%. Dialysis presents long-term challenges, including a high risk of infection from repeated access to the bloodstream and cardiovascular strain. The rapid fluid shifts during treatment stress the cardiovascular system, contributing to higher mortality in this population.
Survival with a Kidney Transplant
Kidney transplantation offers a longer lifespan and improved quality of life compared to long-term dialysis. A successful transplant effectively replaces the function of the failed kidneys, avoiding the limitations and complications of dialysis. Transplant outcomes are tracked using two metrics: patient survival (how long the recipient lives) and graft survival (how long the transplanted kidney remains functional).
The five-year patient survival rate for transplant recipients is higher than for those on dialysis, typically over 80%. Five-year graft survival rates are approximately 75.6% for deceased-donor kidneys and 87.1% for living-donor kidneys. Living-donor transplants often offer an advantage in initial graft longevity because the kidney is healthier and the surgery can be scheduled electively.
Patients must take immunosuppression medications for the rest of their lives to prevent organ rejection. This necessary regimen introduces long-term risks, such as increased susceptibility to severe infections and certain types of cancer. Despite these risks, the long-term survival of transplant recipients is generally about twice that of comparable patients who remain on dialysis.
Variables Affecting Long-Term Prognosis
Beyond the chosen treatment, individual health characteristics play a major role in determining long-term survival for people with kidney failure. Age is a primary factor, as younger patients generally have a better prognosis regardless of treatment path. The overall health of the patient at the time of diagnosis, particularly the presence of other medical conditions, heavily influences life expectancy.
Cardiovascular disease is the leading cause of death for patients with kidney failure, even for those who receive a successful transplant. High blood pressure and chronic inflammation associated with ESRD accelerate heart disease, determining survival time. Diabetes is another major comorbidity that shortens life expectancy for dialysis patients compared to those without it.
Adherence to the prescribed treatment plan is a key variable that patients can control. This includes management of diet, fluid intake, and medication schedules. Poor adherence can lead to fluid overload and electrolyte imbalances, increasing the risk of hospitalization and death. A patient’s commitment to their care regimen affects their prognosis and quality of life.
Prognosis Without Active Treatment (Conservative Care)
For some individuals, pursuing dialysis or transplantation may not be the desired path, or they may be medically unsuitable. In these cases, the patient or medical team may choose conservative kidney management, which focuses on comfort and symptom control rather than life prolongation. This decision is often made by patients with advanced age, numerous severe comorbidities, or those who wish to avoid the burdens of active treatment.
When a patient with kidney failure forgoes life-sustaining treatment, survival time is typically short. For patients who discontinue dialysis, the median survival is generally about one to two weeks, though some may live longer depending on residual kidney function. For those starting conservative care from the point of diagnosis, median survival is measured in months, ranging from six to 31 months, depending on initial health status. The primary focus of care shifts to palliative measures, ensuring symptoms like nausea, shortness of breath, and fluid retention are managed to maintain comfort and dignity.