Stage 4 kidney disease in elderly life expectancy

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Shared decision making is important when deciding the appropriateness of dialysis for any individual, particularly for older patients with advanced chronic kidney disease who have high mortality. Emerging evidence suggests that patients with advanced age, high comorbidity burden, and poor functional status may not have any survival advantage on dialysis compared with those on a conservative kidney management pathway. The purpose of this narrative review is to summarize the existing studies on the survival of older patients with stage 4 or 5 chronic kidney disease managed with or without dialysis and to evaluate the factors that may influence mortality in an effort to assist clinicians with shared decision making. Median survival estimates of conservative kidney management patients are widely varied, ranging from 1-45 months with 1-year survival rates of 29%-82%, making it challenging to provide consistent advice to patients. In existing cohort studies, the selected group of patients on dialysis generally survives longer than the conservative kidney management cohort. However, in patients with advanced age (aged ≥80 years), high comorbidity burden, and poor functional status, the survival benefit conferred by dialysis is no longer present. There is an overall paucity of data, and the variability in outcomes reflect the heterogeneity of the existing studies; further prospective studies are urgently needed.

Index Words

Conservative kidney management

dialysis

elderly

kidney failure

renal failure

shared decision making

survival

© 2022 The Authors. Published by Elsevier Inc. on behalf of the National Kidney Foundation, Inc.

Kidney disease leads to a reduction in life expectancy. How much of a reduction? It depends on several factors, especially a person’s age, sex, and the stage of the disease. Questions like these were first answered less than a decade ago. But thanks to an enormous amount of research, doctors now have an excellent picture of the prognosis for kidney disease.

Nevertheless, it’s important to keep in mind, every person is different—not just in terms of personality, but in terms of genetics, current health condition, and so forth. Life expectancy estimates can make no guarantees, but they may provide you with a general outlook.

The Stages of Kidney Disease

How many stages of kidney disease are there? It’s a little complicated. While there are five primary stages of kidney diseases, the third stage can be broken into two sub-stages. Each stage is determined by measuring glomerular filtration rate (GFR), which is used to indicate how well the kidneys are functioning.

Stage 1 and 2: Early Warnings

Stage 1 indicates a person with normal GFR at or above 90mL/min. The second stage is indicated by GFR between 60-89mL/min, which is when minor symptoms tend to start. In these stages, kidney disease can be caught before it has done any significant damage.

Stage 3, 4, and 5: Nearing Kidney Failure

It’s stage 3 that defines the point at which mortality becomes a greater concern than the likelihood of developing end-stage renal disease. With kidney function reduced between 59-30mL/min, the previously minor symptoms of stage 2 become far more severe. From the end of stage 3, there are only 15-points of kidney function standing between entering stage 5, which indicates total kidney failure.

Life Expectancy by Sex

As much as anything else, life expectancy for kidney disease depends on a person’s age and sex.

For a 60-year-old man, stage 1 kidney disease life expectancy will be approximately 15 years. That figure falls to 13 years, 8 years, and 6 years in the second, third, and fourth stages of kidney disease respectively. For a 60-year old woman, stage 1 life expectancy is 18 years, while stage 2 is only one year less. For stage 3 kidney disease, her life expectancy would be 11 years.

In short, women have a slightly greater life expectancy at all ages. But during stages 4 and 5, those advantages slip away, and life expectancy becomes essentially identical between the sexes.

Life Expectancy by Age

Age changes everything. Consider the life expectancy of 70-year old men and women. For a 70-year old man, his life expectancy for the first four stages of kidney disease would be 9 years, 8 years, 6 years, and 4 years respectively.

For a 70-year-old woman, life expectancy is 11 years, 8 years, and 4 years. Once again, women start with a greater life expectancy, but the differences disappear in later stages of the disease.

Stage Five

Stage 5 kidney disease means total kidney failure and the necessity of dialysis. Five decades ago, a failed kidney meant death was likely. These days, things are quite a bit different. According to the National Kidney Foundation, the average life expectancy for a patient on dialysis is 5-10 years. Though for someone between the ages of 70 and 74, life expectancy is closer to four years on dialysis.

Keeping Healthy Kidneys

Age and health problems can impair your ability to endure kidney disease. While there’s no cure, there are things you can to do learn to manage kidney disease.

If there’s one thing this data should make clear, it’s that taking some simple steps to prevent the progression of kidney disease won’t only preserve health, but it can help save years of life.