Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov;54(11):2891-2900.
doi: 10.1007/s11255-022-03208-2. Epub 2022 May 6.

Dialysis or kidney transplantation in older adults? A systematic review summarizing functional, psychological, and quality of life-related outcomes after start of kidney replacement therapy

Tessa S Schoot  1   2 , Namiko A Goto  3   4 , Rob J van Marum  3   5   6 , Luuk B Hilbrands  7 , Angèle P M Kerckhoffs  8   3
Affiliations

Dialysis or kidney transplantation in older adults? A systematic review summarizing functional, psychological, and quality of life-related outcomes after start of kidney replacement therapy

Tessa S Schoot et al. Int Urol Nephrol. 2022 Nov.

Abstract

Background: In older patients, the choice between kidney transplantation (KT) and dialysis may be complicated because of a high prevalence of comorbidities and geriatric syndromes. Ideally, this decision-making process focusses on older patients' outcome priorities, which frequently include functional, psychological, and quality of life (QOL)-related outcomes.

Purpose: This systematic review aims to summarize functional, psychological (including cognition), and QOL-related outcomes after start of kidney replacement therapy (KRT) in older adults.

Methods: We searched PubMed and Embase for research that investigated change in these variables after start of KRT in patients aged ≥ 60 years. Data were extracted using the summary measures reported in the individual studies. Risk of bias was assessed with the ROBINS-I tool.

Results: Sixteen observational studies (prospective n = 9, retrospective n = 7; KT-recipients n = 3, dialysis patients n = 13) were included. The results show that QOL improves in the majority of the older KT recipients. After start of dialysis, QOL improved or remained stable for most patients, but this seems less prevalent than after KT. Functional status decreases in a substantial part of the older dialysis patients. Furthermore, the incidence of serious fall injuries increases after start of dialysis. Nutritional status seems to improve after start of dialysis.

Conclusion: The interpretability and comparability of the included studies are limited by the heterogeneity in study designs and significant risk of bias in most studies. Despite this, our overview of functional, psychological (including cognition), and QOL-related outcomes is useful for older adults and their clinicians facing the decision between KT and dialysis.

Keywords: Dialysis; Functional status; Geriatric nephrology; Quality of life; Renal transplantation.

PubMed Disclaimer

Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Flow diagram of database search and study selection. *Inter-rater agreement level 98%
Fig. 2
Fig. 2
Bias assessment summary plot
Fig. 3
Fig. 3
Traffic light plot: risk of bias per study
See this image and copyright information in PMC

References

    1. Chadban SJ, Ahn C, Axelrod DA, et al. KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation. 2020;104(Suppl 1):S11–S103. doi: 10.1097/TP.0000000000003136. - DOI - PubMed
    1. Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian society of transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005;173(10):1181–1184. doi: 10.1503/cmaj.051291. - DOI - PMC - PubMed
    1. Dudley C, Harden P. Renal association clinical practice guideline on the assessment of the potential kidney transplant recipient. Nephron Clin Pract. 2011;118(Suppl 1):c209–c224. doi: 10.1159/000328070. - DOI - PubMed
    1. Molnar MZ, Ravel V, Streja E, et al. Survival of elderly adults undergoing incident home hemodialysis and kidney transplantation. J Am Geriatr Soc. 2016;64(10):2003–2010. doi: 10.1111/jgs.14321. - DOI - PMC - PubMed
    1. Meier-Kriesche HU, Ojo AO, Hanson JA, et al. Exponentially increased risk of infectious death in older renal transplant recipients. Kidney Int. 2001;59(4):1539–1543. doi: 10.1046/j.1523-1755.2001.0590041539.x. - DOI - PubMed

Publication types