title: Recent insights into life expectancy with and without dialysis.
abstract: OBJECTIVE
  Elderly patients comprise the fastest growing population initiating dialysis and also experience the worst outcomes, including increased mortality, loss of functional status, and impaired quality of life. Nephrologists are often challenged with how best to engage in dialysis decision-making discussions within this population. Prognostication tools can assist nephrologists in engaging in these discussions, especially in patients for whom survival benefits may be outweighed by the burdens of treatment.
  
  
  RESULTS
  This review includes the latest research in the survival of elderly patients with and without dialysis; prognostic factors associated with renal progression and survival; and integrative prognostic models to predict both short-term and long-term prognosis. The concept of kidney illness disease trajectory is defined with important outcomes including survival, health-related quality of life, and symptoms with and without dialysis. This prognostic information will then be integrated into an individualized approach to shared decision-making regarding treatment decision-making.(Figure is included in full-text article.)
  
  
  CONCLUSIONS
  Treatment decision-making for elderly patients with advanced kidney disease necessitates an active process between nephrologist and patient, incorporating medical information as well as patient preferences. Prognostic information and observational data can facilitate nephrologists' ability to foresee and foretell the illness trajectory both with and without dialysis, further guiding these conversations.
authors: Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania, USA. schelljo@upmc.edu
authors: Jane O
authors: JO
authors: Schell
authors: Maria
authors: M
authors: Da Silva-Gane
authors: Michael J
authors: MJ
authors: Germain
mesh_terms: D000367:Age Factors; D015897:Comorbidity; D003661:Decision Support Techniques; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008017:Life Expectancy; D018579:Patient Selection; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome