Dialysis Longevity: Understanding Life Expectancy on Dialysis

Life expectancy on dialysis varies widely. USRDS data: average survival 5–10 years, but many live 20–30+ years.

Key Determinants

• Age at start: <40 years → median >15 years; >75 years → median <3 years.
• Comorbidities: Diabetes, CVD, PVD, heart failure reduce survival.
• Modality: Peritoneal dialysis (PD) may offer early survival advantage; home hemodialysis (HHD) improves quality of life.
• Adherence: Session attendance, fluid/diet compliance, medication adherence.
• Access type: AV fistula > graft > catheter (infection/mortality risk).
• Residual renal function: Preservation extends survival.

Improving Outcomes

• Early nephrology referral (pre-dialysis education, access planning)
• Transplant evaluation (gold standard — living donor best)
• Multidisciplinary care (dietitian, social worker, pharmacist)
• Symptom management (pruritus, restless legs, fatigue)

Quality of Life

Home modalities (PD, HHD) offer flexibility, better preservation of residual function, and higher satisfaction.

Dialysis is a bridge, not a destination. Transplant remains optimal.