Grant: Operating Grant

More than 50% of people starting dialysis in Canada are > 64 years old. Older patients have extremely high rates of death, hospitalization and functional decline after starting dialysis. Dialysis may provide little or no benefit for some older patients. Certain older patients managed without dialysis may live almost or as long as patients who start dialysis, with better preservation of function and quality of life. Unfortunately, we are unable to identify patients for whom dialysis is unlikely to result in a benefit, thus limiting the ability to align treatment with patients' goals. This study would be the first to evaluate clinically meaningful outcomes of patients > 64 years with stage 5 CKD; and to relate these findings to healthcare use. We will a) characterize survival, function, quality of life, symptom burden, and transition to institutionalized care in patients after development of stage 5 CKD and b) in the last year of life, taking into account the presence or absence of dialysis. We will also identify characteristics associated with poor and good outcomes. Predicting these trajectories will aid timely and effective planning of supportive services. Identifying patients likely to do poorly with dialysis and well without dialysis, will influence patient decision-making, help effective planning of dialysis services, and help determine care plans aligned with patients' goals; c) characterize health care resource use for this population and determine factors associated with resource use. Defining healthcare use will identify unmet needs and help develop health service policies that allow more efficient resource use. Study results will inform the development of decision aids for clinicians and older patients around dialysis starts that could be tested in randomized trials. They will also inform the development of care pathways for older patients unlikely to benefit from dialysis, which could then be evaluated for their impact on patient outcomes.