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Published on: June 5, 2016
Temporal Trends in Decisions to Forgo KRT
Susan P Y Wong1,2, Lindsey M Kornowske3, Cami R Jones3
1Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Kidney360
|June 5, 2026
Summary
Forgoing kidney replacement therapy (KRT) is uncommon, with most patients with kidney failure receiving or preparing for KRT. This trend remained stable over the past decade, indicating KRT
Area of Science:
- Nephrology
- Public Health
- Geriatrics
Background:
- Dialysis initiation rates have declined after years of increase.
- Conservative kidney management is a growing alternative to dialysis.
- Understanding trends in patients forgoing dialysis is crucial.
Purpose of the Study:
- To investigate contemporary trends in treatment decisions for advanced kidney disease.
- To analyze the proportion of patients opting for or against kidney replacement therapy (KRT).
- To examine these trends across different age groups and time periods.
Main Methods:
- Retrospective cohort study of adults with advanced kidney disease (eGFR ≤15 mL/min/1.73m2).
- Analysis of data from a large US health system between 2012-2020.
- Review of administrative codes and clinical notes to determine KRT decisions.
Main Results:
- 90% of patients received KRT, while 6% decided against it.
- Treatment decisions for KRT remained stable over the study period (2012-2020).
- No significant changes in KRT decisions were observed across different age groups.
Conclusions:
- Forgoing KRT is infrequent among patients with advanced kidney disease.
- KRT remains the predominant approach for kidney failure care.
- The default approach to kidney failure care has largely remained consistent over the last decade.
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