5-Year Survival Rate for Dialysis Patients
The 5-year survival rate for patients on dialysis is approximately 40%, meaning that only 4 out of 10 patients will survive 5 years after initiating dialysis therapy. 1, 2
Survival Data by Time Period
The survival trajectory for dialysis patients shows progressive decline over time:
- 1-year survival: 84-90% 3, 2
- 2-year survival: 72-77% 4, 5
- 3-year survival: 55% 1
- 5-year survival: 40% 1, 2
This translates to an annual mortality rate exceeding 20% for the dialysis population. 1
Comparison Between Dialysis Modalities
Survival rates are similar between hemodialysis (HD) and peritoneal dialysis (PD), with no significant mortality difference between the two modalities. 2, 6
Specific 5-year survival data by modality:
- Peritoneal dialysis: 43-56% 5-year survival 4, 5
- In-center hemodialysis: 35-39% 5-year survival 4, 5
- Home hemodialysis: 89% 5-year survival (significantly better) 4
Important caveat: PD shows a survival advantage in the first 1.5-2 years of dialysis, but this advantage diminishes over time, with survival rates equalizing or favoring HD after 2 years. 6, 5
Vascular Access Impact on Survival
The type of vascular access dramatically affects survival outcomes in hemodialysis patients:
- Arteriovenous fistula: 50% 5-year survival 3
- Prosthetic graft: 41.2% 5-year survival 3
- Persistent catheter use: 42.9% 5-year survival 3
Patients who temporize with a catheter experience 51% increased mortality compared to those initiating with arteriovenous fistulas. 3
Key Prognostic Factors
Age
Age is the strongest predictor of survival, with nearly a fourfold increase in mortality risk from youngest to oldest age groups. 4
- Patients under 65 years: >90% 1-year survival 7
- Patients over 85 years: <15% 5-year survival 7
- Elderly patients (≥70 years): 20% mortality in first year alone 8
Comorbidities
Several conditions significantly worsen survival:
- Diabetes mellitus: Associated with worse outcomes compared to polycystic kidney disease or glomerulonephritis 4, 5
- Cardiovascular disease: Present in 43-58% of dialysis patients and represents the leading cause of death (27% of all deaths) 3, 9, 7
- Cardiac disease at baseline: 57% increased mortality risk 5
Nutritional Status
Baseline nutritional markers strongly predict survival:
- Higher serum albumin: 40% reduction in mortality risk per unit increase 5
- Higher baseline weight: Associated with improved survival 5
- Higher baseline creatinine: Indicates better muscle mass and nutrition 5
Race
Black patients demonstrate better survival on dialysis compared to white patients (51% increased mortality risk for white patients). 5
Regional Variations
Mortality rates vary by geographic region:
- China (HD patients): 3.4% annual mortality 3
- China (PD patients): 2.3% annual mortality 3
- Zhejiang province (HD): 11.2% annual mortality 3
- Ningxia province (PD): 8.3% annual mortality 3
These variations likely reflect differences in patient selection, healthcare infrastructure, and comorbidity burden. 3
Common Pitfalls
Do not assume dialysis guarantees long-term survival—the adjusted 5-year survival of only 40% means dialysis extends life but does not normalize life expectancy. 1
Avoid delaying arteriovenous fistula creation—catheter-dependent patients have significantly worse outcomes, with catheter-related bloodstream infections occurring in approximately 50% of patients within 6 months. 3, 2
Do not overlook the importance of timing—there is no mortality benefit to starting dialysis at higher eGFR (10-14 mL/min/1.73 m²) versus lower eGFR (5-7 mL/min/1.73 m²), so avoid premature dialysis initiation. 2