What are the mortality rates for patients with End-Stage Renal Disease (ESRD) undergoing dialysis across different age groups?

Mortality Rates in ESRD Patients on Dialysis by Age Group

Mortality rates for ESRD patients on dialysis increase dramatically with advancing age, with elderly patients (≥65 years) experiencing particularly poor outcomes compared to younger cohorts. 1

Age-Specific Mortality Data

Young Adults (30s)

• Patients developing ESRD in their 30s have a remaining life expectancy of approximately 30 years, representing a total life expectancy of 60-65 years compared to 75-80 years for the general population 2
• This represents the best prognosis among all age groups initiating dialysis 2

Middle-Aged Adults (65-69 years)

• 5-year survival rate: 45.9% 3
• 1-year survival on dialysis: approximately 79.8% for non-diabetic patients 4

Elderly Patients (70-74 years)

• 5-year survival rate: 37.5% 3
• First-year mortality: approximately 17-20% 5

Advanced Elderly (75-79 years)

• 5-year survival rate: 28.4% 3
• Mortality risk increases substantially in this age bracket 3

Very Elderly (80-84 years)

• 5-year survival rate: 24.1% 3
• 1-year survival drops to approximately 52.5% for patients over 85 years 4

Oldest Old (≥85 years)

• 5-year survival rate: 13.7% 3
• This represents the poorest prognosis of all age groups 3
• Mean life expectancy for patients >65 years with atherosclerotic renovascular disease progressing to ESRD is only 2.7 years 1

Age-Related Survival Patterns

The unadjusted 5-year survival rate for all elderly dialysis patients (≥65 years) is 37.6%, with survival decreasing progressively across increasing age categories 3. This contrasts sharply with younger patients, where 1-year survival for those aged 15-24 years approaches 95.1% 4.

Key Mortality Predictors Beyond Age

• Diabetes mellitus significantly worsens outcomes: 1-year survival is 72.7% for diabetic nephropathy versus 79.8% for other causes 4
• Vascular access type matters: arteriovenous fistula provides 84% 1-year survival versus 69.6% for catheters 5
• Underlying etiology affects prognosis: atherosclerotic renovascular disease has median survival of 25 months, compared to 133 months for polycystic kidney disease 1

Temporal Trends

Excess mortality risk has decreased by 12-27% over any 5-year interval between 1995 and 2013, though absolute improvements are greatest for older patients while relative improvements are largest for younger patients 6. Despite these improvements, mortality remains unacceptably high, particularly in the first year of dialysis 5.

Critical Clinical Caveats

The first year of dialysis carries the highest mortality risk, with rates of 17-20% depending on region and individual risk factors 5. A substantial minority of elderly patients experience very high early mortality after dialysis initiation, making shared decision-making essential 7. For patients >65 years with atherosclerotic renovascular disease, 2-year, 5-year, and 10-year survival rates are 56%, 18%, and 5% respectively 1, 2, representing particularly dire outcomes that warrant careful discussion about conservative management alternatives 2.