Survival Rates for ESRD Patients on Dialysis by Age Group
Survival rates for dialysis patients decline dramatically with advancing age, with 5-year survival ranging from approximately 73% for patients under 65 years to only 13.7% for those 85 years and older. 1
Overall Survival Benchmarks
The general dialysis population experiences poor long-term survival regardless of age:
- 1-year survival: 74-80% for all dialysis patients 2
- 3-year survival: 55% for all dialysis patients 3
- 5-year survival: 40% for all dialysis patients 2, 3
These rates remain unacceptably high, with first-year mortality exceeding 20 deaths per 100 patient-years, and some centers experiencing annual mortality rates approaching 30%. 2
Age-Stratified Survival Data
Younger Adults (15-44 years)
- 5-year survival: 95.1% for patients aged 15-24 years 4
- Life expectancy for patients diagnosed in their 30s: Approximately 30 additional years (total life expectancy of 60-65 years versus 75-80 years for the general population) 5
Middle-Aged Adults (45-64 years)
- 5-year survival: Data shows progressive decline with age within this range 4
Elderly Patients (≥65 years)
The Korean national population study provides the most detailed age-stratified survival data for elderly patients: 1
- Ages 65-69: 5-year survival of 45.9% 1
- Ages 70-74: 5-year survival of 37.5% 1
- Ages 75-79: 5-year survival of 28.4% 1
- Ages 80-84: 5-year survival of 24.1% 1
- Ages ≥85: 5-year survival of 13.7% 1
For elderly patients specifically, shorter-term survival rates are: 6
Elderly patients (≥70 years) face 20% mortality in the first year alone. 3
Critical Prognostic Factors Beyond Age
Primary Disease Etiology
Diabetic nephropathy confers significantly worse outcomes across all age groups, with 1-year survival of only 72.7% compared to 79.8% for non-diabetic causes. 4 Patients with atherosclerotic renovascular disease who progress to ESRD have particularly dismal prognoses: 2-year survival of 56%, 5-year survival of 18%, and 10-year survival of only 5%. 2, 5
Cardiovascular Comorbidity
Cardiovascular disease is present in 43-58% of dialysis patients and represents the leading cause of death (27% of all deaths). 3 The presence of myocardial infarction, congestive heart failure, peripheral vascular disease, or cerebrovascular disease independently predicts mortality. 1
Nutritional Status
Lower serum albumin is an independent predictor of mortality in elderly dialysis patients (relative risk: 0.940 per g/dL decrease). 6 Hypoalbuminemia reflects both malnutrition and inflammation, both critical determinants of survival. 6
Vascular Access Type
Patients with arteriovenous fistulas have 50% 5-year survival compared to 41.2% with prosthetic grafts and 42.9% with persistent catheter use. 3 Patients who temporize with catheters experience 51% increased mortality compared to those initiating with arteriovenous fistulas. 3
Regional Variations
China reports more favorable mortality rates than Western countries, with annual mortality of 3.4% for hemodialysis and 2.3% for peritoneal dialysis patients, though regional variation exists (Zhejiang: 11.2% HD mortality; Ningxia: 8.3% PD mortality). 2, 3
Clinical Implications
For elderly patients with multiple comorbidities, particularly those over 80 years with diabetes and cardiovascular disease, conservative management with integrated palliative care should be strongly considered as an alternative to dialysis initiation. 7 The median survival for ESRD patients with renovascular disease is only 25 months, compared to 133 months for polycystic kidney disease. 2
The dramatic age-related mortality gradient underscores that chronological age alone is insufficient for decision-making; functional status, comorbidity burden, and patient preferences must guide individualized treatment planning. 1, 6