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In this population, frailty, multimorbidity, and functional decline often limit the survival benefit of dialysis, challenging the conventional approach to renal replacement therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To summarize current evidence comparing dialysis with conservative kidney management (CKM) in older adults with advanced chronic kidney disease (CKD), focusing on survival, quality of life, hospitalization, and prognostic tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative synthesis was conducted based on observational, cohort, and systematic review studies including adults aged\u2009\u2265\u200970\u00a0years with stage 4\u20135 CKD. The literature search was performed exclusively in the PubMed database, which represents a methodological limitation of this review. Search terms included: end-stage renal disease, chronic kidney disease, kidney failure, dialysis, conservative management, frailty, geriatric patients, and elderly patients. Outcomes were grouped into four domains: survival, quality of life, healthcare utilization, and prognostic models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across studies, dialysis prolonged survival mainly in younger and less comorbid patients, but this advantage diminished with increasing frailty and multimorbidity. CKM provided comparable or superior health-related quality of life (HRQoL) and was associated with fewer hospitalizations. Patients managed conservatively were more likely to die at home, reflecting closer alignment with end-of-life preferences. Prognosis was primarily determined by patient-level factors\u2014age, frailty, and eGFR decline\u2014rather than by treatment modality. CKM-specific prognostic models remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In older adults with advanced CKD, survival gains from dialysis are modest and frequently offset by higher treatment burden. CKM offers a patient-centered alternative focused on quality of life, comfort, and goal-concordant care. The development of validated CKM-specific prognostic tools is essential to support individualized, evidence-informed decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11255-026-05009-3","type":"journal-article","created":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T11:56:20Z","timestamp":1768478180000},"page":"3689-3704","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Dialysis versus conservative kidney management in older adults: why one size does not fit all"],"prefix":"10.1007","volume":"58","author":[{"given":"Dragos","family":"Scripcariu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Covic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loredana-Mariana","family":"Agavriloaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bogdan Dumitru","family":"Agavriloaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodora","family":"Joghiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Onofriescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Burlacu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luminita","family":"Voroneanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Kanbay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Covic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,15]]},"reference":[{"key":"5009_CR1","doi-asserted-by":"publisher","first-page":"1105573","DOI":"10.3389\/fnut.2023.1105573","volume":"10","author":"G \u00c1lvarez-Garc\u00eda","year":"2023","unstructured":"\u00c1lvarez-Garc\u00eda G, P\u00e9rez \u00c1N, Prieto Alaguero MP, Garrote CP, D\u00edaz Testillano A, Caballero M\u00c1M et al (2023) Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: a retrospective 5-year study. 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