{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T03:04:33Z","timestamp":1773889473932,"version":"3.50.1"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001807","name":"FAPESP","doi-asserted-by":"publisher","award":["2019\/04045-5"],"award-info":[{"award-number":["2019\/04045-5"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In older patients with chronic kidney disease (CKD), comorbidities, functional status, nutritional patterns and sleep disorders should be considered in the individualised shared decision-making process to initiate dialysis. We conducted a prospective cohort study to assess independent factors related to dialysis initiation or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single centre observational study that included patients \u226570\u00a0years with stage 4\u20135 CKD undergoing conservative management. We evaluated sleep disorders, nutritional markers, and bone biomarkers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 150 patients (81\u2009\u00b1\u20097\u00a0years, Charlson score 7.8\u2009\u00b1\u20091.6, followed for a median of 1.8\u00a0years). At 2\u00a0years, 90 patients (60%) were alive and not on dialysis, 25 (16.7%) started dialysis, and 35 (23.3%) died. In a multivariable multinomial regression model, higher creatinine [OR 2.38 (1.49\u20133.80), P\u2009=\u2009.001] and excessive daytime sleepiness [OR 7.47 (1.86\u201330.00), P\u2009=\u2009.018] increased the likelihood of dialysis, while higher Charlson comorbidity scores [OR 1.49 (1.08\u20132.05), P\u2009=\u2009.049] and beta-blocker use [OR 4.93 (1.58\u201315.39), P\u2009=\u2009.019] increased the risk of death. Patients using angiotensin-converting enzyme inhibitor\/angiotensin receptor blocker (ACEI-ARB) had a lower probability of requiring dialysis (P\u2009=\u2009.005) and a lower probability of death (P\u2009=\u2009.005).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In older patients with advanced CKD, comorbidity burden and beta-blocker use were associated with an increased risk of death, whereas ACEI\/ARB use was linked to a lower likelihood of both dialysis initiation and death. These findings highlight the importance of a comprehensive, multidimensional approach that integrates clinical, functional, and therapeutic factors to better inform individualised care and enhance outcomes in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afag044","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:23:07Z","timestamp":1771244587000},"source":"Crossref","is-referenced-by-count":1,"title":["AGNES\u2014AGing NEphropathy study\u2014a prospective cohort of older patients with advanced chronic kidney disease"],"prefix":"10.1093","volume":"55","author":[{"given":"Julia C","family":"Lauar","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Nephrology, Universidade de Sao Paulo , S\u00e3o Paulo, SP ,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Venceslau A","family":"Coelho","sequence":"additional","affiliation":[{"name":"Department of 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,","place":["Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4458-8358","authenticated-orcid":false,"given":"Carla","family":"Avesani","sequence":"additional","affiliation":[{"name":"Department of Clinical Science , Intervention and Technology, Karolinska Institutet, Stokholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Stenvinkel","sequence":"additional","affiliation":[{"name":"Department of Clinical Science , Intervention and Technology, Karolinska Institutet, Stokholm,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benght","family":"Lindholm","sequence":"additional","affiliation":[{"name":"Department of Clinical Science , Intervention and Technology, Karolinska Institutet, 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