{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T15:27:50Z","timestamp":1789226870349,"version":"build-2803163510"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The association of end-stage kidney disease (ESKD) with poor outcomes is well recognized. Education and discussions with patients with advanced chronic kidney disease (CKD) are important to facilitate shared decision making regarding care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This study reports longitudinal follow-up of all patients who attended the Advanced Kidney Care Service (AKCS) in a tertiary renal centre in the UK. Patients are routinely referred to AKCS once their estimated glomerular filtration rate (eGFR) drops below 20\u00a0mL\/min\/1.73 m2. A total of 1957 patients who first attended between September 2011 and September 2018 were included, with a minimum of 5\u00a0years follow-up to 30 September 2023.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>During follow-up, 55.7% of the cohort commenced renal replacement therapy (RRT), the initial modality was haemodialysis in 57.2%, peritoneal dialysis in 27.3% and a pre-emptive transplant in 15.5%, of which 42.6% were from live donors. Conservative management was chosen by 17.9% of patients. Of those who had opted for RRT, 26.7% died before reaching it. The 5-year survival was 49.6% from first attendance at AKCS. The 5-year survival rates by age group were: &amp;lt;50\u00a0years, 84.2%; 50\u201364\u00a0years, 66.1%; 65\u201379\u00a0years, 40.1%; and \u226580\u00a0years, 22.3% (P\u00a0&amp;lt;\u00a0.001). The 5-year survival on haemodialysis was 49.6%, peritoneal dialysis 54.7% and 92.3% for pre-emptive transplant 92.3%. For those over 80\u00a0years of age a modest survival benefit was seen with RRT, with a median survival of 17.4\u00a0months from RRT commencement, compared with 11.8\u00a0months once the eGFR declined below 10\u00a0mL\/min\/1.73 m2 in the conservative group.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study highlights the high competing mortality in an advanced CKD cohort. The high rates of pre-emptive transplantation and peritoneal dialysis initiation demonstrate the benefits of a structured AKCS strategy. Older patients with ESKD, particularly those aged over 80\u00a0years, have poor outcomes, regardless of whether they choose RRT or conservative management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfaf211","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T11:33:36Z","timestamp":1751974416000},"source":"Crossref","is-referenced-by-count":4,"title":["Outcomes of patients in a pre-dialysis clinic and implications for shared decision making"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6934-6397","authenticated-orcid":false,"given":"Hannah","family":"O'Keeffe","sequence":"first","affiliation":[{"name":"Salford Royal Hospital, Northern Care Alliance Renal Department, , Manchester , \u00a0","place":["United Kingdom"]},{"name":"Faculty of Biology, Medicine and Health, University of Manchester , Manchester , \u00a0","place":["United 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