{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:49:56Z","timestamp":1791614996666,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100008530","name":"Fondo Europeo de Desarrollo Regional","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The decision to initiate kidney replacement therapy (KRT) rather than conservative care in patients with chronic kidney disease (CKD) depends on various factors and carries significant consequences. This study analyzes the impact of choice of treatment modality on hospitalization and survival of very old patients with advanced CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter, retrospective, observational study analyzed data collected from 11 spanish hospital\u00a0between 2019 and 2022. The study\u00a0included patients aged over 80 years with an estimated glomerular filtration rate (eGFR) of less than 15\u2005mL\/min\/1.73\u2005m2. Baseline epidemiological data and information on comorbidities were collected. The factors associated with the choice of conservative treatment, as well as its impact on hospitalization and survival were analyzed. A sub-analysis was performed comparing patients with a\u00a0survival time\u00a0of less than one year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four hundred ninety-two patients (58.1% male, age 85 \u00b1 4 years) were included. Among them, 262 (53.3%) opted for conservative care, while 230 (46.7%) initiated KRT, of whom 74 (32.1%) did so urgently. Factors independently associated with choosing conservative care were female sex, older age, higher eGFR, and greater level of\u00a0dependency (all P &amp;lt; .001). During follow-up (21 [13\u201334] months), 221 patients (44.9%) died. Choosing conservative care was independently associated with mortality (Hazard Ratio [HR] 2.554, P &amp;lt; .001). There was a trend towards an association between urgent initiation of KRT and mortality compared to programmed KRT (HR 2.064, P = .080). In patients surviving less than 12 months, conservative care and KRT exhibited similar outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In very old patients, KRT is associated with better survival than conservative care. However, urgent initiation of KRT or short expected survival reduces the prognostic benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/joneph\/aajag108","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T11:42:24Z","timestamp":1776253344000},"page":"1257-1265","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the management of advanced kidney disease in patients over 80 years of age: a multicenter Spanish study"],"prefix":"10.1093","volume":"39","author":[{"given":"Ignacio","family":"G\u00f3mez-Rojas","sequence":"first","affiliation":[{"name":"Nephrology Department, Hospital Universitario de la Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc\u00eda","family":"Criado-Bellido","sequence":"additional","affiliation":[{"name":"Nephrology and Hypertension Department, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz , Madrid 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Department, Hospital Universitario 12 de Octubre , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatiana","family":"Ni\u00f1o","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario de la Princesa , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanieli","family":"Hern\u00e1ndez-Perdomo","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]},{"name":"RICORS 2040-Renal , Instituto de Salud Carlos III (ISCIII), Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina M","family":"Le\u00f3n-Machado","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario La Paz , Madrid ,","place":["Spain"]},{"name":"RICORS 2040-Renal , Instituto de Salud Carlos III (ISCIII), Madrid 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,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel A","family":"Navas","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Nuestra Se\u00f1ora de Sonsoles , \u00c1vila ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana","family":"Puente-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital Universitario de Fuenlabrada , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Villa-Vald\u00e9s","sequence":"additional","affiliation":[{"name":"Nephrology Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-9523","authenticated-orcid":false,"given":"Alberto","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Nephrology and 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