Episodes

Weekly · Nov 9: Dialysis or Not for the Frail Older Patient, Reading Frailty at the Chair, and How to Have the Conversation

One decision this week: dialysis, or not, for the frail older patient. The first randomized trial ever run on it, a one-minute frailty score that separates 4% from 27%, and the sentence almost nobody says out loud.

Dr Wael Hussein

— 2 min read
Share
Weekly · Nov 9: Dialysis or Not for the Frail Older Patient, Reading Frailty at the Chair, and How to Have the Conversation

One subject this week, three papers, in the order a clinician needs them. Prepare for Kidney Care, in The Lancet, is the first randomized trial ever run on preparing a frail older patient for dialysis versus preparing them for a life without it — and it looked hard for a winner without finding one. A French cohort in Kidney Medicine shows that a nurse's one-minute read of what a patient can and cannot do separates a 3.6% chance of dying in a year from a 27% chance. And a JASN framework names the thing most of us do instead of having the conversation: we hide in the mechanics.

Disclosure: No spoken disclosure this week; nothing in this episode touches a dialysis product or a payment rule. The Lancet trial had no industry funding (NIHR Health Technology Assessment programme). Among its authors, Simon Davies reports a Byonyks advisory board role and lectures for Vantive; Emma Murphy reports travel support from CSL Vifor; Caoimhe Rice is an employee of PPD Evidera; Joanna Coast developed the ICECAP measures. The Kidney Medicine, AJKD and JASN pieces report no funding and no relevant financial interests.

Chapters

Papers in this episode

  • Caskey FJ, Worthington J, Liu Y, et al. Preparing for responsive management versus renal dialysis in older people living with kidney failure and frailty or multimorbidity in the UK (Prepare for Kidney Care): a two-arm, superiority, parallel-group, open-label, pragmatic, phase 3, individually randomised controlled trial. Lancet. Published online November 4, 2026. Link
  • Ingwiller M, Chantrel F, Krummel T, et al. Frailty as a Predictor of Mortality in Dialysis: A Multicenter Validation of the Clinical Frailty Scale. Kidney Med. 2026;8(11):101510. Link
  • Samyn M-C, Caullet T, Dusautois F, et al. Lived Experiences of Home-Based Conservative Kidney Management in Older Adults: A Qualitative Study (EXPECT). Am J Kidney Dis. 2026;88(5):692-703.e1. Link
  • Hole B, Gelfand S. “There’s No Goal…Except That We Take Care of Them”: Meeting the Needs of People Whose Kidney Failure is Managed Conservatively. Am J Kidney Dis. 2026;88(5):684-686. Link
  • Schell JO, Schwarze ML, Arnold RM, Moss AH. Applying a Better Conversations Framework to Dialysis Decision-Making for Patients with Advanced CKD. J Am Soc Nephrol. 2026;37(11):2571-2573. Link

Also mentioned

  • Hole B, et al. A discrete choice experiment: older people with kidney failure in the UK needed an 8% to 59% absolute survival benefit to accept dialysis. Kidney Int. 2025. Link

Listen anywhere: Apple Podcasts · Spotify · other apps. Discuss: NephSpace on LinkedIn.

Physician-led, AI-assisted. Dr. Wael Hussein chooses the papers, reviews and edits every script, and approves every episode. AI (Claude, by Anthropic) writes the first draft from the full text of each paper, and a separate AI check compares every number with the papers; Dr. Hussein then reviews and edits the draft before the AI hosts (ElevenLabs) voice it. Everything is summarized in our own words. For education and information only, not medical advice. Please talk to your own physician or care team about your health. Clinicians: read the original before changing practice. See our disclaimer. Views are the creator's own and not those of his employer. No sponsors.

Read more