UK trial: for frail older adults, preparing for dialysis was not better than conservative kidney care

A University of Bristol–led randomised trial published in The Lancet on 4 November 2026 found that, for older people with kidney failure plus frailty or multiple illnesses, preparing for dialysis was not clearly better than structured conservative kidney management without dialysis when length and quality of life were considered together.

Study type

• Type: randomised controlled trial (Prepare for Kidney Care), NIHR-funded; described by the team as the first of its kind worldwide for this comparison.
• Participants: 445 people from 31 UK kidney centres (~half of UK kidney services). About 75% were aged 80+; the rest were 65–79 with additional health problems.
• Arms: prepare for renal dialysis vs prepare for responsive/conservative management (active care without dialysis). Participants could leave the assigned pathway. Average follow-up about 4.5 years; the programme took nine years overall.

Results

Neither approach was superior on the combined quality-and-length-of-life outcome. Only 28% of those preparing for dialysis actually started it. In both groups, people were more likely to die of other causes than to need dialysis — reflecting high competing risks in this population. Project lead Fergus Caskey said both options are worth considering and neither should be the default.

Limitations and who this is not for

Results do not apply to people already on dialysis, or to younger, fitter patients for whom dialysis and transplant remain standard. Shared decision-making still depends on individual goals, local services and clinical judgement. This article is not personal medical advice — talk to your kidney team about treatment choices.