| Summary: | Background 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. Methods Single centre observational study that included patients ≥70 years with stage 4–5 CKD undergoing conservative management. We evaluated sleep disorders, nutritional markers, and bone biomarkers. Results In total, 150 patients (81 ± 7 years, Charlson score 7.8 ± 1.6, followed for a median of 1.8 years). At 2 years, 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 (1.49–3.80), P = .001] and excessive daytime sleepiness [OR 7.47 (1.86–30.00), P = .018] increased the likelihood of dialysis, while higher Charlson comorbidity scores [OR 1.49 (1.08–2.05), P = .049] and beta-blocker use [OR 4.93 (1.58–15.39), P = .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 = .005) and a lower probability of death (P = .005). Conclusion 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.
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