| Sumario: | The article focuses on the AGing NEphropathy Study (AGNES), a prospective cohort study of Brazilian adults aged 70 and older with advanced chronic kidney disease (CKD), examining factors influencing dialysis initiation and mortality over two years. AGNES found that most very old adults with advanced CKD neither started dialysis nor died within this period, highlighting that progression to dialysis is not inevitable and that comorbidity burden and symptom experience, particularly excessive daytime sleepiness, play a more significant role in outcomes and treatment decisions than biomarkers or geriatric measures alone. The study emphasizes the limitations of prediction-focused models in this complex population and supports the integration of renal-tailored comprehensive geriatric assessment (CGA) to enhance shared decision-making and care planning across dialysis and transplantation pathways. These findings advocate for a shift from kidney-centric approaches toward multidimensional, geriatric-informed care in managing older adults with advanced CKD.
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