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.

This randomised trial asked whether a protocolised conservative kidney management approach (preparing for responsive management) yields better quality-adjusted life-years than preparing for renal dialysis in older adults with kidney failure who are frail or multimorbid. Among 445 participants followed for a mean of 4.5 years, QALYs did not differ significantly between groups (1.354 vs 1.472; adjusted difference -0.147, 95% CI -0.350 to 0.056), so neither strategy was shown to be superior. Dialysis access complications were significantly lower with responsive management, while hospital admission rates were similar.