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About half of US dialysis patients are alive 5 years after starting treatment — but that average hides enormous variation. A 30-year-old on dialysis has a much better outlook than an 85-year-old, and transplant survival is roughly 2-3× better at every age.
The USRDS reports that roughly 80% of dialysis patients survive the first year after starting treatment, and about 50% survive five years. These are averages across all ages and conditions — cardiovascular disease is the leading cause of death, followed by infection.
Age is the dominant factor: patients who start dialysis at 20-44 have a 5-year survival around 75%; at 65-79 it drops to roughly 35-40%; above 80 it falls further. The underlying cause matters too — diabetic kidney disease carries a higher mortality than many primary kidney diseases.
These numbers are not destiny — they're population averages from people who mostly started dialysis in emergencies. Elective starts with a mature fistula, good blood pressure control, and transplant evaluation change the picture substantially.
The most important comparison: kidney transplant survival. Five-year survival after transplant is roughly 90% — about double dialysis survival at every age. This is why transplant evaluation is recommended for every dialysis candidate.
Survival statistics describe populations, not people. The average dialysis patient is in their 60s with diabetes and heart disease — their outcomes pull the average down. A fit 45-year-old with a working fistula has a materially better outlook than the registry average.
What moves the needle for individuals: starting dialysis electively (not in emergency) with a mature fistula rather than a catheter; controlling blood pressure, phosphorus, and fluid; staying active; and getting on the transplant list — the single biggest survival lever available.
If you're facing dialysis, ask your care team for your own picture: your expected start route (elective vs urgent), your access plan, and your transplant evaluation timeline. That's a far more useful conversation than any average.
Updated August 2026. Figures from federal registries (USRDS, CDC, CMS) — the authoritative sources for US kidney statistics.
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This content is a general reference, not medical advice, a diagnosis, or a treatment plan. Do not change your diet, fluids, medicines, or dialysis plan without your nephrologist or renal dietitian. Individual recommendations depend on your labs, medications, conditions, and care plan.