Many patients with advanced kidney disease who forgo maintenance dialysis can survive for several years and experience improved mental and physical well-being until later in the course of the illness, according to a study published in JAMA Network Open. In a systematic review of 41 cohort studies including 5,102 patients, Susan Wong, MD, and colleagues examined survival, healthcare resource use, changes in QOL, and end-of-life care among patients with advanced kidney disease who forwent dialysis. Per person-year, patients experienced one to two hospital admissions, 6-16 in-hospital days, seven to eight clinic visits, and two ED visits in general. Mental well-being improved during an observational period of 8-24 months, while physical well-being and overall QOL were mainly stable until late in the course of illness. Of the patients who died during follow-up across all 41 studies, 20% to 76% had enrolled in hospice, 27% to 68% died in a hospital setting, and 12% to 71% died at home.