Wachterman MW, et al. - Identifying the necessity accurate estimates of prognosis for shared decision making about dialysis, a potentially burdensome or harmful treatment for older adults, researchers sought to describe mortality within the first year after dialysis initiation using data from the Health and Retirement Study, a nationally representative, longitudinal survey of older adults. Chronic dialysis was initiated in more than 120,000 people in the United States in 2015; of these, half were older than 65 years. As per the United States Renal Data System (USRDS) registry, these older adults currently have a 1-year mortality rate after dialysis initiation of approximately 30%. However, all patients who start dialysis—most notably omitting those who die before an outpatient dialysis provider enters them into the registry-are note included the USRDS. Therefore, a generalization of USRDS-based mortality estimates to all patients who initiate dialysis is not possible. In addition, there is a lack of detailed information on functional and cognitive status in registry data, which can significantly affect treatment decisions and outcomes. Thus, optimal support for real-time decision making about dialysis initiation in older adults could not be provided by the existing data.