Kidney transplantation would be the most likely strategy to provide this patient with the best long-term survival. Although there is an increase in short-term morbidity and mortality following transplantation, there is strong evidence that kidney transplantation decreases mortality and improves quality of life over the long term. Even though increased recipient age is also associated with reduced patient and allograft survival than younger patients after transplant, carefully selected older patients also benefit from kidney transplantation, and many centers therefore do not have an absolute age cutoff for transplant recipients. Moreover, this patient has family members who are willing to be evaluated as living kidney donors, and kidneys from living donors have superior outcomes compared with kidneys from deceased donors. Therefore, referral for possible kidney transplant in this otherwise healthy patient would be most likely to improve her long-term survival.

There is no clinical indication for this patient to change from peritoneal dialysis to hemodialysis, and clinical outcomes, including mortality and quality of life, are approximately equivalent between these modalities. The choice between peritoneal dialysis and hemodialysis should therefore be driven by patient-specific factors and patient preference if dialysis is pursued.

There is evidence that risk of graft loss and overall mortality are increased in patients who have been treated with dialysis prior to transplant, and that this risk of graft loss and overall mortality increase with the length of dialysis prior to transplant. Therefore, continuing dialysis and reevaluating for possible transplant in 2 to 3 years would not be an optimal management strategy in this otherwise good candidate for transplantation.