Choosing conservative therapy in chronic kidney disease

Teruel, J.L.; Vion, Víctor Burguera; Couto, Antonio Gomis; Gorrín, Maite Rivera; Fernández-Lucas, Milagros; Mendiola, Nuria Rodríguez; Quereda, C.

doi:10.1016/j.nefroe.2015.06.004

Cited by 10 publications

(15 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Place of death Deaths at home or in a hospice: CKM, 22 of 34 deaths (65 %) Dialysis, 11 of 41 deaths (27 %); p = 0.001 Tam-Tham , 2018, Canada [ 35 ] CKD5 Age ≥ 65 at inclusion Age 65 to < 75 (n, %) Dialysis, 228 (45.6) CKM, 45 (13.3) Age 75 to < 85 (n, %) Dialysis, 220 (44.0) CKM, 143 (42.3) Age ≥ 85 (n, %) Dialysis, 52 (10.4) CKM, 150 (44.4) CKM, 338 Dialysis, 500 Mortality Dialysis vs. CKM (0–3 years), HR: 0.56 (95 % CI: 0.44–0.71); p < 0.001 Dialysis vs. CKM (after 3 years), HR: 1.98 (95 % CI: 1.16–3.37); p = 0.12 Hospitalization Dialysis vs. CKM, HR: 1.40 (95 % CI: 1.16–1.69), p = 0.001 Tan , 2017, Australia [ 27 ] CKD5 Age > 65 at inclusion CKM, 84 Dialysis, 73 CKM, 8 Dialysis, 12 Symptom burden Change (improvement) in mean symptom POS-score over 6 months: CKM, 1.5; dialysis, 7.58; p < 0.002. Teo , 2010, Singapore [ 26 ] CKD5 CKM, 67.4 ± 11.8 HD, 58.7 ± 12.9 CKM, 16 HD, 102 Mortality CKM, HR: 2.29 (95 % CI: 1.16–4.45); HD, HR: 0.59 (95 % CI: 0.33–1.05); p = 0.042 Teruel , 2015, Spain [ 34 ] CKD5 Median age (IQR) Dialysis, 68 (54,76) CKM, 83 (78,86) CKM, 90 Dialysis, 142 Mortality CKM, 8.2/100 patient months; Dialysis, 0.6/100 patient months; p < 0.001 van Loon , 2019, the Netherlands [ 21 ] CKD5 Age ≥ 65 at inclusion CKM, 82 ± 6 Dialysis, 75 ± 7 CKM, 89 Dialysis, 192 …”

Section: Resultsmentioning

confidence: 99%

Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

et al. 2021

View full text Add to dashboard Cite

Background Patients with stage 5 chronic kidney disease (CKD5) collaborate with their clinicians when choosing their future treatment modality. Most elderly patients with CKD5 may only have two treatment options: dialysis or conservative kidney management (CKM). The objective of this systematic review was to investigate whether CKM offers a quantity or quality of life benefit compared to dialysis for some patients with CKD5. Methods The databases MEDLINE, EMBASE, the Cochrane Library, and CINAHL were systematically searched for studies comparing patients with CKD5 who had chosen or were treated with either CKM or dialysis. The primary outcomes were mortality and quality of life (QoL). Hospitalization, symptom burden, and place of death were secondary outcomes. For studies reporting hazard ratios, pooled values were calculated, and forest plots conducted. Results Twenty-five primary studies, all observational, were identified. All studies reported an increased mortality in patients treated with CKM (pooled hazard ratio 0.47, 95 % confidence interval 0.34–0.65). For patients aged ≥ 80 years and for elderly individuals with comorbidities, results were ambiguous. In most studies, CKM seemed advantageous for QoL and secondary outcomes. Findings were limited by the heterogeneity of studies and biased outcomes favouring dialysis. Conclusions In general, patients with CKD5 who have chosen or are on CKM live for a shorter time than patients who have chosen or are on dialysis. In patients aged ≥ 80 years old, and in elderly individuals with comorbidities, the survival benefits of dialysis seem to be lost. Regarding QoL, symptom burden, hospitalization, and place of death, CKM may have advantages. Higher quality studies are needed to guide patients and clinicians in the decision-making process.

show abstract

Section: Resultsmentioning

confidence: 99%

Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…41 By comparison, other developed countries have established dedicated conservative care programs to support patients who do not want to undergo dialysis. [42][43][44][45][46][47] Distinct conservative care programs can be advantageous because of their streamlined efforts to ensure that patients' goals and preferences are honored in health systems where initiation of dialysis is the norm. 14,16,48 In most cases, these models are intended as an alternative to dialysis, and generally only accept patients who have decided not to pursue dialysis.…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members

Oestreich

Sayre

O’Hare

et al. 2021

American Journal of Kidney Diseases

View full text Add to dashboard Cite

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

show abstract

“…31 In a Spanish single-center study from the same time period, CCM was provided to 39% of ESKD patients. 32 In 2009, researchers from the ERA-EDTA Registry found that in 11 European countries CCM was provided to 15% of the ESKD patients on average. 4 In the current analysis, we repeated part of this previous ERA-EDTA Registry study using the EDITH Nephrologist survey, but covering more countries and allowing comparison per individual country.…”

mentioning

confidence: 99%

Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

Stel¹,

Jong²,

Kramer³

et al. 2021

Kidney International

View full text Add to dashboard Cite

Choosing conservative therapy in chronic kidney disease

Cited by 10 publications

References 12 publications

Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

Perspectives on Conservative Care in Advanced Kidney Disease: A Qualitative Study of US Patients and Family Members

Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

Contact Info

Product

Resources

About