Conservative Management in End-Stage Kidney Disease between the Dialysis Myth and Neglected Evidence-Based Medicine

Abstract

In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice.

Stage 5 Chronic Kidney Disease: Epidemiological Analysis in a NorthEastern District of Italy Focusing on Access to Nephrological Care

“…Our results show an impressive number of ESKD elders in unfollowed patients, who could receive, for example, conservative management. Unfortunately, to date, this therapeutic option seems underused despite its possible positive influence on elderly and comorbid patients, allowing effective control of uremia, delaying CKD progression and the need for dialysis, maintaining their habits, and limiting hospitalization without heavy effects on the quality of life [9]. Likely, a campaign of information on conservative management among general practitioners and geriatrics could positively impact the care of older and frail patients.…”

“…If the longer life expectancy of dialysis patients partially justifies this increase, the higher incidence of ESKD is the main factor impacting the current prevalence [1,3,8]. The increasing number of dialysis patients could also be related to the limited expansion of conservative management in older people [9]. Theoretically, ESKD patients can more easily receive proper treatment in high-income countries, especially where the health system is public.…”

Low-Protein Diet in Elderly Patients with Chronic Kidney Disease Stage 4 and 5 in Conservative Management: Focus on Sarcopenia Development

“…A low-protein diet has demonstrated significant benefits in managing chronic kidney disease [12], slowing its progression and reducing symptoms [13,14]. Studies highlight that reduced protein intake is associated with metabolic improvements, such as increased bicarbonate and reduced phosphorus, and a lower risk of progressing to end-stage renal disease [13].…”