Survival and quality of life in elderly patients in conservative management

Rubio, María Victoria Rubio; Arnal, Luis Miguel Lou; Orna, José Antonio Gimeno; Navarro, Paula Munguía; Gutiérrez-Dalmau, Álex; Ibor, Elena Lambán; Ramos, Javier Paúl; Lavilla, Raquel Pernaute; Gutiérrez, B. Campos; Hernández-Franch, Alberto San Juan

doi:10.1016/j.nefroe.2018.07.010

Cited by 2 publications

(20 citation statements)

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“…A total of 41 cohort studies comprising 5102 patients (study size range, 11-812 patients; 5%-99% men; mean age range, 60-87 years) were included in this review (eTable 1 in the Supplement ). 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 No clinical trials were identified in our search.…”

Section: Resultsmentioning

confidence: 99%

“…Thirty-four studies (3754 patients) 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 25 , 26 , 27 , 29 , 30 , 31 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 50 provided information on median survival and IQR or sufficient information to estimate these values (eTable 2 in the Supplement ). The range of median survival of cohorts was 1 to 41 months as measured from a baseline mean eGFR range of 7 to 19 mL/min/1.73 m 2 ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…The median survival of cohorts ranged from 1 to 31 months in the UK (13 studies; 1320 patients), 12 , 15 , 16 , 18 , 20 , 22 , 25 , 31 , 34 , 35 , 36 , 43 , 50 6 to 37 months in continental Europe (11 studies; 1021 patients), 21 , 23 , 29 , 37 , 38 , 39 , 40 , 45 , 46 , 47 , 48 7 to 41 months in Asia (7 studies; 1147 patients), 13 , 14 , 26 , 27 , 41 , 42 , 44 and 8 to 17 months in Australia (3 studies; 258 patients). 11 , 17 , 30 The wide ranges in median survival for cohort members in these regions corresponded to the wide ranges in baseline mean eGFR (7-18 mL/min/1.73 m 2 for Asia, 14-18 mL/min/1.73 m 2 for Australia, 8-17 mL/min/1.73 m 2 for continental Europe, and 9-19 mL/min/1.73 m 2 for the UK).…”

Section: Resultsmentioning

confidence: 99%

“…Median survival was 6 to 22 months and baseline mean eGFR was 8 to 14 mL/min/1.73 m 2 for cohorts published before 2010 (6 studies; 317 patients), 12 , 20 , 23 , 31 , 43 , 50 6 to 37 months and 7 to 19 mL/min/1.73 m 2 for cohorts published from 2010 to 2015 (11 studies; 851 patients), 11 , 13 , 15 , 17 , 18 , 22 , 39 , 41 , 42 , 44 , 45 and 1 to 39 months and 9 to 16 mL/min/1.73 m 2 for cohorts published after 2015 (17 studies; 2586 patients). 14 , 16 , 21 , 25 , 26 , 27 , 29 , 30 , 34 , 35 , 36 , 37 , 38 , 40 , 46 , 47 , 48 Younger cohorts aged 70 to 79 years (9 studies; 607 patients) 13 , 15 , 18 , 30 , 34 , 42 , 43 , 44 , 50 had a median survival of 7 to 41 months, and cohorts 80 years or older (25 studies; 3186 patients) 11 , 12 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 25 ,…”

Section: Resultsmentioning

confidence: 99%

“… 14 , 16 , 21 , 25 , 26 , 27 , 29 , 30 , 34 , 35 , 36 , 37 , 38 , 40 , 46 , 47 , 48 Younger cohorts aged 70 to 79 years (9 studies; 607 patients) 13 , 15 , 18 , 30 , 34 , 42 , 43 , 44 , 50 had a median survival of 7 to 41 months, and cohorts 80 years or older (25 studies; 3186 patients) 11 , 12 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 45 , 46 , 47 , 48 had a median survival of 1 to 37 months despite overlapping ranges of baseline mean eGFR (7-18 and 8-18 mL/min/1.73 m 2 , respectively). Patients who were treated in usual nephrology care settings or who had received an unspecified approach to care (22 studies; 1886 patients) 15 , 16 , 17 , 18 ,…”

Section: Resultsmentioning

confidence: 99%

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Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

et al. 2022

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IMPORTANCE An understanding of the long-term outcomes of patients with advanced chronic kidney disease not treated with maintenance dialysis is needed to improve shared decision-making and care practices for this population. OBJECTIVE To evaluate survival, use of health care resources, changes in quality of life, and end-oflife care of patients with advanced kidney disease who forgo dialysis.EVIDENCE REVIEW MEDLINE, Embase (Excerpta Medica Database), and CINAHL (Cumulative Index of Nursing and Allied Health Literature) were searched from inception through December 3, 2021, for all English language longitudinal studies of adults in whom there was an explicit decision not to pursue maintenance dialysis. Two investigators independently reviewed all studies and selected those reporting survival, use of health care resources, changes in quality of life, or end-of-life care during follow-up. Studies of patients who initiated and then discontinued maintenance dialysis and patients in whom it was not clear that there was an explicit decision to forgo dialysis were excluded.One author abstracted all study data, of which 12% was independently adjudicated by a second author (<1% error rate). FINDINGS Forty-one cohort studies comprising 5102 patients (range, 11-812 patients) were included in this systematic review (5%-99% men; mean age range, 60-87 years). Substantial heterogeneity in study designs and measures used to report outcomes limited comparability across studies. Median survival of cohorts ranged from 1 to 41 months as measured from a baseline mean estimated glomerular filtration rate ranging from 7 to 19 mL/min/1.73 m 2 . Patients generally experienced 1 to 2 hospital admissions, 6 to 16 in-hospital days, 7 to 8 clinic visits, and 2 emergency department visits per person-year. During an observation period of 8 to 24 months, mental well-being improved, and physical well-being and overall quality of life were largely stable until late in the illness course. Among patients who died during follow-up, 20% to 76% had enrolled in hospice, 27% to 68% died in a hospital setting and 12% to 71% died at home; 57% to 76% were hospitalized, and 4% to 47% received an invasive procedure during the final month of life. CONCLUSIONS AND RELEVANCEMany patients who do not pursue dialysis survived several years and experienced sustained quality of life until late in the illness course. Nonetheless, use of acute care services was common and intensity of end-of-life care highly variable across cohorts. These findings suggest that consistent approaches to the study of conservative kidney management are needed to enhance the generalizability of findings and develop models of care that optimize outcomes among conservatively managed patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

et al. 2022

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Cuidados paliativos en la calidad de vida de los pacientes con enfermedad renal crónica avanzada sin terapia de sustitución renal.

Coss Morales,

Gallardo Guerrero,

Ramírez Reyes

et al. 2024

ceyes

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Objetivo. Analizar la aplicación de cuidados paliativos y su impacto en la calidad de vida en pacientes con enfermedad renal crónica avanzada sin terapia de sustitución renal. Metodología: Revisión sistemática cualitativa guiada por la declaración PRISMA. Se realizó una búsqueda bibliográfica en 4 bases de datos: Scielo, Web of Science, Pubmed y Lilacs. Los criterios de inclusión fueron artículos originales, en idioma español, inglés, y portugués, con un máximo de 5 años de publicación. La calidad metodológica consideró 17 indicadores de una pauta de lectura crítica. Resultados: Se seleccionaron 24 artículos, de los cuales se desprenden 4 categorías: Toma de decisión (Familiar/personal de salud / paciente), Cuidados paliativos v/s diálisis, Calidad de vida en cuidados paliativos, Percepción del personal de salud. Conclusión: A través de este estudio se logró reafirmar que la implementación de cuidados paliativos logra una mejor calidad de vida en pacientes con enfermedad renal en etapa. 5in embargo, en Latinoamérica no se cuenta con suficiente investigación científica, siendo ésta, necesaria para su implementación.

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Survival and quality of life in elderly patients in conservative management

Cited by 2 publications

References 30 publications

Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis

Cuidados paliativos en la calidad de vida de los pacientes con enfermedad renal crónica avanzada sin terapia de sustitución renal.

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