Trajectory of Quality of Life for Poor Prognosis Stage 5D Chronic Kidney Disease with and without Dialysis

Abstract

Background: Renal replacement therapy (RRT) has not always been shown to benefit end-stage renal failure patients who are elderly or have multiple comorbidities in terms of survival or symptom control. Conservative management may be a viable alternative offering comparable health-related quality of life. Methods: This is a prospective observational study of 101 patients who reached an estimated glomerular filtration rate of 8-12 ml/min and were either ≥75 years old or had an age-adjusted Charlson Comorbidity Index ≥8. Patients were all initially on conservative management; 38 later commenced renal replacement therapy while the rest remained conservatively managed. The Kidney Disease Quality of Life-Short Form was assessed at baseline and various scheduled time points over 24 months. The mixed model methodology was used to estimate the quality of life patterns and adjust for covariates. Results: In the conservative management group, the Physical Component Summary and Mental Component Summary scores were stable and showed no significantly different trajectories from the RRT group (both p > 0.05). Though RRT was associated with an improvement in the Cognitive Function Scale score, it was also associated with worse scores on the Effect of Kidney Disease and Burden of Kidney Disease Scale scores. Conclusions: RRT does not improve health-related quality of life of end-stage kidney failure patients who are elderly or have a high comorbidity burden.

Mortality in the Elderly on Dialysis

“…QoL was maintained during the 3-year follow-up period in patients on CKM and patients on HD, except for life satisfaction, which declined after starting dialysis in the HD group. Similar outcomes have been reported in other observational studies (20).…”

Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis

“…Neither of these latter two studies provided the eGFR of the patients in the conservative care groups. A study from Singapore, where all patients have to pay for dialysis treatments, suggested that QoL was similar for older and multiply comorbid patients on conservative care compared with those on dialysis, but the burden of kidney disease is higher in the dialysis group [28]. However, this study could be confounded by social and financial differences between the groups.…”

Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End‐Stage Renal Disease: A Systematic Review

“…Others had a combination of individuals undergoing hemodialysis and peritoneal dialysis (n = 5, 21%) and individuals undergoing hemodialysis and kidney transplantation (n = 2, 8%) . One publication did not define the type of RRT …”