Comprehensive Conservative Kidney Management among Older Population

Key Points Nonfrail patients age 75 years and older with advanced CKD were more likely to select conservative kidney management (CKM). The CKM group had significantly lower hospitalization rates compared with the non-CKM group in older patients with advanced CKD. Mortality outcomes were comparable between the CKM and non-CKM groups, indicating no notable survival disadvantage with CKM. Background In an aging society, conservative kidney management (CKM) has emerged as an alternative to KRT for older patients with advanced CKD. However, current evidence regarding CKM selection and its outcomes is limited. This study compared the rates of hospitalization and survival in CKM patients with those of KRT in the older Japanese general population with advanced CKD. Methods Using a large administrative claims database, we identified individuals age 75 years or older with an eGFR <8 ml/min per 1.73 m 2 who were not receiving KRT at a health checkup. Patients were classified into two groups: CKM and non-CKM. The CKM group comprised those who did not undergo any procedures related to KRT induction for the entire observation period, whereas those who received these procedures were classified into the non-CKM group. A Cox regression model was used to evaluate factors associated with the CKM selection and survival outcomes. A Poisson regression model was used to evaluate incidence rate ratios for hospitalization. Results A total of 428 patients with a median age of 81.0 years (interquartile range, 77.8–84.9) were included. Of them, 307 (71.7%) were assigned to the CKM group. CKM selection was more prevalent among nonfrail individuals (hazard ratio, 1.56; 95% confidence interval CI, 1.23 to 2.00). The CKM group demonstrated a significantly lower hospitalization rate (adjusted incidence rate ratios, 0.40; 95% CI, 0.32 to 0.49). Notably, the mortality rates did not differ significantly between the two groups (hazard ratio, 0.84; 95% CI, 0.45 to 1.56). Conclusions CKM was more commonly chosen by nonfrail patients with advanced CKD. The CKM group had significantly fewer hospitalizations than the non-CKM group without any detrimental effect on survival rate. These findings highlight the potential benefits of CKM and the need for further studies to improve CKM indications in aging populations.