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August 16, 2018BMC NephrologyOpen Access

Conservative care in older patients with advanced chronic kidney disease significantly increased hospital-free days per year compared to dialysis (352.7 vs 282.7 days; IRR 1.15), while the survival benefit of dialysis was lost in patients aged ≥80 years or with severe comorbidity.

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Why the study?

Does dialysis improve survival, quality of life, and treatment burden compared to conservative care in patients aged ≥70 years with advanced CKD?

Population

366 patients aged ≥70 years with advanced chronic kidney disease in a non-academic teaching hospital in The…

Comparison

Dialysis pathway vs Conservative care

Design

Cohort

Key result

Conservative care in older patients with advanced chronic kidney disease significantly increased hospital-free days per year compared to dialysis (352.7 vs 282.7 days; IRR 1.15), while the survival benefit of dialysis was lost in patients aged ≥80 years or with severe comorbidity.

Authors

WVWouter R. VerberneJDJanneke DijkersJKJohannes C. Kelder

Discussion

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Overview

Supports conservative care to reduce burden in older advanced CKD; leaves open randomized confirmation of survival and QoL effects.

Study Design

Type

Cohort (n=366)

Multicenter

No

Structured PICO

Does dialysis improve survival, quality of life, and treatment burden compared to conservative care in patients aged ≥70 years with advanced CKD?

P
Population
366 older adults (aged ≥70 years) with advanced chronic kidney disease who chose either dialysis or conservative care, evaluated for survival, quality of life, treatment burden, and costs.
E
Exposure
Dialysis pathway
C
Comparator
Conservative care
O
Outcome
Survival, health-related quality of life (assessed with Kidney Disease Quality of Life Short Form), treatment burden (hospital free days), and treatment costs

Main Result

Relative Risk: 1.15 (95% CI 1.09–1.21)

Absolute Event Rate: 352.7% vs 282.7%

p-value: p=<0.001

Conservative care in older patients with advanced CKD provides similar quality of life and more hospital-free days at lower costs compared to dialysis, particularly in those ≥80 years or with severe comorbidity.

Limitations

  • Retrospective observational design
  • Single-center study
  • Allocation bias and confounding by indication due to non-random treatment decision
  • Small sample size for the health-related quality of life (HRQOL) assessment
  • Potential lead time bias
  • Cost data limited to the hospital perspective

Cite This Study

Verberne et al. (2018) conducted a cohort in Advanced chronic kidney disease (stage 4/5) (n=366). Conservative care vs. Dialysis was evaluated on Hospital free days per year (IRR 1.15, 95% CI 1.09-1.21, p=<0.001). Conservative care in older patients with advanced chronic kidney disease significantly increased hospital-free days per year compared to dialysis (352.7 vs 282.7 days; IRR 1.15), while the survival benefit of dialysis was lost in patients aged ≥80 years or with severe comorbidity.

synapsesocial.com/papers/6a5cfa17289a75eadbc253dbhttps://doi.org/10.1186/s12882-018-1004-4
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1#2576 Effect of dialysis versus conservative care on all-cause mortality in older patients with advanced CKD: nationwide Swedish cohort study2024
  2. 2Dialysis versus conservative kidney management in older adults: why one size does not fit all2026 · 4 citations
  3. 3Health-related quality of life and symptoms of conservative care versus dialysis in patients with end-stage kidney disease: a systematic review2020 · 59 citations
  4. 4Understanding by Older Patients of Dialysis and Conservative Management for Chronic Kidney Failure2014 · 117 citations
  5. 5Conservative Kidney Management Versus Dialysis Initiation: Can New Statistical Tools Help Understand the Bias in This Choice?2020