Key points are not available for this paper at this time.
Abstract Background and Aims In general, patients with advanced chronic kidney disease (ACKD) on dialysis have a better survival than patients on conservative kidney management (CKM). However, in elderly and frail individuals, with multiple comorbidities, the survival benefits of dialysis seem to be lost. Although the focus of CKM is not quantity but quality of life (QoL), it is important to identify survival modifiers and mortality predictors that may eventually influence QoL and the development of symptoms. Method An observational retrospective and multicenter study of ACKD patients on CKM was conducted from July/2015 to December/2023. Data was retrieved from electronic records, encompassing kidney function, analytical parameters, functional and fragility state, and symptoms evaluation (using Palliative Outcome Scale—Renal). The Kaplan-Meier curves and Cox proportional hazards multivariable regression were used for survival analysis and to evaluate 180-day mortality predictors. Results A total of 212 patients (56.6% females), with a mean age of 83 years old and a mean follow up time of 220 ± 239 days, were included. The follow-up time was determined by the end of the observational period or the patient's death. 56.1% died before a 180-day follow-up period. The main causes for the ACKD were multifactorial (29.7%) and indeterminate (25.9%). The majority (80.7%) had nephrologist oversight before a CKM team initiated its follow-up, and 63.6% opted for CKM as their first treatment choice. Survival at 180 days (Fig. 1) differed significantly depending on sex (51.3 vs 65.6, p = 0.021), age under 80 years-old (51.3 vs 73.9, p = 0.000), provenance (0 vs 39.4 vs 83 vs 93.8, p = 0.000), albumin value (32.7 vs 65.5, p = 0.032), and symptoms such as anorexia and pain (53 vs 95.5, p = 0.000; and 54.5 vs 88.9, p = 0.000). Regarding to mortality predictors (Table 1), albumin under 3g/dL, anorexia and pain were independent predictors of mortality. Conclusion Understanding factors associated with increased mortality and higher rates of survival in CKM patients is crucial to better manage this population. Pain, albumin 3g/dL and anorexia, which may reflect patients with worse nutritional status, were shown to be independent predictors of mortality. Therefore, controlling these symptoms, which often impair QoL, and improving nutritional status appears to have an impact not only on QoL but also on survival of ACKD patients on CKM.
Trigo et al. (Wed,) studied this question.