Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review

Buur Louise Engelbrecht, Madsen Jens Kristian, Eidemak Inge, Krarup Elizabeth, Lauridsen Thomas Guldager, Taasti Lena Helbo, Finderup Jeanette*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

24 Citationer (Scopus)

Abstract

Background: Patients with stage 5 chronic kidney disease (CKD5) collaborate with their clinicians when choosing their future treatment modality. Most elderly patients with CKD5 may only have two treatment options: dialysis or conservative kidney management (CKM). The objective of this systematic review was to investigate whether CKM offers a quantity or quality of life benefit compared to dialysis for some patients with CKD5. Methods: The databases MEDLINE, EMBASE, the Cochrane Library, and CINAHL were systematically searched for studies comparing patients with CKD5 who had chosen or were treated with either CKM or dialysis. The primary outcomes were mortality and quality of life (QoL). Hospitalization, symptom burden, and place of death were secondary outcomes. For studies reporting hazard ratios, pooled values were calculated, and forest plots conducted. Results: Twenty-five primary studies, all observational, were identified. All studies reported an increased mortality in patients treated with CKM (pooled hazard ratio 0.47, 95 % confidence interval 0.34–0.65). For patients aged ≥ 80 years and for elderly individuals with comorbidities, results were ambiguous. In most studies, CKM seemed advantageous for QoL and secondary outcomes. Findings were limited by the heterogeneity of studies and biased outcomes favouring dialysis. Conclusions: In general, patients with CKD5 who have chosen or are on CKM live for a shorter time than patients who have chosen or are on dialysis. In patients aged ≥ 80 years old, and in elderly individuals with comorbidities, the survival benefits of dialysis seem to be lost. Regarding QoL, symptom burden, hospitalization, and place of death, CKM may have advantages. Higher quality studies are needed to guide patients and clinicians in the decision-making process.

OriginalsprogEngelsk
Artikelnummer307
TidsskriftBMC Nephrology
Vol/bind22
Udgave nummer1
ISSN1471-2369
DOI
StatusUdgivet - dec. 2021
Udgivet eksterntJa

Bibliografisk note

Funding Information:
The authors would like to thank the members of the national clinical guideline reference group for their constructive comments and suggestions during the planning and development of this research work. Representatives were: Jan Rishave, Danish Kidney Association; Lisbet Brandi, Danish Society of Nephrology; Karina Bruun, Danish Society of Renal Nurses; Birthe Thoerring, Danish Society of Palliative Medicine; Ellen Holm, Danish Gerontological Society; and Jette Kolding Kristensen, Danish College of General Practitioners. The authors also wish to thank member of the working group Line Staermose Jensen for her work on the national clinical guideline, of which this systematic review is a part.

Publisher Copyright:
© 2021, The Author(s).

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