BACKGROUND: In frail elderly patients, the chronic use of renal replacement therapy sometimes affords no tangible benefits and may even negatively affect their quality of life (Qol), making prolonged conservative management a reasonable option. METHODS: This observational, uncontrolled study was conducted on 11 end-stage renal disease patients over 75 years of age, on prolonged conservative treatment with a follow-up of at least 6 months, to assess compliance with the Italian clinical guidelines concerning the treatment of renal failure, comorbidities, hospital stays, and several psychometric and Qol indicators in the patients and their caregivers. RESULTS: We found a substantial compliance with the targets recommended in the guidelines, a moderate tendency for disease progression and satisfactory psychometric and Qol parameters, which proved much the same as those observed in a parallel (uncontrolled) group of patients on haemodialysis. CONCLUSIONS: Our study shows that a conservative strategy is feasible for frail uraemic patients, achieving acceptable clinical results and a Qol comparable with patients on haemodialysis. The study also provides indications on how to plan trials on this topic, to obtain the evidence needed to guide the difficult choice of whether to recommend dialysis or conservative treatment for such frail patients.
BACKGROUND: In frail elderly patients, the chronic use of renal replacement therapy sometimes affords no tangible benefits and may even negatively affect their quality of life (Qol), making prolonged conservative management a reasonable option. METHODS: This observational, uncontrolled study was conducted on 11 end-stage renal diseasepatients over 75 years of age, on prolonged conservative treatment with a follow-up of at least 6 months, to assess compliance with the Italian clinical guidelines concerning the treatment of renal failure, comorbidities, hospital stays, and several psychometric and Qol indicators in the patients and their caregivers. RESULTS: We found a substantial compliance with the targets recommended in the guidelines, a moderate tendency for disease progression and satisfactory psychometric and Qol parameters, which proved much the same as those observed in a parallel (uncontrolled) group of patients on haemodialysis. CONCLUSIONS: Our study shows that a conservative strategy is feasible for frail uraemic patients, achieving acceptable clinical results and a Qol comparable with patients on haemodialysis. The study also provides indications on how to plan trials on this topic, to obtain the evidence needed to guide the difficult choice of whether to recommend dialysis or conservative treatment for such frail patients.
Authors: Susan P Y Wong; Saritha Boyapati; Ruth A Engelberg; Bjorg Thorsteinsdottir; Janelle S Taylor; Ann M O'Hare Journal: Am J Kidney Dis Date: 2019-09-27 Impact factor: 8.860
Authors: Ikumi Okamoto; Sarah Tonkin-Crine; Hugh Rayner; Fliss E M Murtagh; Ken Farrington; Fergus Caskey; Charles Tomson; Fiona Loud; Roger Greenwood; Donal J O'Donoghue; Paul Roderick Journal: Clin J Am Soc Nephrol Date: 2014-11-11 Impact factor: 8.237
Authors: Susan P Y Wong; Margaret K Yu; Pamela K Green; Chuan-Fen Liu; Paul L Hebert; Ann M O'Hare Journal: Am J Kidney Dis Date: 2018-01-10 Impact factor: 8.860
Authors: Fliss E M Murtagh; Aine Burns; Olivier Moranne; Rachael L Morton; Saraladevi Naicker Journal: Clin J Am Soc Nephrol Date: 2016-08-10 Impact factor: 8.237
Authors: Mario Pacilio; Roberto Minutolo; Carlo Garofalo; Maria Elena Liberti; Giuseppe Conte; Luca De Nicola Journal: J Nephrol Date: 2015-11-19 Impact factor: 3.902