BACKGROUND: It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze. STUDY DESIGN: National observational survey study with random-effects logistic regression. SETTING & PARTICIPANTS: Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009. PREDICTORS: Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit. OUTCOMES & MEASUREMENTS: The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care. RESULTS: 66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98). LIMITATIONS: Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community. CONCLUSIONS: 1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population. Copyright Â
BACKGROUND: It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze. STUDY DESIGN: National observational survey study with random-effects logistic regression. SETTING & PARTICIPANTS: Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009. PREDICTORS: Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit. OUTCOMES & MEASUREMENTS: The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care. RESULTS: 66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98). LIMITATIONS: Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community. CONCLUSIONS: 1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population. Copyright Â
Authors: Ana C Ricardo; Wei Yang; Daohang Sha; Lawrence J Appel; Jing Chen; Marie Krousel-Wood; Anjella Manoharan; Susan Steigerwalt; Jackson Wright; Mahboob Rahman; Sylvia E Rosas; Milda Saunders; Kumar Sharma; Martha L Daviglus; James P Lash Journal: J Am Soc Nephrol Date: 2018-12-03 Impact factor: 10.121
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: Keren Ladin; Renuka Pandya; Allison Kannam; Rohini Loke; Tira Oskoui; Ronald D Perrone; Klemens B Meyer; Daniel E Weiner; John B Wong Journal: Am J Kidney Dis Date: 2018-02-01 Impact factor: 8.860
Authors: Ann M O'Hare; Nancy Armistead; Wendy L Funk Schrag; Louis Diamond; Alvin H Moss Journal: Clin J Am Soc Nephrol Date: 2014-07-17 Impact factor: 8.237
Authors: Roberto Pecoits-Filho; Ikechi G Okpechi; Jo-Ann Donner; David C H Harris; Harith M Aljubori; Aminu K Bello; Ezequiel Bellorin-Font; Fergus J Caskey; Allan Collins; Alfonso M Cueto-Manzano; John Feehally; Bak Leong Goh; Kitty J Jager; Masaomi Nangaku; Muhibur Rahman; Manisha Sahay; Abdulkarim Saleh; Laura Sola; Rumeyza Turan Kazancioglu; Rachael C Walker; Robert Walker; Qiang Yao; Xueqing Yu; Ming-Hui Zhao; David W Johnson Journal: Kidney Int Suppl (2011) Date: 2020-02-19
Authors: Manon J M van Oosten; Richard M Brohet; Susan J J Logtenberg; Anneke Kramer; Lambert D Dikkeschei; Marc H Hemmelder; Henk J G Bilo; Kitty J Jager; Vianda S Stel Journal: Clin Kidney J Date: 2020-11-09