BACKGROUND AND OBJECTIVES: Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5). RESULTS: After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR ± SD was similar (14.0 ± 4.0 ml/min per 1.73 m(2)) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scores were similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients. CONCLUSIONS: Patients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.
BACKGROUND AND OBJECTIVES: Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5). RESULTS: After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR ± SD was similar (14.0 ± 4.0 ml/min per 1.73 m(2)) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scores were similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients. CONCLUSIONS: Patients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.
Authors: Fliss E M Murtagh; James E Marsh; Paul Donohoe; Nasirul J Ekbal; Neil S Sheerin; Fiona E Harris Journal: Nephrol Dial Transplant Date: 2007-04-04 Impact factor: 5.992
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Ann M O'Hare; Susan P Wong; Margaret K Yu; Bruce Wynar; Mark Perkins; Chuan-Fen Liu; Jaclyn M Lemon; Paul L Hebert Journal: J Am Soc Nephrol Date: 2015-02-19 Impact factor: 10.121
Authors: Pietro A Canetta; Jonathan P Troost; Shannon Mahoney; Amy J Kogon; Noelle Carlozzi; Sharon M Bartosh; Yi Cai; T Keefe Davis; Hilda Fernandez; Alessia Fornoni; Rasheed A Gbadegesin; Emily Herreshoff; John D Mahan; Patrick H Nachman; David T Selewski; Christine B Sethna; Tarak Srivastava; Katherine R Tuttle; Chia-Shi Wang; Ronald J Falk; Ali G Gharavi; Brenda W Gillespie; Larry A Greenbaum; Lawrence B Holzman; Matthias Kretzler; Bruce M Robinson; William E Smoyer; Lisa M Guay-Woodford; Bryce Reeve; Debbie S Gipson Journal: Kidney Int Date: 2019-02-27 Impact factor: 10.612
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: Wouter R Verberne; A B M Tom Geers; Wilbert T Jellema; Hieronymus H Vincent; Johannes J M van Delden; Willem Jan W Bos Journal: Clin J Am Soc Nephrol Date: 2016-03-17 Impact factor: 8.237
Authors: Tushar J Vachharajani; Louise M Moist; Marc H Glickman; Miguel A Vazquez; Kevan R Polkinghorne; Charmaine E Lok; Timmy C Lee Journal: Nat Rev Nephrol Date: 2013-12-03 Impact factor: 28.314
Authors: Marije H Kallenberg; Hilda A Kleinveld; Friedo W Dekker; Barbara C van Munster; Ton J Rabelink; Marjolijn van Buren; Simon P Mooijaart Journal: Clin J Am Soc Nephrol Date: 2016-06-24 Impact factor: 8.237