BACKGROUND: Renal replacement therapy (RRT) has not always been shown to benefit end-stage renal failure patients who are elderly or have multiple comorbidities in terms of survival or symptom control. Conservative management may be a viable alternative offering comparable health-related quality of life. METHODS: This is a prospective observational study of 101 patients who reached an estimated glomerular filtration rate of 8-12 ml/min and were either ≥75 years old or had an age-adjusted Charlson Comorbidity Index ≥8. Patients were all initially on conservative management; 38 later commenced renal replacement therapy while the rest remained conservatively managed. The Kidney Disease Quality of Life-Short Form was assessed at baseline and various scheduled time points over 24 months. The mixed model methodology was used to estimate the quality of life patterns and adjust for covariates. RESULTS: In the conservative management group, the Physical Component Summary and Mental Component Summary scores were stable and showed no significantly different trajectories from the RRT group (both p > 0.05). Though RRT was associated with an improvement in the Cognitive Function Scale score, it was also associated with worse scores on the Effect of Kidney Disease and Burden of Kidney Disease Scale scores. CONCLUSIONS: RRT does not improve health-related quality of life of end-stage kidney failure patients who are elderly or have a high comorbidity burden.
BACKGROUND: Renal replacement therapy (RRT) has not always been shown to benefit end-stage renal failurepatients who are elderly or have multiple comorbidities in terms of survival or symptom control. Conservative management may be a viable alternative offering comparable health-related quality of life. METHODS: This is a prospective observational study of 101 patients who reached an estimated glomerular filtration rate of 8-12 ml/min and were either ≥75 years old or had an age-adjusted Charlson Comorbidity Index ≥8. Patients were all initially on conservative management; 38 later commenced renal replacement therapy while the rest remained conservatively managed. The Kidney Disease Quality of Life-Short Form was assessed at baseline and various scheduled time points over 24 months. The mixed model methodology was used to estimate the quality of life patterns and adjust for covariates. RESULTS: In the conservative management group, the Physical Component Summary and Mental Component Summary scores were stable and showed no significantly different trajectories from the RRT group (both p > 0.05). Though RRT was associated with an improvement in the Cognitive Function Scale score, it was also associated with worse scores on the Effect of Kidney Disease and Burden of Kidney Disease Scale scores. CONCLUSIONS: RRT does not improve health-related quality of life of end-stage kidney failurepatients who are elderly or have a high comorbidity burden.
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
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Authors: Susan P Y Wong; Lynne V McFarland; Chuan-Fen Liu; Ryan J Laundry; Paul L Hebert; Ann M O'Hare Journal: JAMA Intern Med Date: 2019-03-01 Impact factor: 21.873
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Authors: Wouter R Verberne; Janneke Dijkers; Johannes C Kelder; Anthonius B M Geers; Wilbert T Jellema; Hieronymus H Vincent; Johannes J M van Delden; Willem Jan W Bos Journal: BMC Nephrol Date: 2018-08-16 Impact factor: 2.388
Authors: Osasuyi Iyasere; Edwina A Brown; Lina Johansson; Andrew Davenport; Ken Farrington; Alexander P Maxwell; Helen Collinson; Stanley Fan; Ann-Marie Habib; John Stoves; Graham Woodrow Journal: Clin Kidney J Date: 2018-07-20
Authors: Barnaby Hole; Brenda Hemmelgarn; Edwina Brown; Mark Brown; Mignon I McCulloch; Carlos Zuniga; Sharon P Andreoli; Peter G Blake; Cécile Couchoud; Alfonso M Cueto-Manzano; Gavin Dreyer; Guillermo Garcia Garcia; Kitty J Jager; Marla McKnight; Rachael L Morton; Fliss E M Murtagh; Saraladevi Naicker; Gregorio T Obrador; Jeffrey Perl; Muhibur Rahman; Kamal D Shah; Wim Van Biesen; Rachael C Walker; Karen Yeates; Alexander Zemchenkov; Ming-Hui Zhao; Simon J Davies; Fergus J Caskey Journal: Kidney Int Suppl (2011) Date: 2020-02-19