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

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Engelbrecht Buur, Louise ; Madsen, Jens Kristian ; Eidemak, Inge ; Krarup, Elizabeth ; Guldager Lauridsen, Thomas ; Taasti , Lena Helbo ; Finderup, Jeanette. / Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review. I: BMC Nephrology. 2021 ; Bind 22, Nr. 1. s. 307.

Bibtex

@article{2bf934bbd5dd43788f2652208c092961,
title = "Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis?: A systematic review",
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.",
keywords = "Conservative kidney management, Dialysis, End-stage kidney disease, Mortality, Quality of life, Stage 5 chronic kidney disease",
author = "{Engelbrecht Buur}, Louise and Madsen, {Jens Kristian} and Inge Eidemak and Elizabeth Krarup and {Guldager Lauridsen}, Thomas and Taasti, {Lena Helbo} and Jeanette Finderup",
note = "{\textcopyright} 2021. The Author(s).",
year = "2021",
month = sep,
day = "11",
doi = "10.1186/s12882-021-02516-6",
language = "English",
volume = "22",
pages = "307",
journal = "BMC Nephrology",
issn = "1471-2369",
publisher = "BioMed Central Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis?

T2 - A systematic review

AU - Engelbrecht Buur, Louise

AU - Madsen, Jens Kristian

AU - Eidemak, Inge

AU - Krarup, Elizabeth

AU - Guldager Lauridsen, Thomas

AU - Taasti , Lena Helbo

AU - Finderup, Jeanette

N1 - © 2021. The Author(s).

PY - 2021/9/11

Y1 - 2021/9/11

N2 - 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.

AB - 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.

KW - Conservative kidney management

KW - Dialysis

KW - End-stage kidney disease

KW - Mortality

KW - Quality of life

KW - Stage 5 chronic kidney disease

UR - http://www.scopus.com/inward/record.url?scp=85114735838&partnerID=8YFLogxK

U2 - 10.1186/s12882-021-02516-6

DO - 10.1186/s12882-021-02516-6

M3 - Journal article

C2 - 34507554

VL - 22

SP - 307

JO - BMC Nephrology

JF - BMC Nephrology

SN - 1471-2369

IS - 1

M1 - 307

ER -

ID: 67645096