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

Louise Engelbrecht Buur, Jens Kristian Madsen, Inge Eidemak, Elizabeth Krarup, Thomas Guldager Lauridsen, Lena Helbo Taasti, Jeanette Finderup, Louise Engelbrecht Buur, Jens Kristian Madsen, Inge Eidemak, Elizabeth Krarup, Thomas Guldager Lauridsen, Lena Helbo Taasti, Jeanette Finderup

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.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart for primary literature search
Fig. 2
Fig. 2
Forest plots of comparison: CKM versus dialysis for outcome: mortality
Fig. 3
Fig. 3
Forest plot of comparison: CKM versus dialysis for outcome: hospitalization – number of days spent in hospital

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