Article Figures & Data
Figures
- Figure 1.
Flowsheet of all incident dialysis patients who were aged ≥70 yr and patients who opted for MCM, showing outcomes, exclusions and patients who were lost to follow-up.
- Figure 2.
Kaplan-Meier survival curves. (A) MCM versus all RRT (from day 0). (B) MCM versus all RRT (from day 90). (C) MCM versus RRT emergency referral subgroup versus RRT nonemergency referral subgroup (from day 0).
- Figure 3.
Median survival for MCM cohort and the hemodialysis-only subgroup in the RRT cohort. Data shown are how many days were spent hospital-free, compared with in-patient stays in hospital and outpatient hospital attendances for dialysis.
- Figure 4.
Literature survey: Summary graph of survival of elderly patients with ESRD in previous studies.
Tables
Characteristic RRT(n = 173) MCM(n = 29) P Age (yr) 0.000001 mean 76.4 81.6 median 75.0 83.0 Female (n [%]) 54 (31.2) 12 (41.4) NS Diabetes (n [%]) 51 (29.5) 4 (13.8) NS Hemoglobin (g/L; mean ± SD) 108 ± 15 109 ± 13 NS Albumin (g/L; mean ± SD) 34.4 ± 7 37.4 ± 15.9 NS Total cholesterol (mmol/L; mean ± SD) 4.5 ± 1.3 4.5 ± 1.0 NS CCI score (mean ± SD) 4.0 ± 1.6 3.7 ± 1.8 NS Age-adjusted CCI score (mean ± SD) 7.2 ± 1.6 7.4 ± 1.9 NS Ethnicity (n [%]) NS white 133 (76.9) 21 (72.4) blacka 18 (10.4) 5 (17.2) Asianb 15 (8.7) 3 (10.3) unknown 7 (4.0) 0 (0.0) eGFR at start of dialysis (ml/min per 1.73 m2; median) 10.8 NA Length of follow-up from onset of RRT or PDI (mo; median) 26.7 12.9 Predialysis care (n [%]) emergency referral 52 (30.1) 11 (37.9) NS nonemergency referral early referral (>120 d) 91 (52.6) 15 (51.7) NS late referral (<120 d) 30 (17.3) 3 (10.3) Dialysis modalities (n [%]) HD only 112 (64.7) NA HD then switched to PD 6 (3.5) NA HD then transplant 1 (0.6) NA PD only 42 (24.3) NA PD then switched to HD 12 (6.9) NA Parameter All RRT Nonemergency Referral RRT Subgroup with ≥14 d of Predialysis Nephrology Care Emergency Referral RRT Subgroup with ≤14 d of Predialysis Nephrology Care HD-Only Patients MCM Value % 95% CI or P versus MCM Value % 95% CI or P versus RRT Emergency Referral Value % 95% CI or P versus MCM Value % 95% CI n including first 90 d 173 121 52 112 29 n excluding first 90 d 148 112 36 26 Survival, mo including first 90 d (median) 37.8 0.003 41.5 <0.001 21.7 33.9 <0.001 13.9 excluding first 90 d (median) 41.9 <0.001 43.0 0.17 25.8 – – 14.8 Rate of hospitalization (days/pt/yr) including first 90 d (mean) 25 6.9 6.8 to 7.0 23 6.2 6.0 to 6.3 – 30 8.1 7.9 to 8.3 16 4.3 4.0 to 4.7 excluding first 90 d (mean) 24 6.5 6.4 to 6.6 22 6.0 5.9 to 6.2 – 27 7.4 7.2 to 7.6 15 4.2 3.8 to 4.5 For HD-only and MCM patients rate of institutionalization, including first 90 d (mean) – – – – – – – 173 47.5 4.7 to 4.8 16 4.3 4.0 to 4.7 Location of death, n (%) Hospital 70 70.0 <0.05 45 67.2 – – – – 9 36.0 Home or in Hospice 21 21.0 14 20.9 – – – – 10 40.0 Unknown 9 9.0 8 11.9 – – – – 6 24.0 Total deaths 100 67 25 OR of dying in hospital 4.15 1.7 to 10.2 – – – – RR for dying in hospital 1.94 1.2 to 3.4 – – – – Censored/lost to follow-up (n) 11 6.0 4 3.0 0 0.0 -
RR, relative risk.
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Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?
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Dialysis
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- 103-year-old on dialysis: was it worth it?
- Conservative Management and End-of-Life Care in an Australian Cohort with ESRD
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- The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review
- Provider Knowledge, Attitudes, and Practices Surrounding Conservative Management for Patients with Advanced CKD
- The Providers Role in Conservative Care and Advance Care Planning for Patients with ESRD
- Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis
- Does the Evidence Support Conservative Management as an Alternative to Dialysis for Older Patients with Advanced Kidney Disease?
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- Conservative care for end-stage kidney disease: joint medical conference with the Renal Association, British Geriatrics Society and Association for Palliative Medicine
- Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis
- Deny Dialysis or "D-NI" Dialysis? The Case for "Do Not Initiate; Do Not Ignore" Orders
- The Ethics of End-of-Life Care for Patients with ESRD
- Critical and Honest Conversations: The Evidence Behind the "Choosing Wisely" Campaign Recommendations by the American Society of Nephrology
- Advance Care Planning in CKD/ESRD: An Evolving Process
- Renal Replacement Therapy in the Elderly Population
- Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease
- Informing Our Elders About Dialysis: Is an Age-Attuned Approach Warranted?
- Trajectories of Illness in Stage 5 Chronic Kidney Disease: A Longitudinal Study of Patient Symptoms and Concerns in the Last Year of Life
- Association between estimated glomerular filtration rate at initiation of dialysis and mortality