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Cited by 457Dialysis and Renal Disease ManagementPalliative Care and End-of-Life IssuesChronic Kidney Disease and Diabetes

Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?

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Carson, Rachel C., Juszczak, Maciej, Davenport, Andrew, Burns, Aine·2009·Clinical Journal of the American Society of Nephrology
DOI 10.2215/cjn.00510109PMC PMC2758251
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Abstract

BACKGROUND AND OBJECTIVES: There is ongoing growth of elderly populations with ESRD in Western Europe and North America. In our center, we offer an alternative care pathway of 'maximum conservative management' (MCM) to patients who elect not to start dialysis, often because of a heavy burden of comorbid illness and advanced age. The objective of our study was to compare clinical outcomes for patients who had ESRD and chose either MCM or renal replacement therapy (RRT). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This is an observational study of a single-center cohort in the United Kingdom that evaluating 202 elderly (> or =70 yr) patients who had ESRD and had chosen either MCM (n = 29) or RRT (n = 173). We report survival, hospitalization rates, and location of death for this cohort. Survival was measured from a standardized 'threshold' estimated GFR of 10.8 ml/min per 1.73 m(2). RESULTS: Median survival, including the first 90 d, was 37.8 mo (range 0 to 106 mo) for RRT patients and 13.9 mo (range 2 to 44) for MCM patients (P < 0.01). RRT patients had higher rates of hospitalization (0.069 [95% confidence interval (CI) 0.068 to 0.070]) versus 0.043 [95% CI 0.040 to 0.047] hospital days/patient-days survived) compared with MCM patients. MCM patients were significantly more likely to die at home or in a hospice (odds ratio 4.15; 95% CI 1.67 to 10.25). A survey of the literature describing elderly ESRD outcomes is also presented. CONCLUSIONS: Dialysis prolongs survival for elderly patients who have ESRD with significant comorbidity by approximately 2 yr; however, patients who choose MCM can survive a substantial length of time, achieving similar numbers of hospital-free days to patients who choose hemodialysis.

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Authors
Carson, R. C., Juszczak, M., Davenport, A., & Burns, A.
Affiliations
The Royal Free Hospital (GB)
Corresponding author
Carson, Rachel C.
ORCID
Venue
Clinical Journal of the American Society of Nephrology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2009-10
Volume
4
Issue
10
Pages
1611-1619
ISSN
1555-9041 (ISSN-L)
DOI
10.2215/cjn.00510109
PMC
PMC2758251
OpenAlex
W2120777698
Cited by
457
References
40
Citations by year
2026: 15 · 2025: 6 · 2024: 14 · 2023: 18 · 2022: 23 · 2021: 25 · 2020: 13 · 2019: 22 · 2018: 34 · 2017: 36 · 2016: 35 · 2015: 51 · 2014: 36 · 2013: 46 · 2012: 41
FWCI
18.83
Type
journal article
Language
en
Open access
Locations
  • Clinical Journal of the American Society of Nephrology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
end-stage renal disease, elderly patients, dialysis, renal replacement therapy, comorbidities, survival, hospitalization, place of death, hospice, hemodialysis, end-of-life care
MeSH terms
Aged, Aged, 80 and over, Female, Glomerular Filtration Rate, Renal Dialysis, Hospitalization, Humans, Kidney Failure, Chronic, Male, Comorbidity, Renal Replacement Therapy

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