The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index.
Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?
Open accessAbstract
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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“Even for younger patients, the promise of rehabilitation after dialysis initiation has not been achieved.”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [6]
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“recent data indicate that only 19% of the patients under the age of 55 are employed [6].”
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“9% of the days they survived (25 d per patient per year) as hospital inpatients, which is similar to three studies that described incident 90-d survivor RRT patients who were aged 80 yr (20), incident peritoneal dialysis patients who were aged 75 yr (21), and RRT patients who were aged 70 yr; had survived 90 d (22); a…”
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Metadata
- Authors
- Carson, R. C., Juszczak, M., Davenport, A., & Burns, A.
- Affiliations
- The Royal Free Hospital (GB)
- Corresponding author
- Carson, Rachel C.
- Venue
- Clinical Journal of the American Society of Nephrology
- Published
- 2009-10
- Volume
- 4
- Issue
- 10
- Pages
- 1611-1619
- ISSN
- 1555-9041 (ISSN-L)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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