Conservative Kidney Management: Quantity and Quality of Life

For patients with advanced kidney failure, conservative kidney management (CKM) is associated with shorter survival compared with dialysis, with no decrease in quality of life, reports a study in the Clinical Journal of the American Society of Nephrology.

The prospective study included 170 elderly patients with advanced, progressive chronic kidney disease: late stage 4 or stage 5. After standard assessments and discussions with patients and family members, 80 patients began to undergo (or were planned for) hemodialysis and 44 received peritoneal dialysis. Thirty patients opted for CKM, which consisted of ongoing medical treatment and multidisciplinary support. The remaining 16 patients remained undecided.

Patients underwent assessments of quality of life, anxiety and depression, and satisfaction with life for as long as 3 years. Quality of life and survival were compared among groups.

Patients selecting CKM were older, had more dependency needs, and had more comorbidity. Patients in the CKM group also had poorer physical health and higher anxiety than did those choosing dialysis. Most quality-of-life measures showed no significant change over time, regardless of treatment choice. The exception was life satisfaction, which decreased after the start of treatment in the dialysis groups but remained unchanged in the CKM group.

Survival was shorter for patients choosing CKM, after comorbidity, performance status, age, physical health, and propensity score were controlled for. Patients in the dialysis groups survived a median of 1317 days after enrollment, compared with 913 days in the CKM group.

Conservative kidney management may be considered by elderly patients with advanced kidney failure, for whom the benefits of dialysis are questionable. This study shows that quality of life tends to be maintained in patients opting for CKM, compared with those starting dialysis. This must be weighed against substantially shorter survival with CKM. [Da Silva-Gane, et al. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol 2012; 7:2002–2009]

March 2013 (Vol. 5, Number 3)