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Conservative management of end-stage renal disease without dialysis: a systematic review.
J Palliat Med 2012; 15(2):228-35JP

Abstract

PURPOSE

To summarize evidence on conservative, nondialytic management of end-stage renal disease regarding 1) prognosis and 2) symptom burden and quality of life (QOL).

METHODS

Medline, Cinahl, and Cochrane were searched for records indexed prior to March 1, 2011. Bibliographies of articles and abstracts from recent meetings were reviewed. Authors and nephrologists were contacted to identify additional studies. Articles were reviewed by two authors and selected if they described stage 5 chronic kidney disease (CKD) patients managed without dialysis, including one or more of the following outcomes: prognosis, symptoms, or QOL. Levels of evidence ratings were assigned using the SORT (Strength of Recommendation Taxonomy) system. Data was abstracted independently by two authors for descriptive analysis.

RESULTS

Thirteen studies were included. In studies of prognosis, conservative management resulted in median survival of at least six months (range 6.3 to 23.4 months). Findings are mixed as to whether dialysis prolongs survival in the elderly versus conservative, nondialytic management. Any survival benefit from dialysis decreases with comorbidities, especially ischemic heart disease. Patients managed conservatively report a high symptom burden, underscoring the need for concurrent palliative care. Additional head-to-head studies are needed to compare the symptoms of age-matched dialysis patients, but preliminary studies suggest that QOL is similar.

CONCLUSIONS

Conservative management is an important alternative to discuss when counseling patients and families about dialysis. Unlike withdrawal of dialysis in which imminent death is expected, patients who decline dialysis initiation can live for months to years with appropriate supportive care.

Authors+Show Affiliations

Arkansas Hospice, North Little Rock, AR, USA. noconnor@arkansashospice.orgNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review
Systematic Review

Language

eng

PubMed ID

22313460

Citation

O'Connor, Nina R., and Pallavi Kumar. "Conservative Management of End-stage Renal Disease Without Dialysis: a Systematic Review." Journal of Palliative Medicine, vol. 15, no. 2, 2012, pp. 228-35.
O'Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-35.
O'Connor, N. R., & Kumar, P. (2012). Conservative management of end-stage renal disease without dialysis: a systematic review. Journal of Palliative Medicine, 15(2), pp. 228-35. doi:10.1089/jpm.2011.0207.
O'Connor NR, Kumar P. Conservative Management of End-stage Renal Disease Without Dialysis: a Systematic Review. J Palliat Med. 2012;15(2):228-35. PubMed PMID: 22313460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Conservative management of end-stage renal disease without dialysis: a systematic review. AU - O'Connor,Nina R, AU - Kumar,Pallavi, Y1 - 2012/02/07/ PY - 2012/2/9/entrez PY - 2012/2/9/pubmed PY - 2012/7/11/medline SP - 228 EP - 35 JF - Journal of palliative medicine JO - J Palliat Med VL - 15 IS - 2 N2 - PURPOSE: To summarize evidence on conservative, nondialytic management of end-stage renal disease regarding 1) prognosis and 2) symptom burden and quality of life (QOL). METHODS: Medline, Cinahl, and Cochrane were searched for records indexed prior to March 1, 2011. Bibliographies of articles and abstracts from recent meetings were reviewed. Authors and nephrologists were contacted to identify additional studies. Articles were reviewed by two authors and selected if they described stage 5 chronic kidney disease (CKD) patients managed without dialysis, including one or more of the following outcomes: prognosis, symptoms, or QOL. Levels of evidence ratings were assigned using the SORT (Strength of Recommendation Taxonomy) system. Data was abstracted independently by two authors for descriptive analysis. RESULTS: Thirteen studies were included. In studies of prognosis, conservative management resulted in median survival of at least six months (range 6.3 to 23.4 months). Findings are mixed as to whether dialysis prolongs survival in the elderly versus conservative, nondialytic management. Any survival benefit from dialysis decreases with comorbidities, especially ischemic heart disease. Patients managed conservatively report a high symptom burden, underscoring the need for concurrent palliative care. Additional head-to-head studies are needed to compare the symptoms of age-matched dialysis patients, but preliminary studies suggest that QOL is similar. CONCLUSIONS: Conservative management is an important alternative to discuss when counseling patients and families about dialysis. Unlike withdrawal of dialysis in which imminent death is expected, patients who decline dialysis initiation can live for months to years with appropriate supportive care. SN - 1557-7740 UR - https://www.unboundmedicine.com/medline/citation/22313460/full_citation L2 - https://www.liebertpub.com/doi/full/10.1089/jpm.2011.0207?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -