MO482: End-Stage Renal Disease in the Elderly: Dialysis or Conservative Management?

Autor: Ghada Denden, Nouha Ben Mahmoud, Meriem Ben Salem, Manel Ben Salah, Ahmed Letaief, Mouna Hammouda, Aloui Sabra, Habib Skhiri
Rok vydání: 2022
Předmět:
Zdroj: Nephrology Dialysis Transplantation. 37
ISSN: 1460-2385
0931-0509
DOI: 10.1093/ndt/gfac071.013
Popis: BACKGROUND AND AIMS Nowadays, end-stage renal disease (ESRD) is overrepresented in elderly patients. The presence of medical comorbidities, limited life expectancy, frailty and poor functional status in these patients poses substantial challenges in clinical decision-making and provision of optimal care. The decision to start dialysis or not should always be based on shared decision-making. The objective of our study was to compare clinical outcomes for patients who had chosen either maximum conservative management (MCM) or renal replacement therapy (RRT). METHOD This is an observational study of a single-center cohort in Tunisia that includes 152 elderly patients (>80 years), with chronic kidney disease (CKD) who consulted our center during the period from 1 January 2015 to 31 December 2016. Demographic and comorbidity data were collected on all patients. Then, we evaluated the management of patients who had reached the end stage of CKD during the study period (dialysis or conservative treatment), and we compared the survival of the two groups. RESULTS Of 152 patients, 54.6% were women. The mean age was 82 ± 2.6 years. High blood pressure, diabetes and dyslipidemia were the most common comorbidities. During follow-up, 65 patients have reached stage 5 of CKD. A total of 46.1% started dialysis and the rest received conservative treatment. Patients choosing dialysis were younger compared with those opting for conservative management and were less functionally impaired. Survival was better in those receiving conservative treatment: The mean survival was 24 months for RRT patients and 30 months for maximum conservative management (MCM) patients (P < .01). A total of 1- and 2-year survival rates were 76.3% and 22% in the dialysis group (n = 30) and 75.3% and 45% in the conservative group (n = 35), respectively. CONCLUSION When caring for older adults with advanced CKD who are contemplating dialysis therapy vs. conservative management, efforts must focus on promoting patient values and preferences, shared decision-making, and symptom burden alleviation.
Databáze: OpenAIRE
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