Outcomes in Elderly CKD Patients Managed without Dialysis

Survival of elderly patients who choose to forego dialysis was a median of 16 months in a prospective observational study conducted recently by Mark A. Brown, MD, and colleagues. The study was designed to examine survival, symptom burden, and quality of life in a cohort of elderly patients with advanced chronic kidney disease managed without dialysis. Outcomes in a group of 122 patients managed with renal supportive care without dialysis (RSC-NFD) were compared with those in 273 predialysis patients who had usual nephrology care. The patients in the RSC-NFD group attended a renal supportive care clinic with a palliative medicine team.

Symptoms were managed using the Memorial Symptom Assessment Scale and the Palliative Care Outcomes Scale–Symptoms (renal) inventory; quality of life was measured using the Short Form-36 survey.

Patients in the nondialysis group were older than in the predialysis group (82 vs 67 years; P<.001). Estimated glomerular filtration rate at the first visit was similar between the two groups. Of the 273 predialysis patients, 34% (n=92) began dialysis. Compared with those in the RSC-NFD group, the death rate was lower in the patients in the predialysis group who did not require dialysis as well as in those requiring dialysis, but not in dialysis patients who had not attended the predialysis clinic.

“Elderly patients who choose not to have dialysis as part of shared decision making survive a median of 16 months and about one-third survive 12 months past a time when dialysis might have otherwise been indicated. Utilizing the skills of palliative medicine helps provide reasonable symptom control and quality of life without dialysis,” the researchers said.