Abstract: FR-PO939

Value-Based Evaluation of Dialysis versus Conservative Care in Older Patients with Advanced CKD

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Verberne, Wouter, St Antonius Hospital, Nieuwegein, Netherlands
  • Dijkers, Janneke, St Antonius Hospital, Nieuwegein, Netherlands
  • Kelder, Johannes C., St Antonius Hospital, Nieuwegein, Netherlands
  • Geers, Tom B.M., St Antonius Hospital, Nieuwegein, Netherlands
  • Jellema, Wilbert, St Antonius Hospital, Nieuwegein, Netherlands
  • Vincent, Hieronymus Henricus, St Antonius Hospital, Nieuwegein, Netherlands
  • Van delden, Johannes, University Medical Center Utrecht, Utrecht, Netherlands
  • Bos, Willem Jan W., St Antonius Hospital, Nieuwegein, Netherlands
Background

Older patients approaching end-stage renal disease face the decision whether or not to start dialysis. Conservative care is argued to be a reasonable alternative as dialysis is not always associated with a survival benefit, as shown in our previous survival analysis. To truly foster decision-making, we analyzed more patient-relevant outcomes and treatment costs in an extended cohort.

Methods

We conducted a single-center cohort study in 366 patients ≥70 years old with stage 4/5 chronic kidney disease, who chose either dialysis (n=240) or conservative care (n=126) after careful counselling. Using a value-based health care approach (value = outcomes/cost), survival, quality of life, assessed with KDQOL-SFTM questionnaire in 98 patients, and treatment burden, determined as hospital free days, were evaluated, together with treatment costs.

Results

The survival advantage in patients choosing dialysis over patients choosing conservative care diminished or disappeared in patients ≥80 years or with severe comorbidity. There were no differences between patients managed conservatively (n=23) and patients started on dialysis (n=34) on physical and mental health summary scores (all P>0.1). Patients choosing conservative care had 353 versus 283 hospital free days per year, measured from date of treatment decision (incidence rate ratio: 1.15, 95% confidence interval 1.09 to 1.21, P<0.001). Annual hospital costs were significantly lower in the conservative care group (cost ratio: 0.43, 95% CI 0.28 to 0.67, P<0.001).

Conclusion

Choosing dialysis was associated with little or no survival benefit in patients with the highest ages or with severe comorbidity. In all patients, choosing conservative care was associated with similar quality of life, lower treatment burden, and lower treatment costs in comparison to choosing dialysis. By achieving similar outcomes against lower treatment burden and costs, value was created for older patients with advanced chronic kidney disease choosing conservative care.

Funding

  • Commercial Support