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Kidney Week

Abstract: TH-PO643

The Oldest Dilemma: Dialysis or Conservative Treatment?

Session Information

  • Geriatric Nephrology
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Santacruz, Juan Cristobal, Hospital Universitario La Paz, Madrid, Spain
  • Alonso-Babarro, Alberto, Hospital Universitario La Paz, Madrid, Spain
  • Del Peso Gilsanz, Gloria, Hospital Universitario La Paz, Madrid, Spain
  • Bajo, Maria A., Hospital Universitario La Paz, Madrid, Spain
  • Marta, Ossorio, Hospital Universitario La Paz, Madrid, Spain
  • Afonso ramos, Sara, Hospital Universitario La Paz, Madrid, Spain
  • Garcia-Llana, Helena, Hospital Universitario La Paz, Madrid, Spain
  • Selgas, Rafael, Hospital Universitario La Paz, Madrid, Spain
Background

In comorbid elderly patients with stage 5 renal disease (ESRD) and functional impairment benefit of dialysis is not clear. The objective of this study is compare survival, characteristics and outcomes of patients who choose conservative palliative care management from those who decide dialysis after a shared decision meeting.

Methods

Prospective observational cohort study in patients with ESRD (CKD-EPI <12 ml / min, or CKD-EPI <15 ml / min in diabetics) who:
1. Prefer conservative palliative care management or
2. Meet the following criteria: > 75 years with comorbidity (Charlson Comorbidity Index (CI) > 5) or functional impairment (Barthel Index <95 or Palliative performance score (PPS) <60).
The decision between dialysis (D) vs conservative management (CV) was taken after a reception meeting with patient, closest family and multidisciplinary team (nephrologists, nursery, palliative care physician, psychologist). Nephrology and Palliative Care team drove follow-up until death.

Results

One hundred two patients were included with no differences in ESRD etiology. Seventy eight (76.5%) chose CV, 24 (23.5%) D, 16 hemodialysis and 8 peritoneal dialysis. 55% were male although females chose mostly CV (p=0.015). Average age was 83.4±5.5 ys, statistically significant in CV vs D (84,5±5.9 vs 80.8±3.1ys; p=0,033), no differences in CI. Functional status was statistically lower measured by Barthel Index (77.3±20.3 vs. 94.48±10.8; p<0,0001) and PPS score (64.26±15.5 vs. 84.1±1.7; p:0.000) in CV vs D groups.
Follow-up time was greater in D vs CV (median 25.2±17.1 vs 9.75±10 mo; p=0.000). Only 4 patients of CV group changed their decision to dialysis. Forty patients (39%) from CV required visits from home palliative care team (median 5, mean 7.83±9.9 visits). Sixty six died, 62 from CV and 4 from hemodialysis (p=0,0000). Survival was 43% at one year and 20% at 2 years in CV vs 96% at one year and 91% at 2 years in D group (p=0,0000). Places of death were, in frequency: Palliative care unit (n=25), hospitalization (n=20), home (n=17), medical residence (n=5) and ER (n=3).

Conclusion

ESRD patients who decide conservative treatment are oldest, with decreased functionality and mostly women. Despite a lower survival the decision remains firm which would indicate a probable stability in quality of life throughout their last days.