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Abstract: FR-PO329

Dialysis vs. Conservative Care to Treat ESRD: A Systematic Review and Meta-Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Fu, Rui, University of Toronto, Toronto, Ontario, Canada
  • Sekercioglu, Nigar, McMaster University, Hamilton, Ontario, Canada
  • Kim, Joseph, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  • Couban, Rachel, McMaster University, Hamilton, Ontario, Canada
  • Lopes, Luciane C., Universidade de Sorocaba, Sorocaba, Brazil
  • Coyte, Peter C., University of Toronto, Toronto, Ontario, Canada
Background

The advantage of treating selected ESRD patients with dialysis over non-dialysis, conservative therapy, is unclear. We addressd this gap by providing a comprehensive evidence synthesis on the outcomes of dialysis vs. conservative care in ESRD patients.

Methods

MEDLINE and EMBASE were searched from January 2009 to April 2019 for prospective and retrospective cohort studies that examined outcomes of ESRD patients receiving dialysis vs. conservative care. We calculated pooled risk ratios (RRs) and 95% confidence intervals (CIs) as well as statistical measures of variability in results across studies using random-effects models for all-cause mortality at years 1, 2, 3 and 5. Annual hospital inpatient days were pooled using standardized mean differences (SMD).

Results

Among 1,075 citations, 14 were included that involved 16794 and 3857 patients initially treated with dialysis or conservative care. Dialysis was associated with lower risk of all-cause mortality at year 1 (RR, 0.40, 95% CI, 0.26-0.63), year 2 (RR, 0.57, 95% CI, 0.44-0.72), and end of study (RR 0.66, 95% CI, 0.51-0.84), while no difference was detected at year 3 (RR, 0.68, 95% CI, 0.41-1.14) and year 5 (RR, 0.87, 95% CI, 0.71-1.06). There was no difference of annual hospital inpatient days (SMD, 14.64, 95% CI, -173.56-202.84).

Conclusion

Dialysis results in lower mortality in the short-term (the first two years) but may not improve survival thereafter (after the third year).

Forest plot: Mortality at end of study

Forest plot: Mortality at years 1, 2, 3, and 5