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Abstract: PO1218

Survival Outcomes in Patients with Advanced CKD Who Opt for Dialysis Treatment or Conservative Care: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Voorend, Carlijn G N, Universiteit Leiden, Leiden, Zuid-Holland, Netherlands
  • Verberne, Wouter, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
  • Mooijaart, Simon, Universiteit Leiden, Leiden, Zuid-Holland, Netherlands
  • Van Buren, Marjolyn, Universiteit Leiden, Leiden, Zuid-Holland, Netherlands
  • Bos, Willem Jan W., Universiteit Leiden, Leiden, Netherlands
Background

Non-dialytic conservative care (CC) has been proposed as a viable treatment option for end-stage kidney disease, alternate to dialysis. This systematic review aims to compare survival outcomes on survival in dialysis and conservative care treatment pathways.

Methods

PubMed, Embase, Cochrane, CINAHL Plus and PsycINFO were searched from origin up to October 1st 2019 for studies comparing survival outcomes among patients choosing dialysis treatment or CC. Unadjusted survival for patients choosing dialysis versus CC was derived from Kaplan Meier curves. Meta-analysis was performed on outcomes of studies with limited clinical heterogeneity.

Results

From 6,126 citations, 21 observational cohort studies were included covering 20,212 adult patients. Studies varied in study design, target group, inclusion criteria (e.g. varying age groups), and starting point of survival analysis, and were receptive for selection bias and confounding. Patients opting for CC were in general older and had more comorbid conditions than patients who chose for dialysis treatment. Unadjusted median survival (reported in 16 studies) ranged from 8-67 months among patients who chose for dialysis and from 6-31 months in the CC group. Unadjusted one year survival (N=18 studies) ranged from 72% to 100% in patients choosing dialysis, and from 31% to 88% in patients choosing CC. Meta-analysis of studies (N=12) reporting survival adjusted for age, sex, and/or comorbid conditions, showed a pooled adjusted hazard ratio for death of 0.49 (95% CI 0.40-0.58) for patients choosing dialysis compared to CC. Survival benefit in patients choosing dialysis with severe comorbidities was highly reduced.

Conclusion

Observational studies, whilst heterogenous, suggest that patients who choose dialysis live twice as long as patients who opt for CC. Severe comorbidity is suggested to substantially reduce the survival benefit of dialysis compared to CC. Due to (high risk of) confounding, results should be interpreted cautiously and cannot be translated to individual patients. Future prospective data, using clear definitions and stratified for subpopulations, are critical to estimate relative survival benefit in clinical practice.

Funding

  • Private Foundation Support