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Nephrology, JAMA Network Open

Nephrology, JAMA Network Open

Opting Out of Dialysis Not Instant Death Sentence for Kidney Disease

Opting Out of Dialysis Not Instant Death Sentence for Kidney Disease

Dialysis and organ transplantation aren’t your only choices when your kidneys no longer function. Discover the findings from a systematic review of conservative care management in advanced CKD patients.

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A common belief among many chronic kidney disease (CKD) patients is that, once their kidney has failed, there is no alternative to dialysis or a kidney transplant. The truth is, however, that many older patients with advanced CKD may live several years with conservative care and have a good quality of life. Learn more from experts who are bringing awareness to conservative care (which focuses on symptom control and quality of life) and the research findings to support it.*

How have studies supported conservative care?

Susan Wong, MD, of the Renal Dialysis Unit, Seattle, Washington, and several colleagues conducted a systematic review of 41 studies across the United Kingdom, Europe, and Asia. Their work dispels the notion that conservative kidney care means a grim and near-immediate death. 

Of the 41 studies, there were 5102 patients with a mean age ranging between 60 to 87 years. The median survival of cohorts ranged from 1 to 41 months as measured by a baseline mean estimated glomerular filtration rate (eGFR) ranging from 7 to 19 mL/min/1.73m2. Patients between the ages of 70 to 79 years were found to have longer survival rates than those 80 years or older. 

During an observation period of 8 to 24 months, mental well-being improved, and physical well-being and overall quality of life were largely stable until late in the course of illness.

Between the studies that looked at end-of-life care, rates of hospice enrollment, hospitalizations, in-hospital deaths, and at-home deaths varied greatly across different regions. This indicates substantial disparity in access to supportive care near the end of life across cohorts, the authors observe. Nevertheless, “Most patients survived several years after the decision to forgo dialysis was made,” they stress.

Using aggressive symptom management and a multidisciplinary team approach, conservative kidney management may be a viable and positive therapeutic alternative to dialysis for some patients. 

Why is conservative care not being used? 

Many experts, such as Christine Liu, M.D., and Kurella Tamura, M.D., M.P.H., both from the Stanford University School of Medicine, California, see the importance of conservative kidney care and believe the lack of awareness is an issue.

“We believe it is time to broaden the scope of kidney replacement therapy registries to include persons who receive conservative treatment of kidney failure,” write Liu and Tamura, “…and we need to address the conservative care information gap so that lack of awareness is no longer a barrier to informed decision making.”

*Liu, C. K. and Kurella Tamura, M. (2022, March 14). Conservative Care for Kidney Failure—The Other Side of the Coin. Nephrology | JAMA Network Open. doi:10.1001/jamanetworkopen.2022.2252

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