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Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy

Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited. Methods. We studied surviva...

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Autores principales: Chandna, Shahid M., Da Silva-Gane, Maria, Marshall, Catherine, Warwicker, Paul, Greenwood, Roger N., Farrington, Ken
Formato: Texto
Lenguaje:English
Publicado: Oxford University Press 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084441/
https://www.ncbi.nlm.nih.gov/pubmed/21098012
http://dx.doi.org/10.1093/ndt/gfq630
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author Chandna, Shahid M.
Da Silva-Gane, Maria
Marshall, Catherine
Warwicker, Paul
Greenwood, Roger N.
Farrington, Ken
author_facet Chandna, Shahid M.
Da Silva-Gane, Maria
Marshall, Catherine
Warwicker, Paul
Greenwood, Roger N.
Farrington, Ken
author_sort Chandna, Shahid M.
collection PubMed
description Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited. Methods. We studied survival in a large cohort of CM patients in comparison to patients who received RRT. Results. Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM. CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival. Conclusions. In patients aged > 75 years with high extra-renal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Age > 75 years and female gender predicted better survival in CM patients. The reasons for this are unclear.
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spelling pubmed-30844412011-05-02 Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy Chandna, Shahid M. Da Silva-Gane, Maria Marshall, Catherine Warwicker, Paul Greenwood, Roger N. Farrington, Ken Nephrol Dial Transplant Original Article Background. Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited. Methods. We studied survival in a large cohort of CM patients in comparison to patients who received RRT. Results. Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM. CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival. Conclusions. In patients aged > 75 years with high extra-renal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Age > 75 years and female gender predicted better survival in CM patients. The reasons for this are unclear. Oxford University Press 2011-05 2010-11-22 /pmc/articles/PMC3084441/ /pubmed/21098012 http://dx.doi.org/10.1093/ndt/gfq630 Text en © The Author 2010. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org http://creativecommons.org/licenses/by-nc/2.5 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Chandna, Shahid M.
Da Silva-Gane, Maria
Marshall, Catherine
Warwicker, Paul
Greenwood, Roger N.
Farrington, Ken
Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title_full Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title_fullStr Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title_full_unstemmed Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title_short Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy
title_sort survival of elderly patients with stage 5 ckd: comparison of conservative management and renal replacement therapy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3084441/
https://www.ncbi.nlm.nih.gov/pubmed/21098012
http://dx.doi.org/10.1093/ndt/gfq630
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