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Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review

Shared decision making is important when deciding the appropriateness of dialysis for any individual, particularly for older patients with advanced chronic kidney disease who have high mortality. Emerging evidence suggests that patients with advanced age, high comorbidity burden, and poor functional...

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Detalles Bibliográficos
Autores principales: Chou, Angela, Li, Kelly Chenlei, Brown, Mark Ashley
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046625/
https://www.ncbi.nlm.nih.gov/pubmed/35498159
http://dx.doi.org/10.1016/j.xkme.2022.100447
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author Chou, Angela
Li, Kelly Chenlei
Brown, Mark Ashley
author_facet Chou, Angela
Li, Kelly Chenlei
Brown, Mark Ashley
author_sort Chou, Angela
collection PubMed
description Shared decision making is important when deciding the appropriateness of dialysis for any individual, particularly for older patients with advanced chronic kidney disease who have high mortality. Emerging evidence suggests that patients with advanced age, high comorbidity burden, and poor functional status may not have any survival advantage on dialysis compared with those on a conservative kidney management pathway. The purpose of this narrative review is to summarize the existing studies on the survival of older patients with stage 4 or 5 chronic kidney disease managed with or without dialysis and to evaluate the factors that may influence mortality in an effort to assist clinicians with shared decision making. Median survival estimates of conservative kidney management patients are widely varied, ranging from 1-45 months with 1-year survival rates of 29%-82%, making it challenging to provide consistent advice to patients. In existing cohort studies, the selected group of patients on dialysis generally survives longer than the conservative kidney management cohort. However, in patients with advanced age (aged ≥80 years), high comorbidity burden, and poor functional status, the survival benefit conferred by dialysis is no longer present. There is an overall paucity of data, and the variability in outcomes reflect the heterogeneity of the existing studies; further prospective studies are urgently needed.
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spelling pubmed-90466252022-04-29 Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review Chou, Angela Li, Kelly Chenlei Brown, Mark Ashley Kidney Med Review Shared decision making is important when deciding the appropriateness of dialysis for any individual, particularly for older patients with advanced chronic kidney disease who have high mortality. Emerging evidence suggests that patients with advanced age, high comorbidity burden, and poor functional status may not have any survival advantage on dialysis compared with those on a conservative kidney management pathway. The purpose of this narrative review is to summarize the existing studies on the survival of older patients with stage 4 or 5 chronic kidney disease managed with or without dialysis and to evaluate the factors that may influence mortality in an effort to assist clinicians with shared decision making. Median survival estimates of conservative kidney management patients are widely varied, ranging from 1-45 months with 1-year survival rates of 29%-82%, making it challenging to provide consistent advice to patients. In existing cohort studies, the selected group of patients on dialysis generally survives longer than the conservative kidney management cohort. However, in patients with advanced age (aged ≥80 years), high comorbidity burden, and poor functional status, the survival benefit conferred by dialysis is no longer present. There is an overall paucity of data, and the variability in outcomes reflect the heterogeneity of the existing studies; further prospective studies are urgently needed. Elsevier 2022-03-12 /pmc/articles/PMC9046625/ /pubmed/35498159 http://dx.doi.org/10.1016/j.xkme.2022.100447 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review
Chou, Angela
Li, Kelly Chenlei
Brown, Mark Ashley
Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title_full Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title_fullStr Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title_full_unstemmed Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title_short Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review
title_sort survival of older patients with advanced ckd managed without dialysis: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9046625/
https://www.ncbi.nlm.nih.gov/pubmed/35498159
http://dx.doi.org/10.1016/j.xkme.2022.100447
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