Conservative care is as good as dialysis for elderly kidney failure patients

Elderly patients with end-stage renal disease have no better chance of survival if they choose dialysis over conservative management, according to a new study published March 17, 2016 in the Clinical Journal of the American Society of Nephrology. Thus, conservative care is a reasonable alternative to dialysis in certain patients, the study authors concluded.

The number of older patients with end-stage renal disease (ESRD) is increasing worldwide; for instance, one half or more of all patients on dialysis are 65 years old or older in The Netherlands, the United Kingdom, and the United States. So, researchers have questioned whether older patients with ESRD, who often have multiple comorbidities, are likely to benefit from renal replacement therapy.

To study the issue, investigators at St. Antonius Hospital in Nieuwegein, The Netherlands, compared survival in older patients with ESRD who chose either dialysis (204 patients) or conservative management (107 patients) between 2004 and 2014.

The results showed that patients ages 70 and older who chose dialysis did have better survival compared with patients who chose conservative management. However, there was no statistically significant survival advantage among patients 80 years old and older who chose dialysis over conservative care. In general, patients with additional medical illnesses died sooner than patients without comorbidities.

“We do not conclude that dialysis treatment should not be given to anybody 80 years or older with severe comorbidity, but we show that the treatment is on average of little advantage regarding survival,” said study co-author Wouter Verberne, MD, resident in Internal Medicine at St. Antonius Hospital.

“Our next task is to predict who benefits and who does not. Until we are able to give a better prediction of the results of dialysis treatment at high age, we can merely suggest that conservative management is an option which should honestly be discussed when ESRD is approaching,” Dr. Verberne said.

He added that more research is needed to determine how different treatment options affect patients' other outcomes, such as quality of life and severity of symptoms.

Conservative management programs can vary considerably from place to place. “Further research is necessary for enhancing and evaluating the multiple components necessary for a comprehensive conservative management program,” wrote Helen Tam-Tham, MSc, and Chandra Thomas, MSc, MD, of the University of Calgary, in Canada, in an accompanying editorial.