Original InvestigationDialysisPatients Who Plan for Conservative Care Rather Than Dialysis: A National Observational Study in Australia
Section snippets
Study Design and Participants
We conducted a prospective national survey study of all incident patients with stage 5 CKD (including pre-emptive transplant, dialysis, and conservative-care patients) who were identified during a 3-month period in Australian renal units, the Patient Information about Options for Treatment (PINOT) Study. All adult and pediatric centers and private nephrology practices that contribute to the Australia and New Zealand Dialysis and Transplant Association registry (ANZDATA, www.anzdata.org.au) were
Study Participants
Sixty-six of 73 (90%) Australian renal units participated (Table 1). Ten of 66 (15%) had a formal (written and documented) conservative-care pathway for patients with CKD, and several others were in the process of developing one. Nonparticipating centers included 2 pediatric renal units and 5 small private nephrology practices that managed 30-70 privately insured prevalent hemodialysis patients each. Incident patients from these units would not be expected to differ from those included in the
Discussion
Our study showed that despite only 15% of renal units having a formal conservative-care pathway, two-thirds of patients approaching end-stage kidney disease were presented with information about conservative care as a treatment option. These patients were more likely to be older, have a caregiver, and be well known to their nephrologist compared with patients not presented with this option. One in 7 (14%) of all incident patients with stage 5 CKD planned for conservative care and were more
Acknowledgements
The authors thank the nephrologists and CKD coordinators from Australian renal units who participated in this study.
Support: Ms Morton is supported by National Health and Medical Research Council (NHMRC) grants #457281 and #571372. Dr Turner is supported by NHMRC program grants #402764 and #633003.
Financial Disclosure: The authors declare that they have no other relevant financial interests.
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Cited by (54)
Sex-Based Differences in Risk Factors and Complications of Chronic Kidney Disease
2022, Seminars in NephrologyCitation Excerpt :For example, the risk of doubling of creatinine is affected by factors in addition to the rate of decrease, such as the baseline GFR.60 If KRT is a marker of progression, it should be noted that females are more likely to choose conservative kidney care rather than dialysis.62 Significant sex- and age-dependent differences in the initiation of KRT, with males more likely to receive KRT, recently was described in a multinational European study.63
The Other Way Around: Living With Chronic Kidney Disease From the Perspective of Men
2022, Seminars in NephrologyKidney Function, Kidney Replacement Therapy, and Mortality in Men and Women
2022, Kidney International ReportsSex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study
2022, Kidney International ReportsCKD Progression and Mortality Among Men and Women: A Nationwide Study in Sweden
2021, American Journal of Kidney DiseasesCitation Excerpt :Earlier findings also suggest old age is associated with a decreased risk of dialysis or kidney transplantation,30 although that could partly be explained by medical decisions to treat elderly patients more conservatively.31,32 We have no information in the present study for whether men and women were offered or accepted KRT to the same extent, but an earlier study suggests that women may be more likely to receive conservative treatment.33 In this study, we observed better survival in women, although the results were not consistently statistically significant through all CKD stages.
Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes
2020, Kidney International SupplementsCitation Excerpt :Although the evidence indicates that the majority of patients with ESKD in the world do not receive KRT, it is unclear to what extent in each country this reflects unrecognized ESKD (thereby preventing KRT from being offered), difficulty accessing KRT due to the various patient and health care–related factors described previously, or medically informed patient choice to receive comprehensive conservative care (also known as nondialysis supportive care). Whereas comprehensive conservative care has been widely recognized and provided,37–40 the incidence or prevalence of this treatment pathway has been poorly studied.41 A survey of comprehensive conservative care practice patterns in relation to older patients (≥75 years old) was administered to all 71 adult renal units in the UK in 2013 and demonstrated that comprehensive conservative care was practiced in almost all units but varied markedly in its scale and approach between centers.42
Originally published online October 21, 2011.