Choosing conservative therapy in chronic kidney disease

Area of Science:

• Nephrology
• Geriatrics
• Public Health

Background:

• Data on the utilization of conservative treatment for chronic kidney failure (CKD) is limited.
• Renal replacement therapies (RRTs) like dialysis and transplantation are common, but non-dialytic pathways are less understood.

Purpose of the Study:

• To determine the proportion of patients with stage 5 CKD who opt for conservative treatment.
• To identify factors influencing the selection of conservative therapy over RRTs.

Main Methods:

• A prospective study was conducted over one year involving 232 patients with stage 5 CKD.
• Patients received counseling on all therapeutic options before making a decision.
• Logistic regression analysis was used to identify factors associated with conservative treatment selection.

Main Results:

• 39% of patients (90 out of 232) chose conservative treatment.
• Factors associated with conservative treatment selection included older age, higher comorbidity burden (Charlson index), walking difficulties, and functional dependence.
• The primary reasons for choosing conservative treatment were severe disease prognosis (49%) and patient refusal of RRT (26%).
• Mortality was significantly higher in the conservative group (8.2/100 patient-months) compared to the RRT group (0.6/100 patient-months).
• Baseline glomerular filtration rate impacted survival in the conservative therapy group.

Conclusions:

• Approximately 39% of stage 5 CKD patients selected conservative therapy.
• Age, comorbidities, and functional status are key determinants in choosing conservative management for CKD.