Characteristics of Patients Involved With the Kidney Supportive Care Program: A Cohort Study of Routinely Collected Data

People with kidney failure face a significantly higher risk of death and symptom burden. We sought insights into the survival and symptom burden of people receiving medical management of kidney failure without dialysis.

Retrospective cohort study.

People with an estimated glomerular filtration rate (eGFR) ≤ 15 mL/min/1.73 m² receiving nondialytic/conservative/palliative management and known to the Kidney Supportive Care Team in a tertiary care hospital.

eGFR at cohort entry, living arrangement, and history of ischemic heart disease, heart failure, or stroke, according to routine care databases.

Primary: median survival. Secondary: number of hospitalizations and symptom burden assessed through the Integrated Palliative Care Outcome Scale-Renal score.

Cox regression survival modeling and descriptive statistics for hospitalizations and symptom burden.

The cohort included 223 people receiving care between January 2016 and April 2023, with a median age of 84 (interquartile range, 77-87) years. Median survival was 452 days (95% CI, 351-552). People with an eGFR of 11-15 mL/min/1.73 m² at cohort entry had a median survival of 517 days (95% CI, 406-623); those with an eGFR of 6-10 mL/min/1.73 m² had a median survival of 260 days (95% CI, 138-382), whereas people with an eGFR of < 5 mL/min/1.73 m² had a median survival of 61 days (95% CI, 46-107). People living independently at home had significantly higher median survival (538 days), compared with assisted living at home (356 days) or living in a nursing home (232 days) (P < 0.05). The studied comorbidities were not predictive of survival. At year 1, the most prevalent symptom was weakness (60%) with median "moderate" severity, with similar findings at year 2.

Single-center, retrospective study with univariable analysis.

The study provided valuable insights into life expectancy and symptom burden with kidney failure managed without dialysis, including the prognostic value of considering the baseline living situation in anticipating survival, to help guide clinicians facing the uncertainty of this clinical scenario.