Conceitos essenciais
Older patients with advanced chronic kidney disease who initiate dialysis within a month may experience modest survival benefits, but this comes at the cost of spending more time in inpatient care settings compared to those who continue medical management.
Resumo
The study examined the trade-offs between initiating dialysis and continuing medical management for older adults with advanced chronic kidney disease (CKD). Key findings:
- Patients who started dialysis within 30 days had a mean survival of 770 days, compared to 761 days for those who continued medical management - a difference of just 9.3 days.
- However, the dialysis group spent 13.6 fewer days at home (not receiving inpatient care) compared to the medical management group.
- In the 80+ age group, starting dialysis was associated with 60 days longer survival but 12.9 fewer days at home.
- In the 65-79 age group, the medical management group actually had 16.6 days longer survival than the dialysis group, while still spending 14.4 fewer days at home.
- The authors conclude that decisions to start dialysis should carefully consider the trade-off between potential survival benefits and increased time spent in inpatient settings, in the context of the patient's values and goals.
Estatísticas
"Patients who started dialysis within a month had a mean survival of 770 vs 761 days among the group choosing medical management, for a mean difference of just 9.3 days."
"The group that started dialysis had a mean of 13.6 fewer days at home, defined as not receiving inpatient care in a hospital, skilled-nursing facility, nursing home, or rehabilitation facility, vs medical management."
"Among those aged 80 years or older, starting dialysis within a month was associated with a mean of 60 days longer survival compared with medical management but 12.9 fewer days at home."
"Among adults aged 65-79 years, the survival time in fact favored those continuing medical management by a mean of 16.6 days, while those starting dialysis still spent 14.4 fewer days at home."
Citações
"Decisions to start dialysis at this level of kidney function should consider the clinical factors that affect this trade-off and whether the expected outcomes of starting dialysis align with an individual's values and goals."
"Widely referenced estimates of survival after dialysis initiation are misleading to use in shared decision-making because these figures underestimate early mortality and run the risk of misattributing how long patients live to a beneficial effect of dialysis treatment."
"In the 65-80 age group, our findings are consistent with the IDEAL trial and suggest that it's reasonable to defer dialysis until patients have more advanced symptoms and/or lower kidney function."