Survival outcomes of supportive care versus dialysis therapies for elderly patients with end‐stage kidney disease: A systematic review and meta‐analysis
- 11 August 2015
- journal article
- review article
- Published by Wiley in Nephrology
- Vol. 21 (3), 241-253
- https://doi.org/10.1111/nep.12586
Abstract
Aim Elderly people comprise a large and growing proportion of the global dialysis population. Regional differences in rates of dialysis in the elderly suggest multiple factors influence treatment decision‐making including beliefs about the relative benefits and harms of dialysis and supportive (non‐dialysis) care. We therefore systematically reviewed the literature reporting survival of elderly patients treated with either treatment pathway. Methods Systematic review and meta‐analysis of cohort studies or randomized controlled trials identified in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials published before July 2014. Survival by treatment modality was calculated. Subgroup analyses by study design, study size, patient age and cohort era were conducted. Results Eighty‐nine studies published between 1976 and 2014 reported on 294 921 elderly end‐stage kidney disease (ESKD) patients. There was a paucity of data for supportive care (724 patients or 0.2% of the total patients) and supportive care studies were susceptible to lead‐time bias. One‐year survival for elderly patients treated with undifferentiated dialysis was 73.0% (95% confidence interval (CI) 66.3–79.7%), 78.4% (95% CI 75.2–81.6) for haemodialysis and 77.9% (95% CI 73.8–81.9) for peritoneal dialysis. Supportive care patients had a 1‐year survival of 70.6% (95% CI 63.3–78.0%). Residual heterogeneity remained within individual treatment modalities despite subgroup analyses. Conclusions While the available literature demonstrates a broadly similar 1‐year survival in elderly ESKD patients, it does not allow a confident estimate of the relative survival benefits of dialysis or supportive care. This uncertainty needs urgent attendance by further prospective data, which avoid bias and allow comparisons of quality of life and survival.This publication has 23 references indexed in Scilit:
- Conservative Management of End-Stage Renal Disease without Dialysis: A Systematic ReviewJournal of Palliative Medicine, 2012
- GRADE guidelines: 4. Rating the quality of evidence—study limitations (risk of bias)Journal of Clinical Epidemiology, 2011
- End-of-Life Care Preferences and NeedsClinical Journal of the American Society of Nephrology, 2010
- Predicting Six-Month Mortality for Patients Who Are on Maintenance HemodialysisClinical Journal of the American Society of Nephrology, 2010
- Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?Clinical Journal of the American Society of Nephrology, 2009
- A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal diseaseNephrology Dialysis Transplantation, 2008
- Renal dialysis abatement: lessons from a social studyPalliative Medicine, 2005
- Epidemiology of end-stage renal disease: International comparisons of renal replacement therapyKidney International, 2000
- Survival on renal replacement therapy in Europe: is there a 'centre effect'?Nephrology Dialysis Transplantation, 1996
- Validation of a combined comorbidity indexJournal of Clinical Epidemiology, 1994