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Many patients with advanced kidney disease who forgo maintenance dialysis can survive for several years and experience improved mental well-being and stable physical well-being until late in the illness course, according to a review published online March 14 in JAMA Network Open.
In a systematic review of 41 cohort studies with 5,102 patients, Susan P. Y. Wong, M.D., from the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues examined survival, health care resource use, changes in quality of life, and end-of-life care among patients with advanced kidney disease who forgo dialysis.
The researchers found that comparability across studies was limited by substantial heterogeneity in study designs and measures used to report outcomes. The median survival of cohorts varied from one to 41 months. Per person-year, patients experienced one to two hospital admissions, six to 16 in-hospital days, seven to eight clinic visits, and two emergency department visits in general. Mental well-being improved during an observational period of eight to 24 months, while physical well-being and overall quality of life were mainly stable until late in the course of illness. Of the patients who died during follow-up, 20 to 76 percent had enrolled in hospice, 27 to 68 percent died in a hospital setting, and 12 to 71 percent died at home; during the final month of life, 57 to 76 percent were hospitalized and 4 to 47 percent received an invasive procedure.
“Our findings demonstrate the need to implement systematic and unified research methods for conservative kidney management and to develop models of care and the care infrastructure to advance practice and outcomes of conservative kidney management,” the authors write.
HealthDay