Choosing conservative therapy in chronic kidney disease

Abstract

Introduction: Incidence of use for various renal replacement therapies is well known, but no data are available on the use of conservative treatment. Objective: To assess the proportion of patients with chronic kidney failure receiving conservative treatment. Results: From July 1, 2013 to June 30, 2014, 232 patients with stage 5 CKD were seen in the Nephrology Department. After having received information on the existing therapeutic options and having known the opinion of their physicians, 81 patients (35%) selected haemodialysis, 56 (24%) preferred peritoneal dialysis, 5 (2%) selected a preemptive transplant from a living donor, and in 90 (39%) a conservative treatment option was selected. In a univariate analysis using logistic regression, variables associated to a preference for conservative treatment were age, Charlson index excluding age, walking difficulties, and the level of functional dependendce, with the first three factors achieving statistical significance in a multivariate analysis. Presence of a severe disease with a poor prognosis was the main reason for selecting a conservative treatment (49%), with the second one being symple, patients refusal to receive a renal replacement therapy (26%). Mortality rate was 8.2/100 patient-months in conservative therapy group versus 0.6/100 patient-months in patients receiving renal replacement therapy (p < 0.001). In patients receiving conservative therapy, baseline glomerular filtration rate at the time of study enrollment was the only variable showing a significant impact on survival. Conclusions: About 39% of patients with stage 5 CKD seen over a 1-year period in the Nephrology Department received conservative therapy. Age, co-morbidity, and functional disability were the factors associated to selecting a conservative therapy option.

Keywords

• Stage 5 chronic kidney disease
• Conservative therapy