Conservative management better than dialysis for some advanced kidney disease patients

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For some individuals with advanced kidney disease, dialysis may not be the optimal treatment strategy for their condition, and these patients may be better served with conservative non-dialytic management that focuses on quality-of-life and symptom control. Investigators recently examined the differential impact of conservative management versus dialysis on hospitalisation outcomes across varying racial/ethnic groups in a large national cohort of patients with advanced kidney disease. The research was presented at American Society of Nephrology (ASN) Kidney Week 2022 (3–6 November, Orlando, USA). 

In this study, the investigators compared hospitalisation rates among 309,188 patients with advanced kidney disease who were treated with conservative management or dialysis over the period of 2007–2020. During follow-up, 55% of patients had one or more hospitalisations, and the most common causes of hospitalisation in both groups were related to congestive heart failure/fluid overload, respiratory problems, or hypertension. 

In non-Hispanic white, non-Hispanic Black, and Hispanic patients, patients on dialysis had higher hospitalisation rates than those who received conservative management, and patients who started dialysis early (transitioned to dialysis at higher levels of kidney function) demonstrated the highest rates across all age groups when compared with those who started dialysis late (transitioned to dialysis at lower levels of kidney function) or were treated with conservative management. Among Asian patients, those on dialysis also had higher hospitalisation rates than those receiving conservative management, but patients who started dialysis late had higher rates than those on early dialysis, especially in older age groups. 

“There has been growing recognition of the importance of conservative non-dialytic management as an alternative patient-centred treatment strategy for advanced kidney disease. However, conservative management remains under-utilised in the USA, which may in part be due to uncertainties regarding which patients will most benefit from dialysis versus non-dialytic treatment,” said corresponding author Connie Rhee (University of California Irvine, Irvine, USA). “We hope that these findings and further research can help inform treatment options for patients, care partners, and providers in the shared decision-making process of conservative management versus dialysis.” 

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