Survival of Elderly Patients with End Stage Kidney Disease Treated with Supportive Care or Dialysis: A systematic review and meta analysis

Celine Foote, Sradha Kotwal, Martin Gallagher, Alan Cass, M Brown, Meg J. Jardine

    Research output: Contribution to journalMeeting Abstract

    Abstract

    Aim: To systematically review the outcomes of elderly patients with end stage kidney disease (ESKD) treated with supportive (non‐dialysis) and dialysis care.

    Background:
    Elderly people comprise a large and growing proportion of the global dialysis population. Elderly ESKD patients face difficult decisions regarding dialysis versus supportive care. Older patients' treatment preferences may differ from younger patients due to high comorbid burden and reduced life expectancy. Comparative data about fundamental treatment outcomes remains unclear, making counseling and treatment of ESKD challenging in the elderly.

    Methods: A systematic search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials was conducted for cohort studies or randomized controlled trials published before September 2012 reporting survival in elderly ESKD patients treated with supportive care or dialysis. The study author definition for age of ‘elderly’ patients was accepted. Survival estimates were pooled using random effects models.

    Results: Seventy‐seven studies published between 1976 and 2012 reported on 191,586 elderly ESKD patients. One‐year survival for elderly patients treated with different dialysis modalities was 72.8% (95% confidence interval (CI) 65.9–79.7%) for undifferentiated dialysis, 77.4% (95%CI 73.7–81.0) for haemodialysis and 77.7% (95%CI 73.9–81.4) for peritoneal dialysis. Elderly supportive care patients had a one‐year survival of 66.5% (95%CI 55.3–77.7%) and represented 417 (0.2%) of the total patients. Supportive care studies were susceptible to lead‐time bias.

    Conclusions: The available literature suggests that one‐year survival of elderly ESKD patients is broadly similar with dialysis or supportive care. There is a paucity of evidence around supportive care. Generalizability of these findings needs to be enhanced by further prospective data that avoids bias and allows comparisons of both quality of life and survival.
    Original languageEnglish
    Article number053
    Pages (from-to)31-31
    Number of pages1
    JournalNephrology
    Volume19
    Issue numberSuppl. 4
    DOIs
    Publication statusPublished - 20 Jul 2014

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