Paula Span writing in a 9/1/2024 article in The New York Times titled “Dialysis May Prolong Life for Older Patients. But Not by Much” suggests that such care only added 77 days in a recent study. The article goes on to suggest that “Conservative Kidney Care” or “Supportive Kidney Care” may be more germane.
Specifically, the cited article states ” …dialysis can prolong the lives of patients with kidney failure. But a new study published in the journal Annals of Internal Medicine analyzed data from a simulated trial involving records from more than 20,000 older patients (average age: about 78) in the Veterans Health Administration system. It found that their survival gains were “modest.”
How modest? Over three years, older patients with kidney failure who started dialysis right away lived for an average of 770 days — just 77 days longer than those who never started it.”
If those of you on PD experienced what I did at the onset, my options were transplant, dialysis, or death the preferred treatment in that order. I was not, to my recollection, ever apprised of “conservative kidney care” and/or “supportive Kidney Care.” Let’s get Perplexity to help us unpack these terms.
Conservative kidney care is an approach to managing end-stage kidney disease without dialysis, focusing on symptom management and quality of life rather than extending life through renal replacement therapy. Here’s an overview comparing conservative kidney care to dialysis:
Conservative Kidney Care
Conservative kidney care, also known as comprehensive conservative care or conservative management, involves:
- Holistic, patient-centered care for those with stage 5 chronic kidney disease (CKD)[1]
- Focus on symptom management and quality of life
- Medication management to control symptoms
- Dietary modifications with relaxed restrictions compared to dialysis
- Psychosocial and spiritual support
- Involvement of palliative care services
Key aspects:
- Maintains quality of life and mental well-being in many patients[4]
- Median survival ranges from 1-41 months after choosing this option[4]
- Avoids the burdens associated with dialysis treatments
- May be preferred by some older, frail patients with multiple comorbidities
Dialysis
Dialysis is a renal replacement therapy that artificially filters waste from the blood. It includes:
- Hemodialysis: Blood is filtered through a machine
- Peritoneal dialysis: The abdominal lining is used to filter blood
Key aspects:
- Can extend life significantly for many patients
- Requires frequent treatments (typically 3-4 times per week for hemodialysis)
- Associated with lifestyle disruptions and potential complications
- This may lead to a rapid decline in physical function for some older, frail patients[3]
Comparison
- Survival: For older, frail patients with multiple health conditions, survival may be similar between conservative care and dialysis[2]
- Quality of life: Conservative care patients often report better quality of life compared to those on dialysis[2]
- Symptom burden: Symptom levels are likely to be similar in both groups[2]
- Healthcare utilization: Conservative care may involve less time spent in hospitals compared to dialysis[4]
Decision-making
The choice between conservative care and dialysis should involve shared decision-making, considering:
- Patient’s overall health status and prognosis
- Personal values and preferences
- Impact on quality of life
- Family and social support
It’s important to note that conservative kidney care is now recognized as a valid “fourth treatment option” alongside hemodialysis, peritoneal dialysis, and transplantation in many renal centers[2].
Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160947/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953263/
[3] https://www.nature.com/articles/s41581-021-00511-6
[4] https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790050
[5] https://www.sciencedirect.com/science/article/abs/pii/S0272638611013096
[6] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/kidney-failure
[7] https://www.sciencedirect.com/science/article/pii/S2157171615322024
[8] https://www.happiesthealth.com/articles/kidney-health/conservative-care-non-dialytic-approach
Leave a Reply