Back
If elderly, functional impaired patients with end-stage kidney disease (ESKD) benefit from dialysis is unclear. Little is known about the outcomes and symptomatic burden of elderly, functional impaired ESKD patients who opt for kidney supportive care after a shared decision-making process. The objective of this study was to compare clinical characteristics, outcomes, symptomatic and healthcare burden of elderly, functional impaired ESKD patients who chose kidney supportive care versus those who chose dialysis after a shared decision-making process.
Prospective observational cohort study conducted from April 2013 to December 2018 among functionally impaired elderly patients with end-stage kidney disease (ESKD). The inclusion criteria were as follows: 1. Age > 75 years, 2. CKD-EPI < 12 ml/min, or CKD-EPI < 15 ml/min in diabetics, 3. Comorbidity burden (Charlson Comorbidity Index > 5), and 4. Functional impairment (Barthel Index < 95 or Palliative Performance Score < 60). Participants were those who made a choice between two options: 1. Kidney supportive care (CV) or 2. Dialysis (D) following a shared decision-making process.
A total of 103 patients, with an average age of 84.9 years (±5.4 years), were included in the study. Among them, 72% chose kidney supportive care (CV), while 28% opted for dialysis (D). Despite a male predominance (55%), females significantly preferred CV (p=0.01). The CV group consisted of significantly older individuals (p<0.001), and they were more functionally impaired based on the Barthel Index (BI) and Palliative Performance Score (PPS) (p<0.001). At baseline, the CV group experienced a significantly greater symptomatic burden for asthenia (p=0.02), constipation (p=0.03), and reduced mobility (p<0.001). However, during the last visit, symptoms were notably more intense in the CV group for vomits (p=0.04), asthenia (p=0.006), anxiety (p=0.027), anorexia (p=0.03), and somnolence (p=0.03). A total of 69 patients died, 65 from the CV group (p<0.001).
ESKD patients who chose kidney supportive care with shared decision-making are older, mostly women, and more functionally impaired. Despite a lower survival rate and increased symptomatic burden in CV group, the decision of treatment modality remains consistent over time suggesting a positive influence of shared decision-making in treatment modality decision. Conservative treatment seems to be a feasible treatment option, with significatively less healthcare burden, which suggest that formation to young nephrologists in kidney palliative care and more research of how shared decision-making impacts ESKD patient´s quality of life is needed.