THE HEALTH-RELATED QUALITY OF LIFE WITH END-STAGE RENAL DISEASE PATIENTS UNDERGOING CONSERVATIVE KIDNEY MANAGEMENT COMPARED TO MAINTENANCE DIALYSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

CKM (conservative kidney management) is defined as palliative care apart from renal replacement treatment for patients with ESRD (end-stage renal disease). Given few survival benefits of maintenance dialysis for older people with multiple comorbidities, CKM has been considered as another possible choice for them. HRQOL (health-related quality of life) is one of patient-reported outcomes which has room for improvement by medical treatment. However, HRQOL of patients with CKM is rarely reported, nor compared to those in dialysis. Therefore, we aimed to conduct a systematic review with meta-analysis to identify the HRQOL of CKM compared to dialysis.

We systematically searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, APA PsycInfo, The Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), and Google Scholar for studies comparing CKM with maintenance dialysis in patients with ESRD on July 7th, 2025. The primary outcome was HRQOL of patients with ESRD evaluated with questionnaires, and the secondary outcomes were mortality, symptoms, hospitalization, comorbidities, and the place of death. Each study was assessed for its risk of bias using ROBINS-I V2. We conducted a meta-analysis using a random-effects model for both PCS (physical component summary) and MCS (mental component summary) of SF-36, SF-12, KDQOL-SF. Mean differences (MD) were pooled with the corresponding 95% confidence intervals (CI). Heterogeneity of all studies was evaluated using the I2 test, and publication bias was examined using the Egger’s test.

Seven cross-sectional studies comprising 899 patients were included. The number of patients in the CKM group was 455, and that of maintenance dialysis was 444. In all studies, the average age was higher in the CKM group compared to the dialysis group. In Australia, Italy, and the UK, the average age of patients was over 70, whereas in Nepal, South Africa, and Uganda, that was around 50. In 5 studies, patients in the CKM group were more likely to live alone. In the study of Uganda, the dialysis sessions were restricted to twice per week because of the limited resources to cover healthcare related expenditure, and patients in CKM did not necessarily receive adequate care. In the study of Italy, patients in CKM had a very low-protein diet (0.4-0.6 g/kg/day). Four studies were single-centered. Overall, patients who received CKM showed higher PCS scores (MD 2.55; 95% CI -0.67 to 5.78; I2 = 63.0%; Figure 1) and MCS scores (MD -0.00; 95% CI -1.59 to 1.58; I2 = 45.2%; Figure 2) than those with dialysis, while the differences of both scores were not statistically significant. Most studies did not account for potential confoundings. For both PCS and MCS, publication bias did not exist based on Egger’s test.

This is the first systematic review that conducted a meta-analysis of HRQOL in CKM compared to dialysis as we know. In our meta-analysis, the HRQOL did not vary between CKM and dialysis. Our findings suggest that CKM can be an alternative option of dialysis for patients with ESRD. Heterogeneity may be caused by the variety of CKM realities, such as extra dietary therapy or no sufficient care, compared to palliative care primarily required for patients with CKM. Most studies were likely to be affected by potential confounding factors, therefore, further studies are expected.