Douma, M.H. (2016) Ouderen met terminaal nierfalen , een betere overlevingskans bij dialyse of een conservatieve behandeling? thesis, Medicine.
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Abstract
Abstract Background The number of elderly patients with kidney disease stage 5 is increasing steadily. More elderly patients are treated with dialysis. Little is known about differences in survival and in quality of life of patients managed either with dialysis or conservatively, especially in patients with multiple comorbid conditions. For better decision making more evidence is needed. Objectives The aim of the study is to find differences in survival between patients with kidney disease stage 5 who are older than 70 years who choose for a conservative treatment and patients who choose for dialysis. In addition this study is looking at the existence of any effect of age, comorbidity, functional status and nutritional status at the survival of these two groups. Design and setting A retrospective analysis was performed during the period of 2004-2014, looking at patients of over 70 years with kidney disease stage 5, managed either with dialysis or conservatively. Patients are included from the pre-dialysis care outpatient clinic of the Deventer Hospital. Method Data were collected concerning demographics, comorbidity, functional status, nutritional status at the time estimated eGFR fell below 15 ml/min. Results In total 167 patients were included, 32 in the conservative group and 135 in the dialysis group. Mean age for the conservative group was 83.0 years (SD 5.4), and for the dialysis group 77.5 years respectively (SD 4.4), witch differed significantly (p < 0.001). Both groups included slightly more men (56.3% versus 66.7%). 130 Patients died during the study period. Survival analysis from estimated eGFR<15 ml/min showed a mean survival of 17.4 months (SD 2.9) in the conservative group and 59.3 months (SD 4.9) in the dialysis group, which differed significantly (p = <0.001). Univariate analysis found a significant association between dialysis and a decreased mortality (0.26-fold, 95%-CI 0.22-0.26, p = <0.001). Age and functional status were found as confounders. Multivariate analysis also showed a significant association between dialysis and a decreased mortality (0.55-fold, 95%-CI 0.33-0.90, p = 0.02), also when corrected for age and functional status. One year survival rates were 53.1% in the conservative group and 85.2% in the dialysis group. There were no subgroups who did better at conservative management rather then dialysis. Conclusion In this retrospective analysis, treatment modality is found to be an independent predictor of mortality for patients with stage 5 kidney disease who are older than 70 years, even when corrected for age and functional status. No subgroups could be identified where dialysis might confer a worse prognosis than conservative management. These results need confirmation in further, prospective, analyses.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Sluiter, Dr H.E. Internist-Nefroloog Deventer Ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1170 |
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