A study on health care utilisation, quality of life and clinical decision making in elderly patients with end-stagerenal disease choosing either conservative management or renal replacement therapy

Dijkers, J. (Janneke) (2015) A study on health care utilisation, quality of life and clinical decision making in elderly patients with end-stagerenal disease choosing either conservative management or renal replacement therapy. thesis, Medicine.

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Abstract

Background: With the growing numbers of elderly patients on dialysis, who often deal with multiple co-morbid conditions, questions are raising if this burdensome treatment is truly beneficial for everyone. Evidence has shown that the survival advantage in elderly patients with end-stage-renal-disease (ESRD) on renal replacement therapy (RRT) is limited in those patients with multiple co morbidities and poor functional status. However, little is known about differences in QoL and health care utilization among elderly patients choosing conservative, non-dialytic management (CM) and patients opting for dialysis. Besides, it is unclear how these patients feel about the difficult treatment decisions they have to make. Objectives: This mixed method study, including both retrospective and observational designs aimed to assess whether, in elderly ESRD patients, CM leads to lower disease burden in terms of QoL and health care utilisation compared to RRT. Besides, we aimed to explore the decision making process. Methods: 311 patients aged ≥ 70 years, with advanced chronic kidney disease (CKD), who made a decision to start or forego dialysis in the past ten years, were selected from a recent survival study in our hospital. They were designated as CM- or RRT-patients, according to their final decision. Outcomes measured were 1) QoL, measured with the KDQOL-SF-36 questionnaire. 2) Inpatient, outpatient and dialysis-related healthcare costs. 3) Number and duration of hospital admissions and number of outpatient visits. 4) Satisfaction with decision making, measured with a self-developed questionnaire. Results: Overall physical and mental QoL were not significantly different between groups, although minor differences were seen in several mental sub-scores favouring patients opting for RRT. In both patient groups, the level of satisfaction with treatment decision was high, although slightly higher in patients on CM and CM-patients autonomy was more often warranted during the decision making process. Costs and hospitalization rates adjusted for survival, were lower in patients on CM compared to patients on RRT. Conclusions: In addition to a recent survival-study in our hospital, we have shown that CM is a valid alternative for RRT in elderly patients ≥70 years with CKD: In patients opting for CM, QoL was similar, levels of health care utilisation were lower and satisfaction with treatment was higher compared to RRT-patients.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Sluiter, Dr. H.E. Nephrologist
Supervisor name:	Local supervisors: and Bos, Dr. W.J.W. Nephrologist and Verberne, Drs. W. Resident Internal Medicine and Department of Nephrology, St. Antonius Ziekenhuis
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:01
Last Modified:	25 Jun 2020 11:01
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2102

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