Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?
Is Maximum Conservative Management an Equivalent Treatment Option to Dialysis for Elderly Patients with Significant Comorbid Disease?
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DOI：
10.2215/cjn.00510109
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发表时间：
2009-10-01
影响因子：
9.8
通讯作者：
Burns, Aine
中科院分区：
文献类型：
--
作者：
Carson, Rachel C.;Juszczak, Maciej;Burns, Aine
背景和目的：在西欧和北美，患有终末期肾病的老年人群正在持续增长。在我们的中心，我们为选择不开始透析的患者提供“最大保守管理”（MCM）的替代护理途径，这些患者通常是因为共病和高龄的沉重负担。本研究的目的是比较选择MCM或肾脏替代治疗（RRT）的终末期肾病患者的临床结局。设计、设置、参与者和测量：这是一项在英国进行的单中心队列观察性研究，评价了202例老年（≥ 70岁）ESRD患者，选择了MCM（n = 29）或RRT（n = 173）。我们报告了该队列的生存率、住院率和死亡位置。结果：RRT患者的中位生存期（包括前90天）为37.8个月（范围0 - 106个月），MCM患者为13.9个月（范围2 - 44个月）（P < 0.01）。与MCM患者相比，RRT患者的住院率更高（0.069 [95%置信区间（CI）0.068 - 0.0701）vs 0.043 [95% CI 0.040 - 0.0471住院日/生存患者日）。MCM患者在家中或临终关怀中死亡的可能性显著更高（比值比4.15; 95%CI 1.67 - 10.25）。一项调查的文献描述老年人终末期肾病outcomes也presented.Conclusions：透析治疗生存的老年患者有终末期肾病与显着comorrhosis约2年，但是，选择MCM的患者可以生存相当长的时间，实现类似的住院天数的患者谁选择血液透析。Clin J Am Soc Nephrol 4：1611-1619，2009. doi：10.2215/CJN.00510109
Background and objectives: There is ongoing growth of elderly populations with ESRD in Western Europe and North America. In our center, we offer an alternative care pathway of 'maximum conservative management' (MCM) to patients who elect not to start dialysis, often because of a heavy burden of comorbid illness and advanced age. The objective of our study was to compare clinical outcomes for patients who had ESRD and chose either MCM or renal replacement therapy (RRT).Design, setting, participants, & measurements: This is an observational study of a single-center cohort in the United Kingdom that evaluating 202 elderly (>= 70 yr) patients who had ESRD and had chosen either MCM (n = 29) or RRT (n = 173). We report survival, hospitalization rates, and location of death for this cohort. Survival was measured from a standardized 'threshold' estimated GFR of 10.8 ml/min per 1.73 m(2).Results: Median survival, including the first 90 d, was 37.8 mo (range 0 to 106 mo) for RRT patients and 13.9 mo (range 2 to 44) for MCM patients (P < 0.01). RRT patients had higher rates of hospitalization (0.069 [95% confidence interval (CI) 0.068 to 0.0701) versus 0.043 [95% CI 0.040 to 0.0471 hospital days/patient-days survived) compared with MCM patients. MCM patients were significantly more likely to die at home or in a hospice (odds ratio 4.15; 95% CI 1.67 to 10.25). A survey of the literature describing elderly ESRD outcomes is also presented.Conclusions: Dialysis prolongs survival for elderly patients who have ESRD with significant comorbidity by approximately 2 yr, however, patients who choose MCM can survive a substantial length of time, achieving similar numbers of hospital-free days to patients who choose hemodialysis. Clin J Am Soc Nephrol 4: 1611-1619, 2009. doi: 10.2215/CJN.00510109