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Dialysis improves some quality of life measures for older, frail patients vs. conservative management
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Although worsening frailty impacted older patients with ESKD similarly whether treated with dialysis or conservative management, certain quality of life measures did improve with dialysis, according to a study published in the Clinical Kidney Journal.
“There is little information about quality of life for patients with end-stage kidney disease choosing conservative kidney management,” Osasuyi Iyasere, MD, of the John Walls Renal Unit at Leicester General Hospital in the U.K., and colleagues wrote. “The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer quality of life outcomes with little difference between dialysis modalities (assisted peritoneal dialysis or hemodialysis). We therefore extended the FEPOD study to include conservative kidney management patients with eGFR [10 mL/min/1.73m2 or less] (ie, individuals with ESKD otherwise likely to be managed with dialysis).”
For the study, researchers propensity matched 28 patients aged 60 years or older who chose conservative management with those on assisted PD or hemodialysis. They matched patients by age (median age, 82 years), sex, ethnicity, diabetes status and index of deprivation. The definition of conservative management was no dialysis but active support and interventions to delay the progression of kidney disease.
At baseline, researchers assessed frailty as a potential confounder through the Clinical Frailty Scale (scores from 1 to 7, with higher scores indicating increased frailty; scores 5 in 39.3%, 60.7% and 39.3% in conservative management patients, assisted PD patients and hemodialysis patients, respectively).
Investigators used questionnaires to assess quality of life and physical function outcomes. These questionnaires included the Short Form-12 (physical and mental health-related QoL), Hospital Anxiety and Depression Scale, Palliative Outcomes Scale-Symptoms (associated burden of symptoms), Illness Intrusiveness Rating Scale (how illness and/or treatment interferes with life), Renal Treatment Satisfaction Questionnaire (convenience, flexibility and freedom of treatment, as well as impact on lifestyle) and the Barthel score (performance in ten activities of daily living).
The data showed that, based on SF-12 responses, patients on assisted PD had better physical and mental-health related QOL than those who chose conservative management (Exp B = 1.20; 95% CI, 1-1.45). Patients on assisted PD also had lower symptom scores (Exp B = 0.62; 95% CI, 0.43-0.9).
Further, depression scores were lower for patients on hemodialysis than those on conservative management (Exp B = 0.7; 95% CI, 0.52-0.92).
Researchers observed that worsening frailty was associated with worse QOL measures, including higher depression scores, for all patients regardless of whether they were on dialysis or conservative management.
“These findings highlight the need for an individualized approach to the management of ESKD in older people,” the researchers wrote. “For patients with ESKD whose renal function has fallen to a level when dialysis is likely to be considered, many aspects of QOL (mental component score and illness intrusiveness) will be similar whether managed conservatively or with dialysis. However, physical QOL appears to be higher and symptom score lower for those opting for assisted PD compared with conservative care. Treatment satisfaction was similar for both conservative care and assisted PD, but probably lower for hemodialysis.
Shared decision-making is a key component of comprehensive conservative care of ESKD. This study provides information for older and/or frail patients and their families, who are making decisions whether to have conservative care for ESKD or dialysis — and which dialysis modality to choose.” – by Melissa J. Webb
Disclosures: Iyasere reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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