Dialysis confers survival benefits to patients with advanced CKD vs. conservative care
Click Here to Manage Email Alerts
Dialysis initiation “considerably” reduced mortality for patients with advanced chronic kidney disease when compared with conservative care, according to a meta-analysis of studies conducted across the globe.
“[The] survival benefits due to dialysis were robust to potential unmeasured confounding,” Rui Fu, MSc, of the University of Toronto, and colleagues wrote, contending that observational studies have been limited due to unmeasured confounders.
“In the absence of randomized controlled trials, results of these observational studies are hindered by confounding by indication, as patients who avoid dialysis are driven by reasons that also impact their survival,” they elaborated. “Effects of confounders that are unmeasured, unknown or incorrectly specified are difficult to remove and concerns of the unmeasured confounding in each study may translate to internal bias in a meta-analysis, as pooling studies improves statistical precision but generally does not mitigate bias.”
For this study, Fu and colleagues extracted data from 12 studies performed in Europe, Asia, North America and Australia, conducting a bias analysis for unmeasured confounding (the studies assessed 16,609 patients on dialysis and 3,691 conservatively managed patients).
“Random-effects model suggested dialysis initiation was associated with a mean mortality HR of 0.47, where 92% of the true effects were more protective than HRs of 0.8,” the researchers wrote. “To reduce the percentage of HRs [less than] 0.8 to 10%, unmeasured confounder(s) would need to be associated with both dialysis initiation and mortality by relative risks of 4.05, which is equivalent to shifting each study’s estimated HR by 2.31-fold.”
Although Fu and colleagues found “significant survival advantages” for adults in most age groups who initiated dialysis, including a subset older than 65 years, they noted that outcomes of patients older than 75 years remain uncertain.
“[This] highlights the need for future investigations to provide a more comprehensive understanding of the benefits of dialysis initiation,” they wrote.
Collapse
Read more about
Click Here to Manage Email Alerts