Study: Conservative kidney management may be viable alternative to dialysis to treat CKD
Click Here to Manage Email Alerts
Key takeaways:
- Overall, 7% of patients in a cohort of 1,018 planned for conservative kidney management.
- Of 407 patient surveys, 18% of patients spoke with a nephrologist about forgoing dialysis.
Conservative kidney management may be a viable treatment for patients with chronic kidney disease, but researchers found not many patients are aware of the therapy.
For older adults with comorbidities, “there is increasing evidence for the potential of [conservative kidney management (CKM)] to maintain quality of life without necessarily decreasing life expectancy,” Jennifer S. Scherer, MD, of the NYU Grossman School of Medicine, and colleagues wrote.
Researchers examined several factors affecting the uptake of CKM — defined as a holistic approach to managing CKD without dialysis — including characteristics of patients who choose CKM, provider practice patterns and availability of CKM resources to providers.
Researchers used a cross-sectional study that analyzed data from the Chronic Kidney Disease Outcomes and Practice Patterns Study, collected between 2014 and 2020. Research included information from 1,018 patients with an eGFR of 30 mL/min/1.73 m² or less, as well as information on whether the patient chose to pursue CKM at the time of kidney failure. In addition, researchers surveyed 407 patients about discussions with their nephrologists about forgoing dialysis and included 26 provider responses.
“Few patients reported discussion of forgoing dialysis with their providers and even fewer anticipated a choice of CKM on reaching kidney failure,” the researchers wrote.
Findings showed 7% of patients in the cohort of 1,018 adults recorded planning for CKM. The patients tended to be older, have comorbidities and were likely to need assistance with transfers. In evaluating the 407 patient surveys, investigators found 18% of patients reported talking with a nephrologist about forgoing dialysis.
“In contrast, most providers felt comfortable discussing CKM; however, none reported working in an environment with a dedicated CKM clinic or protocol,” the authors wrote.
“CKM is a large part of American nephrology practice, and the one that more patients may continue to choose with higher frequency. However, it is a clinical pathway that is understudied, poorly understood, lacks vital resources in its delivery and is heterogeneously implemented,” they added. “Our data suggests the need for a coordinated national effort to better support and to better study providers, patients and health systems who strive to optimally deliver CKM for people with kidney failure.”
Collapse
Read more about
Click Here to Manage Email Alerts