Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study

• Published in: BMC nephrology 2018-08, Vol.19 (1), p.205-205, Article 205
• Main Authors: Verberne, Wouter R, Dijkers, Janneke, Kelder, Johannes C, Geers, Anthonius B M, Jellema, Wilbert T, Vincent, Hieronymus H, van Delden, Johannes J M, Bos, Willem Jan W
• Format: Article
• Language: English
• Subjects: Aged; Aged patients; Aged, 80 and over; Analysis; Care and treatment; Chronic kidney failure; Cohort analysis; Cohort Studies; Comorbidity; Confidence intervals; Conservative treatment; Conservative Treatment - economics; Conservative Treatment - methods; Costs; Cross-Sectional Studies; Decision making; Dialysis; End-stage renal disease (ESRD); Female; Frailty; Health aspects; Humans; Kidney diseases; Male; Medical care; Medical prognosis; Mental disorders; Nephrology; Netherlands - epidemiology; Patients; Peritoneal dialysis; Quality management; Quality of Life; Renal dialysis; Renal Dialysis - economics; Renal Dialysis - methods; Renal Insufficiency, Chronic - economics; Renal Insufficiency, Chronic - epidemiology; Renal Insufficiency, Chronic - therapy; Retrospective Studies; Studies; Survival; Survival analysis; Teaching hospitals; Transplants & implants; Value-Based Health Insurance
• ISSN: 1471-2369; 1471-2369
• DOI: 10.1186/s12882-018-1004-4

Conservative care is argued to be a reasonable treatment alternative for dialysis in older patients with advanced chronic kidney disease (CKD). However, comparisons are scarce and generally focus on survival only. Comparative data on more patient-relevant outcomes are needed to truly foster shared decision-making on an individual level, and cost comparison is needed to assess value of care. We conducted a retrospective observational single-center cohort study in 366 patients aged ≥70 years with advanced CKD, who chose dialysis (n = 240) or conservative care (n = 126) after careful counselling by a multidisciplinary team in a non-academic teaching hospital in The Netherlands. Using a value-based health care approach (value = outcomes/cost): survival, health-related quality of life-cross-sectionally assessed with the Kidney Disease Quality of Life Short Form™-treatment burden, and treatment costs were evaluated. The overall survival benefit of patients on a dialysis pathway compared with patients on conservative care diminished or lost significance in patients aged ≥80 years or with severe comorbidity. There were no differences between patients managed conservatively and dialysis patients on physical and mental health summary scores (all P > 0.1). Patients on conservative care had 352.7 hospital free days per year versus 282.7 in patients on a dialysis pathway, calculated from treatment decision (adjusted incidence rate ratio: 1.15, 95% confidence interval: 1.09 to 1.21, P