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Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study
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 d...
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| Published in: | BMC nephrology 2018-08, Vol.19 (1), p.205-205, Article 205 |
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| creator | 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 |
| description | 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 |
| doi_str_mv | 10.1186/s12882-018-1004-4 |
| format | article |
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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 < 0.001). Annual treatment costs were lower in patients on conservative care (adjusted cost ratio: 0.43, 95% confidence interval: 0.28 to 0.67, P < 0.001).
In this study, conservative care is shown to be a viable treatment option in older patients with advanced CKD, particularly in the oldest old and those with severe comorbidity. By achieving similar outcomes at lower treatment burden and treatment costs, value was generated for older patients choosing conservative care and society.</description><identifier>ISSN: 1471-2369</identifier><identifier>EISSN: 1471-2369</identifier><identifier>DOI: 10.1186/s12882-018-1004-4</identifier><identifier>PMID: 30115028</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>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</subject><ispartof>BMC nephrology, 2018-08, Vol.19 (1), p.205-205, Article 205</ispartof><rights>COPYRIGHT 2018 BioMed Central Ltd.</rights><rights>Copyright © 2018. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s). 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c560t-899bf5b8ed9c8ec81a8de391dd1f5c147f68ff26df5d1f2371baa75ffcdaa3fd3</citedby><cites>FETCH-LOGICAL-c560t-899bf5b8ed9c8ec81a8de391dd1f5c147f68ff26df5d1f2371baa75ffcdaa3fd3</cites><orcidid>0000-0003-4262-7162</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097302/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2089837907?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30115028$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Verberne, Wouter R</creatorcontrib><creatorcontrib>Dijkers, Janneke</creatorcontrib><creatorcontrib>Kelder, Johannes C</creatorcontrib><creatorcontrib>Geers, Anthonius B M</creatorcontrib><creatorcontrib>Jellema, Wilbert T</creatorcontrib><creatorcontrib>Vincent, Hieronymus H</creatorcontrib><creatorcontrib>van Delden, Johannes J M</creatorcontrib><creatorcontrib>Bos, Willem Jan W</creatorcontrib><title>Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study</title><title>BMC nephrology</title><addtitle>BMC Nephrol</addtitle><description>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 < 0.001). Annual treatment costs were lower in patients on conservative care (adjusted cost ratio: 0.43, 95% confidence interval: 0.28 to 0.67, P < 0.001).
In this study, conservative care is shown to be a viable treatment option in older patients with advanced CKD, particularly in the oldest old and those with severe comorbidity. By achieving similar outcomes at lower treatment burden and treatment costs, value was generated for older patients choosing conservative care and society.</description><subject>Aged</subject><subject>Aged patients</subject><subject>Aged, 80 and over</subject><subject>Analysis</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Confidence intervals</subject><subject>Conservative treatment</subject><subject>Conservative Treatment - economics</subject><subject>Conservative Treatment - methods</subject><subject>Costs</subject><subject>Cross-Sectional Studies</subject><subject>Decision making</subject><subject>Dialysis</subject><subject>End-stage renal disease (ESRD)</subject><subject>Female</subject><subject>Frailty</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medical care</subject><subject>Medical prognosis</subject><subject>Mental disorders</subject><subject>Nephrology</subject><subject>Netherlands - epidemiology</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Quality management</subject><subject>Quality of Life</subject><subject>Renal dialysis</subject><subject>Renal Dialysis - economics</subject><subject>Renal Dialysis - methods</subject><subject>Renal Insufficiency, Chronic - economics</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>Retrospective Studies</subject><subject>Studies</subject><subject>Survival</subject><subject>Survival analysis</subject><subject>Teaching hospitals</subject><subject>Transplants & implants</subject><subject>Value-Based Health Insurance</subject><issn>1471-2369</issn><issn>1471-2369</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkkFvFCEUxydGY2v1A3gxJF68TAVmGMCDSdNYbdLEi3olLDx2WWeHFWbG7NVP3rdurV1jOACP__u9vMe_ql4yes6Y6t4WxpXiNWWqZpS2dfuoOmWtZDVvOv34wfmkelbKmlImVUufVicNZUxQrk6rX99sP0G9sAU8gRkvdoxpICkQH22_K7GQGXKZCnFpKJBnfJ-BOJuBRNT1HjLZYhCGsZCfcVwR62c7OOS5VU5DdOR79APsEFgA67wjFlmrlEdSxsnvnldPgu0LvLjbz6qvVx--XH6qbz5_vL68uKmd6OhYK60XQSwUeO0UOMWs8tBo5j0LwmGroVMh8M4HgRHeSLawVooQnLe2Cb45q64PXJ_s2mxz3Ni8M8lG8zuQ8tLYPEbXg1FUIQaYksK2zAetuOuERBrXqus0st4fWNtpsQHvsPls-yPo8csQV2aZZtNRLRvKEfDmDpDTjwnKaDaxOOh7O0CaiuFUaSUkFy1KX_8jXacpDziqg6qRmsq_qqXFBuIQEtZ1e6i5EKLTWlK5Z53_R4XLwybiB0OIGD9KYIcEl1MpGcJ9j4yavQnNwYQGTWj2JjT7nFcPh3Of8cd1zS1zBdm2</recordid><startdate>20180816</startdate><enddate>20180816</enddate><creator>Verberne, Wouter R</creator><creator>Dijkers, Janneke</creator><creator>Kelder, Johannes C</creator><creator>Geers, Anthonius B M</creator><creator>Jellema, Wilbert T</creator><creator>Vincent, Hieronymus H</creator><creator>van Delden, Johannes J M</creator><creator>Bos, Willem Jan W</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-4262-7162</orcidid></search><sort><creationdate>20180816</creationdate><title>Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c560t-899bf5b8ed9c8ec81a8de391dd1f5c147f68ff26df5d1f2371baa75ffcdaa3fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aged</topic><topic>Aged patients</topic><topic>Aged, 80 and over</topic><topic>Analysis</topic><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>Cohort analysis</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Confidence intervals</topic><topic>Conservative treatment</topic><topic>Conservative Treatment - economics</topic><topic>Conservative Treatment - methods</topic><topic>Costs</topic><topic>Cross-Sectional Studies</topic><topic>Decision making</topic><topic>Dialysis</topic><topic>End-stage renal disease (ESRD)</topic><topic>Female</topic><topic>Frailty</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Medical care</topic><topic>Medical prognosis</topic><topic>Mental disorders</topic><topic>Nephrology</topic><topic>Netherlands - epidemiology</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Quality management</topic><topic>Quality of Life</topic><topic>Renal dialysis</topic><topic>Renal Dialysis - economics</topic><topic>Renal Dialysis - methods</topic><topic>Renal Insufficiency, Chronic - economics</topic><topic>Renal Insufficiency, Chronic - epidemiology</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>Retrospective Studies</topic><topic>Studies</topic><topic>Survival</topic><topic>Survival analysis</topic><topic>Teaching hospitals</topic><topic>Transplants & implants</topic><topic>Value-Based Health Insurance</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Verberne, Wouter R</creatorcontrib><creatorcontrib>Dijkers, Janneke</creatorcontrib><creatorcontrib>Kelder, Johannes C</creatorcontrib><creatorcontrib>Geers, Anthonius B M</creatorcontrib><creatorcontrib>Jellema, Wilbert T</creatorcontrib><creatorcontrib>Vincent, Hieronymus H</creatorcontrib><creatorcontrib>van Delden, Johannes J M</creatorcontrib><creatorcontrib>Bos, Willem Jan W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>BMC nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Verberne, Wouter R</au><au>Dijkers, Janneke</au><au>Kelder, Johannes C</au><au>Geers, Anthonius B M</au><au>Jellema, Wilbert T</au><au>Vincent, Hieronymus H</au><au>van Delden, Johannes J M</au><au>Bos, Willem Jan W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study</atitle><jtitle>BMC nephrology</jtitle><addtitle>BMC Nephrol</addtitle><date>2018-08-16</date><risdate>2018</risdate><volume>19</volume><issue>1</issue><spage>205</spage><epage>205</epage><pages>205-205</pages><artnum>205</artnum><issn>1471-2369</issn><eissn>1471-2369</eissn><abstract>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 < 0.001). Annual treatment costs were lower in patients on conservative care (adjusted cost ratio: 0.43, 95% confidence interval: 0.28 to 0.67, P < 0.001).
In this study, conservative care is shown to be a viable treatment option in older patients with advanced CKD, particularly in the oldest old and those with severe comorbidity. By achieving similar outcomes at lower treatment burden and treatment costs, value was generated for older patients choosing conservative care and society.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>30115028</pmid><doi>10.1186/s12882-018-1004-4</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0003-4262-7162</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC nephrology, 2018-08, Vol.19 (1), p.205-205, Article 205 |
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| source | Publicly Available Content Database; PubMed Central |
| 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 |
| title | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
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