ISN-Cochrane Webinar: Conservative kidney management versus dialysis for stage 5 chronic kidney disease in older people

The prevalence of kidney failure in older people is increasing. However, there is insufficient evidence to determine whether dialysis or conservative kidney management (CKM) is better for this population. 

Twenty-four non-randomised studies (26,127 people ≥65 years with kidney failure) were identified. Most studies were at high or unclear risk of bias for most methodological domains. Compared to dialysis, CKM had uncertain effects on death and cardiovascular death. For health-related quality of life, the Physical and Mental Component Summary scores were lower with CKM compared with dialysis.

Learning objectives:

• Understand the benefits and harms of conservative kidney management versus dialysis for older people with kidney failure.
• Understand how the findings of this review inform >span class="s22">clinical management of older people with kidney failure.
• What are the implications for future research to guide clinical management of older people with kidney failure?

Further reading:

• Farrington_K, Covic_A, Nistor_I, Aucella_F, Clyne_N, De Vos_L, et al. Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR < 45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group. Nephrology Dialysis Transplantation. 2017;32(1):9–16.
• Davison_SN, Pommer_W, Brown_MA, Douglas_CA, Gelfand_SL, Gueco_IP, et al. Conservative kidney management and kidney supportive care: core components of integrated care for people with kidney failure. Kidney International. 2024;105(1):35–45.
• Murtagh_FE, Burns_A, Moranne_O, Morton_RL, Naicker_S. Supportive care: comprehensive conservative care in end-stage kidney disease. Clinical Journal of the American Society of Nephrology. 2016;11(10):1909–1914.
• Voorend_CG, van_Oevelen_M, Verberne_WR, van_den_Wittenboer_ID, Dekkers_OM, Dekker_F, et al. Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis. Nephrology Dialysis Transplantation. 2022;37(8):1529–1544.
• Foote_C, Kotwal_S, Gallagher_M, Cass_A, Brown_M, Jardine_M. Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: a systematic review and meta-analysis. Nephrology. 2016;21(3):241–253.
• Reindl-Schwaighofer_R, Kainz_A, Kammer_M, Dumfarth_A, Oberbauer_R. Survival analysis of conservative vs. dialysis treatment of elderly patients with CKD stage 5. PLoS ONE [Electronic Resource]. 2017;12(7):e0181345.
• Raman_M, Middleton_RJ, Kalra_PA, Green_D. Outcomes in dialysis versus conservative care for older patients: a prospective cohort analysis of stage 5 chronic kidney disease. PLoS ONE [Electronic Resource]. 2019;13(10):e0206469.