Premium
Survival outcomes of supportive care versus dialysis therapies for elderly patients with end‐stage kidney disease: A systematic review and meta‐analysis
Author(s) -
Foote Celine,
Kotwal Sradha,
Gallagher Martin,
Cass Alan,
Brown Mark,
Jardine Meg
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12586
Subject(s) - medicine , end stage kidney disease , meta analysis , dialysis , end stage renal disease , intensive care medicine , stage (stratigraphy) , disease , kidney disease , paleontology , biology
Aim Elderly people comprise a large and growing proportion of the global dialysis population. Regional differences in rates of dialysis in the elderly suggest multiple factors influence treatment decision‐making including beliefs about the relative benefits and harms of dialysis and supportive (non‐dialysis) care. We therefore systematically reviewed the literature reporting survival of elderly patients treated with either treatment pathway. Methods Systematic review and meta‐analysis of cohort studies or randomized controlled trials identified in MEDLINE , EMBASE and the C ochrane C entral R egister of C ontrolled T rials published before J uly 2014. Survival by treatment modality was calculated. Subgroup analyses by study design, study size, patient age and cohort era were conducted. Results Eighty‐nine studies published between 1976 and 2014 reported on 294 921 elderly end‐stage kidney disease ( ESKD ) patients. There was a paucity of data for supportive care (724 patients or 0.2% of the total patients) and supportive care studies were susceptible to lead‐time bias. One‐year survival for elderly patients treated with undifferentiated dialysis was 73.0% (95% confidence interval ( CI ) 66.3–79.7%), 78.4% (95% CI 75.2–81.6) for haemodialysis and 77.9% (95% CI 73.8–81.9) for peritoneal dialysis. Supportive care patients had a 1‐year survival of 70.6% (95% CI 63.3–78.0%). Residual heterogeneity remained within individual treatment modalities despite subgroup analyses. Conclusions While the available literature demonstrates a broadly similar 1‐year survival in elderly ESKD patients, it does not allow a confident estimate of the relative survival benefits of dialysis or supportive care. This uncertainty needs urgent attendance by further prospective data, which avoid bias and allow comparisons of quality of life and survival.