Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study
Abstract Background 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 t...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-018-1004-4 |
| _version_ | 1818249174237315072 |
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| author | Wouter R. Verberne Janneke Dijkers Johannes C. Kelder Anthonius B. M. Geers Wilbert T. Jellema Hieronymus H. Vincent Johannes J. M. van Delden Willem Jan W. Bos |
| author_facet | Wouter R. Verberne Janneke Dijkers Johannes C. Kelder Anthonius B. M. Geers Wilbert T. Jellema Hieronymus H. Vincent Johannes J. M. van Delden Willem Jan W. Bos |
| author_sort | Wouter R. Verberne |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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. Results 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). Conclusions 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. |
| first_indexed | 2024-12-12T15:32:18Z |
| format | Article |
| id | doaj.art-808df5e1875a41df982c65775f298669 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-12T15:32:18Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-808df5e1875a41df982c65775f2986692022-12-22T00:20:05ZengBMCBMC Nephrology1471-23692018-08-0119111110.1186/s12882-018-1004-4Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort studyWouter R. Verberne0Janneke Dijkers1Johannes C. Kelder2Anthonius B. M. Geers3Wilbert T. Jellema4Hieronymus H. Vincent5Johannes J. M. van Delden6Willem Jan W. Bos7Department of Internal Medicine, St Antonius HospitalDepartment of Internal Medicine, St Antonius HospitalDepartment of Clinical Epidemiology and Medical Statistics, St Antonius HospitalDepartment of Internal Medicine, St Antonius HospitalDepartment of Internal Medicine, St Antonius HospitalDepartment of Internal Medicine, St Antonius HospitalUniversity Medical Centre Utrecht, Julius Centre for Health Sciences and Primary CareDepartment of Internal Medicine, St Antonius HospitalAbstract Background 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. Methods 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. Results 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). Conclusions 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.http://link.springer.com/article/10.1186/s12882-018-1004-4AgedChronic kidney failureEnd-stage renal disease (ESRD)Renal dialysisConservative treatment |
| spellingShingle | Wouter R. Verberne Janneke Dijkers Johannes C. Kelder Anthonius B. M. Geers Wilbert T. Jellema Hieronymus H. Vincent Johannes J. M. van Delden Willem Jan W. Bos Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study BMC Nephrology Aged Chronic kidney failure End-stage renal disease (ESRD) Renal dialysis Conservative treatment |
| title | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
| title_full | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
| title_fullStr | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
| title_full_unstemmed | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
| title_short | Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study |
| title_sort | value based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease a cohort study |
| topic | Aged Chronic kidney failure End-stage renal disease (ESRD) Renal dialysis Conservative treatment |
| url | http://link.springer.com/article/10.1186/s12882-018-1004-4 |
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