No clear winner between kidney care plans for older adults
Life-years adjusted for health-related quality of life averaged 1.354 with planned care without dialysis versus 1.472 with dialysis preparation over 4.5 years’ average follow-up.
Our read
Interventions- Studied:
- Randomized trial in 445 older adults with kidney failure, against people preparing for renal dialysis
- What changed:
- Life-years adjusted for quality of life were similar: 1·354 with nondialysis preparation versus 1·472 with dialysis preparation
- The catch:
- Knowing the assigned care plan could influence patients' reported quality of life
- In the record:
- The 4th paper on conservative kidney management with results in people; 11 on record in all.
Editor of record: Boris Djordjevic · AgingResearch.News
The 445 UK adults with kidney failure in this randomized trial had a median age of 82; 137 were women. Participants were at least 80, or 65–79 with frailty or multiple illnesses. They prepared either for dialysis, a procedure that filters the blood, or for care focused on managing symptoms, slowing disease progression and preserving quality of life without dialysis or transplantation.
Neither plan showed superiority on a measure combining lifespan and health-related quality of life. Hospital admission rates were similar. Complications involving access sites used for dialysis were less frequent with care planned without dialysis (adjusted rate ratio 0.41; 74 events in 36 people overall). Serious adverse events totaled 667 versus 578 with dialysis preparation. These included 157 deaths (69%) and 510 hospital admissions versus 136 deaths (63%) and 442 admissions, respectively.
Why it matters
Kidney failure in later life raises choices about balancing survival with quality of life. The comparison offers evidence to guide decisions about whether to prepare for dialysis.
Caveats
Participants and clinicians knew the assigned care plan, and specific harm outcomes were not prespecified. The trial did not cover adults under 65 or those aged 65–79 without frailty or multiple illnesses.
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