For some individuals with advanced kidney disease, dialysis might not be the optimal treatment strategy for his or her condition, and these patients could also be higher served with conservative non-dialytic management that focuses on quality of life and symptom control. Investigators recently examined the differential impact of conservative management vs. dialysis on hospitalization outcomes across various racial/ethnic groups in a big national cohort of patients with advanced kidney disease. The research can be presented at ASN Kidney Week 2022 November 3–November 6.

On this study, the investigators compared hospitalization rates amongst 309,188 patients with advanced kidney disease who were treated with conservative management or dialysis over the period of 2007–2020. During follow-up, 55% of patients had 1 or more hospitalizations, and essentially the most common causes of hospitalization in each groups were related to congestive heart failure/fluid overload, respiratory problems, or hypertension.

In Non-Hispanic White, Non-Hispanic Black, and Hispanic patients, patients on dialysis had higher hospitalization rates than those that received conservative management, and patients who began dialysis early (transitioned to dialysis at higher levels of kidney function) demonstrated the very best rates across all age groups when put next with those that began dialysis late (transitioned to dialysis at lower levels of kidney function) or were treated with conservative management. Amongst Asian patients, those on dialysis also had higher hospitalization rates than those receiving conservative management, but patients who began dialysis late had higher rates than those on early dialysis, especially in older age groups.


“There was growing recognition of the importance of conservative non-dialytic management in its place patient-centered treatment strategy for advanced kidney disease. Nonetheless, conservative management stays under-utilized within the US, which can partly be because of uncertainties regarding which patients will most profit from dialysis vs. non-dialytic treatment,” said corresponding creator Connie Rhee, MD, of the University of California, Irvine. “We hope that these findings and further research may help inform treatment options for patients, care partners, and providers within the shared decision-making strategy of conservative management vs. dialysis.”

Source:

American Society of Nephrology