IN THE NEWS: Conservative management in CKD, and no dialysis

A recent study published in a non nephrology journal highlights a critical point that is often missed by nephrologists. Although there is data coming out from prior studies that conservative management might be better for certain groups of patients then offering dialysis, more studies need to confirm this. This study is a retrospective observational study that looked at conservative management vs offering dialysis.

Some key points

1. The renal replacement therapy group survived for longer when survival was taken from the time estimated glomerular filtration rate at different GFRs.
2. When factors influencing survival were stratified for both groups independently, renal replacement therapy failed to show a survival advantage over conservative management, in patients older than 80 years or with a World Health Organization performance score of 3 or more. 

3. Acute hospitalizations were more in the RRT arm

4.Seventy-six percent of the conservative management group accessed community palliative care services compared to 0% of renal replacement therapy patients ( THIS is a striking number).

I would urge all to read the renal physician associations statements regarding palliative care in nephrology.

http://onlinelibrary.wiley.com/doi/10.1111/nep.12064/abstract
ASN had a series of videos on this topic as well.
Finally, a nice blog post on GeriPal on this topic on HD patients.

Image source: www.gloryhpc.com