Prolonged conservative treatment for frail elderly patients with end-stage renal disease: the Verona experience.
BACKGROUND
In frail elderly patients, the chronic use of renal replacement therapy sometimes affords no tangible benefits and may even negatively affect their quality of life (Qol), making prolonged conservative management a reasonable option.


METHODS
This observational, uncontrolled study was conducted on 11 end-stage renal disease patients over 75 years of age, on prolonged conservative treatment with a follow-up of at least 6 months, to assess compliance with the Italian clinical guidelines concerning the treatment of renal failure, comorbidities, hospital stays, and several psychometric and Qol indicators in the patients and their caregivers.


RESULTS
We found a substantial compliance with the targets recommended in the guidelines, a moderate tendency for disease progression and satisfactory psychometric and Qol parameters, which proved much the same as those observed in a parallel (uncontrolled) group of patients on haemodialysis.


CONCLUSIONS
Our study shows that a conservative strategy is feasible for frail uraemic patients, achieving acceptable clinical results and a Qol comparable with patients on haemodialysis. The study also provides indications on how to plan trials on this topic, to obtain the evidence needed to guide the difficult choice of whether to recommend dialysis or conservative treatment for such frail patients.
De Biase
Vincenzo
V
Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy.
Tobaldini
Olga
O
Boaretti
Claudia
C
Abaterusso
Cataldo
C
Pertica
Nicoletta
N
Loschiavo
Carmelo
C
Trabucco
Gaetano
G
Lupo
Antonio
A
Gambaro
Giovanni
G
D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000627:therapeutic use*; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D005665:Furosemide / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D007902:Length of Stay / Q000639:trends; D008297:Male; D009017:Morbidity / Q000639:trends; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
D004232:Diuretics; D004921:Erythropoietin; D005665:Furosemide