title: Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy.
abstract: BACKGROUND
  Elderly patients with end-stage renal disease and severe extra-renal comorbidity have a poor prognosis on renal replacement therapy (RRT) and may opt to be managed conservatively (CM). Information on the survival of patients on this mode of therapy is limited.
  
  
  METHODS
  We studied survival in a large cohort of CM patients in comparison to patients who received RRT.
  
  
  RESULTS
  Over an 18-year period, we studied 844 patients, 689 (82%) of whom had been treated by RRT and 155 (18%) were CM. CM patients were older and a greater proportion had high comorbidity. Median survival from entry into stage 5 chronic kidney disease was less in CM than in RRT (21.2 vs 67.1 months: P < 0.001). However, in patients aged > 75 years when corrected for age, high comorbidity and diabetes, the survival advantage from RRT was ~ 4 months, which was not statistically significant. Increasing age, the presence of high comorbidity and the presence of diabetes were independent determinants of poorer survival in RRT patients. In CM patients, however, age > 75 years and female gender independently predicted better survival.
  
  
  CONCLUSIONS
  In patients aged > 75 years with high extra-renal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Age > 75 years and female gender predicted better survival in CM patients. The reasons for this are unclear.
authors.affiliation: Renal Unit, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK. shahid.chandna@nhs.net
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Chandna
authors.forename: Maria
authors.initials: M
authors.lastname: Da Silva-Gane
authors.forename: Catherine
authors.initials: C
authors.lastname: Marshall
authors.forename: Paul
authors.initials: P
authors.lastname: Warwicker
authors.forename: Roger N
authors.initials: RN
authors.lastname: Greenwood
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012307:Risk Factors; D015996:Survival Rate