title: Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis.
abstract: OBJECTIVE
  Benefits of dialysis in elderly dependent patients are not clearcut. Some patients forego dialysis, opting for conservative kidney management (CKM). This study prospectively compared quality of life and survival in CKM patients and those opting for dialysis.
  
  
  METHODS
  Quality-of-life assessments (Short-Form 36, Hospital Anxiety and Depression Scale, and Satisfaction with Life Scale) were performed every 3 months for up to 3 years in patients with advanced, progressive CKD (late stage 4 and stage 5).
  
  
  RESULTS
  After 3 years, 80 and 44 of 170 patients had started or were planned for hemodialysis (HD) or peritoneal dialysis, respectively; 30 were undergoing CKM; and 16 remained undecided. Mean baseline estimated GFR ± SD was similar (14.0 ± 4.0 ml/min per 1.73 m(2)) in all groups but was slightly higher in undecided patients. CKM patients were older, more dependent, and more highly comorbid; had poorer physical health; and had higher anxiety levels than the dialysis patients. Mental health, depression, and life satisfaction scores were similar. Multilevel growth models demonstrated no serial change in quality-of-life measures except life satisfaction, which decreased significantly after dialysis initiation and remained stable in CKM. In Cox models controlling for comorbidity, Karnofsky performance scale score, age, physical health score, and propensity score, median survival from recruitment was 1317 days in HD patients (mean of 326 dialysis sessions) and 913 days in CKM patients.
  
  
  CONCLUSIONS
  Patients choosing CKM maintained quality of life. Adjusted median survival from recruitment was 13 months shorter for CKM patients than HD patients.
authors.affiliation: Lister Renal Unit, Stevenage, Herts, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Da Silva-Gane
authors.forename: David
authors.initials: D
authors.lastname: Wellsted
authors.forename: Hannah
authors.initials: H
authors.lastname: Greenshields
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.forename: Shahid M
authors.initials: SM
authors.lastname: Chandna
authors.forename: Ken
authors.initials: K
authors.lastname: Farrington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000523:psychology; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*; D018709:Statistics, Nonparametric; D013997:Time Factors