title: Trajectory of quality of life for poor prognosis stage 5D chronic kidney disease with and without dialysis.
abstract: BACKGROUND
  Renal replacement therapy (RRT) has not always been shown to benefit end-stage renal failure patients who are elderly or have multiple comorbidities in terms of survival or symptom control. Conservative management may be a viable alternative offering comparable health-related quality of life.
  
  
  METHODS
  This is a prospective observational study of 101 patients who reached an estimated glomerular filtration rate of 8-12 ml/min and were either ≥75 years old or had an age-adjusted Charlson Comorbidity Index ≥8. Patients were all initially on conservative management; 38 later commenced renal replacement therapy while the rest remained conservatively managed. The Kidney Disease Quality of Life-Short Form was assessed at baseline and various scheduled time points over 24 months. The mixed model methodology was used to estimate the quality of life patterns and adjust for covariates.
  
  
  RESULTS
  In the conservative management group, the Physical Component Summary and Mental Component Summary scores were stable and showed no significantly different trajectories from the RRT group (both p > 0.05). Though RRT was associated with an improvement in the Cognitive Function Scale score, it was also associated with worse scores on the Effect of Kidney Disease and Burden of Kidney Disease Scale scores.
  
  
  CONCLUSIONS
  RRT does not improve health-related quality of life of end-stage kidney failure patients who are elderly or have a high comorbidity burden.
authors: Khoo Teck Phuat Hospital, Singapore, Singapore. yingseow@gmail.com
authors: Ying-Ying
authors: YY
authors: Seow
authors: Yin Bun
authors: YB
authors: Cheung
authors: Li Min
authors: LM
authors: Qu
authors: Alethea Chung Pheng
authors: AC
authors: Yee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology*; D012720:Severity of Illness Index