title: Choosing conservative therapy in chronic kidney disease.
abstract: BACKGROUND
  Incidence of use for various renal replacement therapies is well-known, but no data are available on conservative treatment use.
  
  
  OBJECTIVE
  To assess the proportion of patients with chronic kidney failure receiving a conservative treatment.
  
  
  RESULTS
  From July 1, 2013 to June 30, 2014, 232 patients with stage 5 CKD were seen in the Nephrology Department. After having received information on existing therapeutic options and having known the opinion of their treating physicians, 81 patients (35%) selected hemodialysis, 56 (24%) preferred peritoneal dialysis, 5 (2%) selected a preemptive transplant from a living donor, and in 90 (39%) a conservative treatment option was selected. In a univariate analysis using logistic regression, variables associated to a preference for conservative treatment were age, Charlson index excluding age, degree of walking difficulties, and functional dependence level, with the first three factors achieving statistical significance in a multivariate analysis. Presence of a severe disease resulting in a poor prognosis was the main reason for selecting a conservative treatment (49%), with the second one being patient refusal to receive a renal replacement therapy (26%). Mortality rate was 8.2/100 patient-months in conservative therapy group versus 0.6/100 patient-months in patients receiving renal replacement therapy (P<.001). In patients receiving conservative therapy, baseline glomerular filtration rate at the time of study enrollment was the sole variable showing a significant impact on survival.
  
  
  CONCLUSIONS
  About 39% of patients with stage 5 CKD seen over a 1-year period in the Nephrology Department received conservative therapy. Age, co-morbidity, and functional disability were the factors associated to selecting a conservative therapy option.
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España. Electronic address: jteruel.hrc@salud.madrid.org.
authors: José Luis
authors: JL
authors: Teruel
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Víctor
authors: V
authors: Burguera Vion
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Antonio
authors: A
authors: Gomis Couto
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Maite
authors: M
authors: Rivera Gorrín
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Milagros
authors: M
authors: Fernández-Lucas
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Nuria
authors: N
authors: Rodríguez Mendiola
authors: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, España.
authors: Carlos
authors: C
authors: Quereda
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D015897:Comorbidity; D000072700:Conservative Treatment / Q000523:psychology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D057240:Patient Preference; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D012042:Registries; D017582:Renal Replacement Therapy / Q000523:psychology / Q000706:statistics & numerical data; D016312:Treatment Refusal; D055815:Young Adult
keywords: Conservative therapy; Enfermedad renal crónica en estadio 5; Stage 5 chronic kidney disease; Tratamiento conservador