title: Stage 5-CKD under nephrology care: to dialyze or not to dialyze, that is the question.
abstract: Appropriate timing of starting chronic dialysis in patients with advanced chronic kidney disease (CKD) under nephrology care still is undefined. We systematically reviewed the most recent studies that have compared outcomes of stage 5-CKD under conservative versus substitutive treatment. Eleven studies, most in elderly patients, were identified. Results indicate no advantage of dialysis over conservative management in terms of survival, hospitalization or quality of life. This information is integrated with a case report on a middle-aged CKD patient followed in our clinic who has remained for 15 years in stage 5 despite severe disease. The patient is a diabetic woman who underwent right nephrectomy in 1994 because of renal tuberculosis. In 1999, she commenced regular nephrology care in our clinic and, since 2000, when she was 53 years old, her estimated glomerular filtration rate (eGFR) has been ≤15 ml/min/1.73 m(2). Over the last decade, despite, several episodes of acute kidney injury and placement of permanent percutaneous nephrostomy in 2001, renal function has remained remarkably stable, though severely impaired (eGFR 7.7-5.6 ml/min/1.73 m(2)). Our systematic analysis of the literature and this case report highlight the need for further studies, not limited exclusively to elderly patients, to verify the efficacy of non-dialysis treatment in stage 5-CKD patients. Meanwhile, nephrologists may consider that their intervention can safely prolong for several years the dialysis-free condition in ESRD independently of age.
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pacilio
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Minutolo
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Garofalo
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Liberti
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Conte
authors.affiliation: Nephrology Division, Second University of Naples-Med School, S.M.d.P Incurabili Hospital, Via Maria Longo 50, 80138, Naples, Italy. luca.denicola@unina2.it.
authors.forename: Luca
authors.initials: L
authors.lastname: De Nicola
mesh_terms: D000368:Aged; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D018579:Patient Selection; D006435:Renal Dialysis / Q000009:adverse effects; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: CKD; Case report; Diabetic kidney disease; Nephrology care; Proteinuria; Systematic review