The value of dialysis and conservative care for older patients with advanced chronic kidney disease

Author(s):
Verberne, W.R.
Published
2021
Publication type
Doctoral Thesis

Abstract

The main objective of this thesis was to determine the value of dialysis and conservative care for older patients with advanced chronic kidney disease. To do so, we compared a combination of patient-relevant outcomes and treatment costs in a cohort of older patients (≥70 years old) who chose either dialysis or conservative care after a shared decision-making process. Overall, we observed that older patients who chose dialysis lived longer compared with older patients who chose conservative care. There was, however, little or no significant survival advantage in patients aged ≥80 years old and patients aged ≥70 years old with severe comorbidity who chose dialysis over conservative care, while similar outcomes on quality of life and symptoms were observed between both patient groups, and lower treatment burden and treatment costs were observed in patients who chose conservative care. Therefore, we conclude that conservative care is a viable treatment alternative to dialysis in selected older patients. In clinical practice, conservative care needs to become available and openly discussed as one of the possible treatment pathways for advanced chronic kidney disease in older patients. Moreover, a shift towards a person-centered process of shared decision-making is needed that aims to focus on all that matters to the patient as person, in order to come to a treatment plan that fits best with the patient.

Chronic kidney diseaseOlder adultsDialysisConservative careShared decision makingSurvivalHealth-related quality of lifeValue-based healthcarePerson-centered care
Defense date
2021-10-14
Language
English
Supervisor(s)
Bos, W.J.W.; Delden, J.J.M. van
Committee member(s)
Rabelink, A.J.; Biesma, D.H.; Verhaar, M.C.; Emmelot-Vonk, M.H.
Qualification
Ph.D.
Degree granting institution
Faculty of Medicine, Leiden University Medical Center [LUMC], Leiden University, Leiden
hdl
1887/3217180
ISBN(s)
9789464213966

Funding

Sponsorship
Financial support for the research described in this thesis was kindly provided by the St. Antonius Research Fund; Maatschap Internal Medicine of St. Antonius Hospital; Roche; and Zilveren Kruis. The ICHOM project described in Chapter 2 was funded by the Agency for Clinical Innovation (Australia); Providence Health and Services (USA); European Renal Care Providers Association (Belgium); Santeon (Netherlands); and the Dutch Kidney Foundation.