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Am J Kidney Dis. 2012 Mar;59(3):419-27. doi: 10.1053/j.ajkd.2011.08.024. Epub 2011 Oct 20.

Patients who plan for conservative care rather than dialysis: a national observational study in Australia.

Author information

1
School of Public Health, The University of Sydney, Australia. rachael.morton@sydney.edu.au

Abstract

BACKGROUND:

It is unclear how many incident patients with stage 5 chronic kidney disease (CKD) referred to nephrologists are presented with information about conservative care as a treatment option and how many plan not to dialyze.

STUDY DESIGN:

National observational survey study with random-effects logistic regression.

SETTING & PARTICIPANTS:

Incident adult and pediatric pre-emptive transplant, dialysis, and conservative-care patients from public and private renal units in Australia, July to September 2009.

PREDICTORS:

Age, sex, health insurance status, language, time known to nephrologist, timing of information, presence of caregiver, unit conservative care pathway, and size of unit.

OUTCOMES & MEASUREMENTS:

The 2 main outcome measures were information provision to incident patients about conservative care and initial treatment regardless of planned conservative care.

RESULTS:

66 of 73 renal units (90%) participated. 10 (15%) had a formal conservative-care pathway. Of 721 incident patients with stage 5 CKD, 470 (65%) were presented with conservative care as a treatment option and 102 (14%) planned not to dialyze; median age was 80 years. Multivariate analysis for information provision showed that patients older than 65 years (OR, 3.40; 95% CI, 1.97-5.87) and those known to a nephrologist for more than 3 months (OR, 6.50; 95% CI, 3.18-13.30) were more likely to receive information about conservative care. Patients with conservative care as planned initial treatment were more likely to be older than 65 years (OR, 4.71; 95% CI, 1.77-12.49) and women (OR, 2.23; 95% CI, 1.23-4.02) than those who started dialysis therapy. Those with private health insurance were less likely to forgo dialysis therapy (OR, 0.40; 95% CI, 0.17-0.98).

LIMITATIONS:

Cross-sectional design prohibited longer term outcome measurement. Excluded patients with stage 5 CKD managed in the community.

CONCLUSIONS:

1 in 7 patients with stage 5 CKD referred to nephrologists plans not to dialyze. Comprehensive service provision with integrated palliative care needs to be improved to meet the demands of the aging population.

PMID:
22014401
DOI:
10.1053/j.ajkd.2011.08.024
[Indexed for MEDLINE]

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