CKD Conservative care and preparation for dialysis - UK ：CKD患者保守治疗和准备透析英国.ppt

In a retrospective study in four major renal units in the South Thames Region, In CKD stage 5 patients over 75 years, the survival advantage of dialysis is substantially lost in those patients with high comorbidity and ischaemic heart disease in particular. The Royal Free Hospital data: prospective study design, Patients in this study was slightly younger and they looked at all patients 70 year, Dialysis prolongs survival for elderly patients who have ESRD with significant comorbidity by approximately 2 yr; but allowing for admissions, dialysis sessions, transport and post dialysis recovery they spent 47.5% of days survived in hospital. Those on conservative care spent on average 4.3% of days survived in hospital Dr Farrington group from Stevenage: In patients aged 75 years with high extrarenal comorbidity, the survival advantage conferred by RRT over CM is likely to be small. Corrected for age, presence of high comorbidity and diabetes survival avantage only 4 mo (not statistically signinficant) Age 75 years and female gender predicted better survival in CM patients. The reasons for this are unclear. * * ? Rational treatment, not rationing– Needs at the very least, robust and generalizable evidence ‐ population‐based evidence better Renal registries have focused on those who do receive renal replacement therapy, not those who don’t ? Service‐based evidence– Limitations ? Little or no population based evidence on conservatively‐managed * CKD data Need to know the denominator with CKD stage 5 to understand conservative and withdrawal issues to allow adjustment for survival and other outcomes Unreferred CKD John et al AJKD 2004;43:825-835 East Kent - Population 688,193 Lower eGFR in unreferred: 23.4 ml/min/1.73m2 (range 4.8-39.8) in unreferred vs. 28.5 ml/min/1.73m2 (range 4.1-42.8) in those known Spectrum Maximum conservative management: full MDT member and very frequent engagement with renal unit Moderate: outpatient managed (less than full MDT) CKM Minimal