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Treatment of end stage kidney failure without renal replacement therapy

Treatment of end stage kidney failure without renal replacement therapy
Treatment of end stage kidney failure without renal replacement therapy
For the majority of patients with end-stage kidney failure (ESKF) replacement of excretory renal function by dialysis or transplantation (RRT) can extend life and alleviate symptoms. Historically, the availability of RRT has been insufficient and this remains the case for much of the world. However, RRT is now widely available in healthcare systems of higher income countries. Increasing numbers of elderly patients are developing ESKF. RRT in this population is largely by dialysis, comorbidity is high and life expectancy short. Evidence of effectiveness coupled with the burden of treatment among these individuals has raised concerns that health services in high-income countries may have moved from an era of unmet need into one of potential over-treatment. Alongside the requirement to make treatment more patient-centered, this has driven the development of comprehensive conservative care as an alternative approach for older comorbid individuals with ESKF, with the potential for acceptable symptom control and reduced treatment burden. This paper provides a largely UK-perspective on treating ESKF without RRT. Emphasis is on the need for high-quality evidence to inform treatment decisions. Complexities of defining, delivering and improving treatment of ESKF without dialysis care are explored. Quantitative and qualitative evidence are summarized and the relationship with palliative and terminal care examined. A framework is suggested for classifying management of ESKF and recommendations made to improve delivery of nondialysis care in the future. For patients with a poor prognosis, such treatment may not result in significantly different survival or quality of life when compared with dialysis. There is a key need to generate the best possible evidence of person-centered health outcomes associated with the various treatment options for ESKF and to present this to patients in a balanced, personalized way that allows them to make the treatment decision most appropriate for them.
0894-0959
491-506
Hole, Barnaby
be254820-f4cb-4082-81c9-5c9f0ad7fa66
Tonkin-Crine, Sarah
65679835-9bdc-48b6-92f3-cc6322cccc4f
Caskey, Fergus J.
028fef54-dffa-460a-98ff-99e90a0d2f56
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a
Hole, Barnaby
be254820-f4cb-4082-81c9-5c9f0ad7fa66
Tonkin-Crine, Sarah
65679835-9bdc-48b6-92f3-cc6322cccc4f
Caskey, Fergus J.
028fef54-dffa-460a-98ff-99e90a0d2f56
Roderick, Paul
dbb3cd11-4c51-4844-982b-0eb30ad5085a

Hole, Barnaby, Tonkin-Crine, Sarah, Caskey, Fergus J. and Roderick, Paul (2016) Treatment of end stage kidney failure without renal replacement therapy. Seminars in Dialysis, 29 (6), 491-506. (doi:10.1111/SDI.12535).

Record type: Article

Abstract

For the majority of patients with end-stage kidney failure (ESKF) replacement of excretory renal function by dialysis or transplantation (RRT) can extend life and alleviate symptoms. Historically, the availability of RRT has been insufficient and this remains the case for much of the world. However, RRT is now widely available in healthcare systems of higher income countries. Increasing numbers of elderly patients are developing ESKF. RRT in this population is largely by dialysis, comorbidity is high and life expectancy short. Evidence of effectiveness coupled with the burden of treatment among these individuals has raised concerns that health services in high-income countries may have moved from an era of unmet need into one of potential over-treatment. Alongside the requirement to make treatment more patient-centered, this has driven the development of comprehensive conservative care as an alternative approach for older comorbid individuals with ESKF, with the potential for acceptable symptom control and reduced treatment burden. This paper provides a largely UK-perspective on treating ESKF without RRT. Emphasis is on the need for high-quality evidence to inform treatment decisions. Complexities of defining, delivering and improving treatment of ESKF without dialysis care are explored. Quantitative and qualitative evidence are summarized and the relationship with palliative and terminal care examined. A framework is suggested for classifying management of ESKF and recommendations made to improve delivery of nondialysis care in the future. For patients with a poor prognosis, such treatment may not result in significantly different survival or quality of life when compared with dialysis. There is a key need to generate the best possible evidence of person-centered health outcomes associated with the various treatment options for ESKF and to present this to patients in a balanced, personalized way that allows them to make the treatment decision most appropriate for them.

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More information

e-pub ahead of print date: 25 August 2016
Published date: November 2016
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 403983
URI: http://eprints.soton.ac.uk/id/eprint/403983
ISSN: 0894-0959
PURE UUID: 97827679-4670-45ec-b295-e3e6672833db
ORCID for Paul Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 19 Dec 2016 11:44
Last modified: 10 Dec 2019 01:55

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Contributors

Author: Barnaby Hole
Author: Sarah Tonkin-Crine
Author: Fergus J. Caskey
Author: Paul Roderick ORCID iD

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