A comparison of treatment options for management of end stage kidney disease in elderly patients: a systematic review

Abstract

The primary objective is to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with end stage kidney disease (ESKD). ESKD is defined as an estimated glomerular filtration rate (eGFR) of less than 15mL/min. Dialysis is defined as either hemodialysis or peritoneal dialysis. Non-dialysis management is also known as conservative management, palliative care and supportive care. More specifically, the sub objectives are to identify: The effects of dialysis on quality of life in elderly patients (65 years and over) with ESKD (<15mL/min) compared with non-dialysis management The effects of dialysis on survival in elderly patients (65 years and over) with ESKD (<15mL/min) compared with non-dialysis management Compare the functional capacity in elderly patients (65 years and over) with ESKD (<15mL/min) on dialysis compared with those on non-dialysis management Compare the symptoms and severity of ESKD (<15mL/min) in patients (65 years and over) on dialysis with that of those receiving non-dialysis management Compare the rate of hospital admissions for those elderly patients (65 years and over) with ESKD (15mL/min) on dialysis with those receiving non-dialysis management. Inclusion criteria Types of participants This review will consider studies that include participants who are 65 years and older. These participants need to have been diagnosed with ESKD for greater than three months and also be either receiving dialysis (hemodialysis or peritoneal dialysis) or non-dialysis management. The settings for the studies would be home, self-care centre, satellite centers, hospital, hospice or nursing homes. Types of intervention(s) This review will consider studies where the intervention is dialysis (peritoneal or hemodialysis) for the participants with ESKD. There is no restriction on frequency of dialysis or length of time the participant receives dialysis. The comparator will be patients who are not undergoing dialysis. Types of outcomes Primary outcomes This review will consider studies that include any of the following outcome measures: • Quality of life (e.g. KDQOL, SF36 , HRQOL), • Co-morbidities (eg. Charlson Comorbidity index ) • Survival, • Functional capacity (eg. Karnofsky Performance score), • Symptoms and severity of ESKD and • Hospital admissions.