Survival Outcomes in Patients with End-Stage Kidney Disease Treated with Dialysis versus Conservative Management in a Rural Hospital
Article Sidebar
Main Article Content
Abstract
Background: Data on survival outcomes of patients with end-stage kidney disease (ESKD) in Thailand remain scarce. This study aimed to compare the survival outcomes of patients managed with dialysis versus conservative management in a rural hospital setting.
Design: A retrospective observational cohort study.
Methods: ESKD patients aged ≥ 18 years who selected their treatment option from January 2017 to December 2023 were followed up until December 2024. Patient data were extracted from medical records and recorded using a data record form. Survival was analyzed on an intention- to-treat basis using Kaplan–Meier estimation and Laplace regression, adjusting for age, Charlson Comorbidity Index, baseline estimated glomerular filtration rate, and erythropoiesis-stimulating agents use.
Results: A total of 192 patients aged 18–90 years (mean ± SD, 61.9 ± 15.0 years) were included. The unadjusted median survival time was longer in the dialysis group than in the conservative management group (5.4, 95% confidence interval (95%CI:) 4.2–6.3 vs 1.9, 95%CI: 1.4–2.6 years; p < 0.001). However, after adjustment, the survival difference was attenuated and no longer statistically significant (adjusted median survival time differences: 1.1 years; 95%CI: -1.7–3.8; p = 0.440). Subgroup analysis revealed that patients younger than 65 years derived greater survival benefit from dialysis (adjusted median survival time differences: 2.7 years; 95%CI: 0.12–5.3; p = 0.04).
Conclusions: Dialysis tended to improve survival, particularly among patients younger than 65 years. Treatment decisions should be guided by clear communication and shared decision-making among physicians, patients, and their families.
Keywords: chronic kidney failure, chronic kidney failure, renal dialysis, conservative treatment, mortality, rural hospital
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The content and information in articles published in the PCFM journal are solely the opinions and responsibilities of the authors. The journal's editorial board does not necessarily agree with or share any responsibility for them.
All articles, information, content, images, etc., published in the PCFM journal are the copyright of the PCFM journal. If any individual or organization wishes to reproduce, distribute, or use any part or the entirety of the content, they must obtain written permission from the PCFM journal beforehand.
References
KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4s):S117-s314.
Li Z, He R, Wang Y, Qu Z, Liu J, Yu R, Yang S. Global trends of chronic kidney disease from 1990 to 2021: a systematic analysis for the global burden of disease study 2021. BMC Nephrol. 2025;26(1):385. PubMed PMID: 40660180
Ingsathit A, Thakkinstian A, Chaiprasert A, Sangthawan P, Gojaseni P, Kiattisunthorn K, et al. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol Dial Transplant. 2010;25:1567-75.
กองยุทธศาสตร์และแผนงาน กระทรวงสาธารณสุข. สถิติสุขภาพคนไทย [อินเทอร์เน็ต]. [เข้าถึงเมื่อ 19 ก.ย. 2567]. เข้าถึงได้จาก: https://www.hiso.or.th/thaihealthstat/area/index.php?ma=1&pf=01818101&tm=2&tp=12_5
กรมการแพทย์ กระทรวงสาธารณสุข. Thailand Medical Services Profile 2011-2014 (การแพทย์ไทย ๒๕๕๔-๒๕๕๗) [อินเทอร์เน็ต]. [เข้าถึงเมื่อ 19 ก.ย. 2567]. เข้าถึงได้จาก: https://www.hiso.or.th/hiso/picture/reportHealth/report/report8.pdf
สมาคมโรคไตแห่งประเทศไทย. ข้อมูลการบำบัดทดแทนไตในประเทศไทย พ.ศ. 2563.
Apiwatnakorn A, Chaiprasitti S. Renal dialysis refusal in end-stage renal disease patients under universal health coverage scheme in Uttaradit Province. Srinagarind Medical Journal. 2019;34:546-51.
Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int. 2015;88:447-59.
สมาคมโรคไตแห่งประเทศไทย, ศูนย์การุณรักษ์ คณะแพทย-ศาสตร์ มหาวิทยาลัยขอนแก่น, สมาคมพยาบาลโรคไตแห่งประเทศไทย, คณะกรรมการพัฒนาระบบบริการสุขภาพสาขาไต, สมาคมนักกำหนดอาหารแห่งประเทศไทย, สมาคมเพื่อนโรคไตแห่งประเทศไทย. คำแนะนำสำหรับการดูแลรักษาสนับสนุนและประคับประคองผู้ป่วยโรคไตเรื้อรัง พ.ศ. 2566 [อินเทอร์เน็ต]. [เข้าถึงเมื่อ 19 ก.ย. 2567]. เข้าถึงได้จาก: https://www.nephrothai.org/wp-content/uploads/2023/06/e-BOOK-palliative-care.pdf
Voorend CGN, van Oevelen M, Verberne WR, van den Wittenboer ID, Dekkers OM, Dekker F, et al. Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis. Nephrol Dial Transplant. 2022;37:1529-44.
Wongrakpanich S, Susantitaphong P, Isaranuwatchai S, Chenbhanich J, Eiam-Ong S, Jaber BL. Dialysis Therapy and Conservative Management of Advanced Chronic Kidney Disease in the Elderly: A Systematic Review. Nephron. 2017;137:178-89.
Chou A, Li KC, Brown MA. Survival of Older Patients With Advanced CKD Managed Without Dialysis: A Narrative Review. Kidney Med. 2022;4(5):100447. PubMed PMID: 35498159
Shum CK, Tam KF, Chak WL, Chan TC, Mak YF, Chau KF. Outcomes in older adults with stage 5 chronic kidney disease: comparison of peritoneal dialysis and conservative management. J Gerontol A Biol Sci Med Sci. 2014;69:308-14.
Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis. Clin J Am Soc Nephrol. 2016;11:633-40.
Noppakun K, Tantraworasin A, Khorana J, Nochaiwong S, Vongsanim S, Narongkiatikhun P, et al. Survival rates in comprehensive conservative care compared to dialysis therapy in elderly end-stage kidney disease patients: a propensity score analysis. Ren Fail. 2024;46(2):2396448. PubMed PMID: 39212241
KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 update. Am J Kidney Dis. 2015; 66:884-930.
Hussain JA, Mooney A, Russon L. Comparison of survival analysis and palliative care involvement in patients aged over 70 years choosing conservative management or renal replacement therapy in advanced chronic kidney disease. Palliat Med. 2013; 27:829-39.
Kanjanabuch T, Takkavatakarn K. Global dialysis perspective: Thailand. Kidney360. 2020;1:671-5.
Premprasong A, Nata N, Tangwonglert T, Supasyndh O, Satirapoj B. Risk factors associated with mortality among patients on maintenance hemodialysis: The Thailand Renal Replacement Therapy registry. Ther Apher Dial. 2024;28:839-54.
Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26:1608-14.
Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5. Nephrol Dial Transplant. 2007;22:1955-62.
Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Choosing not to dialyse: evaluation of planned non-dialytic management in a cohort of patients with end-stage renal failure. Nephron Clin Pract. 2003;95:c40-6.
Ladin K, Lin N, Hahn E, Zhang G, Koch-Weser S, Weiner DE. Engagement in decision-making and patient satisfaction: a qualitative study of older patients’ perceptions of dialysis initiation and modality decisions. Nephrol Dial Transplant. 2017;32:1394-401.
Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, et al. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015;385(9981):1975-82.
Morton RL, Schlackow I, Mihaylova B, Staplin ND, Gray A, Cass A. The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review. Nephrol Dial Transplant. 2016;31:46-56.
