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

Brown, Leanne, Gardner, Glenn E., & Bonner, Ann (2014) A comparison of treatment options for management of end stage kidney disease in elderly patients : a systematic review. JBI Database of Systematic Reviews & Implementation Reports, 12(7), pp. 374-404.

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Chronic kidney disease is a global public health problem of increasing prevalence. There are five stages of kidney disease, with Stage 5 indicating end stage kidney disease (ESKD) requiring dialysis or death will eventually occur. Over the last two decades there have been increasing numbers of people commencing dialysis. A majority of this increase has occurred in the population of people who are 65 years and over. With the older population it is difficult to determine at times whether dialysis will provide any benefit over non-dialysis management. The poor prognosis for the population over 65 years raises issues around management of ESKD in this population. It is therefore important to review any research that has been undertaken in this area which compares outcomes of the older ESKD population who have commenced dialysis with those who have received non-dialysis management.


The primary objective was to assess the effect of dialysis compared with non-dialysis management for the population of 65 years and over with ESKD.

Inclusion criteria

Types of participants

This review considered studies that included participants who were 65 years and older. These participants needed to have been diagnosed with ESKD for greater than three months and also be either receiving renal replacement therapy (RRT) (hemodialysis [HD] or peritoneal dialysis [PD]) or non-dialysis management. The settings for the studies included the home, self-care centre, satellite centre, hospital, hospice or nursing home.

Types of intervention(s)/phenomena of interest

This review considered studies where the intervention was RRT (HD or PD) for the participants with ESKD. There was no restriction on frequency of RRT or length of time the participant received RRT. The comparator was participants who were not undergoing RRT.

Types of studies

This review considered both experimental and epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case control studies and analytical cross sectional studies.

This review also considered descriptive epidemiological study designs including case series, individual case reports and descriptive cross sectional studies for inclusion.

This review included any of the following primary and secondary outcome measures:

•Primary outcome – survival measures

•Secondary outcomes – functional performance score (e.g. Karnofsky Performance score)

•Symptoms and severity of end stage kidney disease

•Hospital admissions

•Health related quality of life (e.g. KDQOL, SF36 and HRQOL)

•Comorbidities (e.g. Charlson Comorbidity index).

Impact and interest:

1 citations in Scopus
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ID Code: 77740
Item Type: Journal Article
Refereed: Yes
Keywords: Non-Dialysis Management, Renal Replacement Therapy , Maximum Conservative Care , Conservative Management, Chronic Kidney Disease, End Stage Kidney Disease , Dialysis , End-Of-Life Management
DOI: 10.11124/jbisrir-2014-1152
ISSN: 2202-4433
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > NURSING (111000) > Nursing not elsewhere classified (111099)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Nursing
Deposited On: 17 Oct 2014 00:13
Last Modified: 08 Dec 2014 21:25

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