SynthesisJournal of palliative medicine2012
Conservative management of end-stage renal disease without dialysis: a systematic review.
Synthesis in Journal of palliative medicine, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 80 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
80 citing papers in PubMed, 7 syntheses or guidelines pooled it, 246 citations in OpenAlex.
- Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis.European journal of clinical nutrition · 2024Pooled it
- Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022Pooled it
- Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review.JAMA network open · 2022Pooled it
- Does conservative kidney management offer a quantity or quality of life benefit compared to dialysis? A systematic review.BMC nephrology · 2021Pooled it
- Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review.Health and quality of life outcomes · 2019Pooled it
- Stage 5-CKD under nephrology care: to dialyze or not to dialyze, that is the question.Journal of nephrology · 2016Pooled it
- Position statement of the Brazilian Society of Nephrology on the refusal and discontinuation of dialysis.Jornal brasileiro de nefrologiaGuideline
- Trial
- Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial.American journal of nephrology · 2020Trial
- Temporal Trends in Decisions to Forgo KRT.Kidney360 · 2026Article
- Nondialytic Care vs Dialysis Transition on Hospitalization: Outcomes in Veterans With Advanced Chronic Kidney Disease.Mayo Clinic proceedings · 2026Article
- Conservative kidney management in a young patient with severe intellectual disability: clinical implications for kidney therapy decision-making - a case report.BMC nephrology · 2026Article
- Personalized Hemodialysis Approaches in Frail Older Individuals.Geriatrics (Basel, Switzerland) · 2026Review
- Decisional Conflict and Patient Experiences in Dialysis Treatment Decision-Making: A Mixed-Methods Study in a Portuguese Cohort.Healthcare (Basel, Switzerland) · 2026Article
- Charlson comorbidity index and palliative performance scale predict prognosis in dialysis patients: a retrospective cohort study.BMC palliative care · 2026Article
- Article
- Factors associated with self-care in people with advanced chronic kidney disease and their experience of care in Catalonia: an application of Leventhal's self-regulatory model.BMC nephrology · 2025Article
- Article
- Short-Term Safety of Nutri-Jelly in Adults Undergoing Hemodialysis.Food science & nutrition · 2024Article
- Nephrology providers' perspective and use of mortality prognostic tools in dialysis patients.BMC nephrology · 2024Article
20 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
Abstract
purposeTo summarize evidence on conservative, nondialytic management of end-stage renal disease regarding 1) prognosis and 2) symptom burden and quality of life (QOL).
methodsMedline, Cinahl, and Cochrane were searched for records indexed prior to March 1, 2011. Bibliographies of articles and abstracts from recent meetings were reviewed. Authors and nephrologists were contacted to identify additional studies. Articles were reviewed by two authors and selected if they described stage 5 chronic kidney disease (CKD) patients managed without dialysis, including one or more of the following outcomes: prognosis, symptoms, or QOL. Levels of evidence ratings were assigned using the SORT (Strength of Recommendation Taxonomy) system. Data was abstracted independently by two authors for descriptive analysis.
resultsThirteen studies were included. In studies of prognosis, conservative management resulted in median survival of at least six months (range 6.3 to 23.4 months). Findings are mixed as to whether dialysis prolongs survival in the elderly versus conservative, nondialytic management. Any survival benefit from dialysis decreases with comorbidities, especially ischemic heart disease. Patients managed conservatively report a high symptom burden, underscoring the need for concurrent palliative care. Additional head-to-head studies are needed to compare the symptoms of age-matched dialysis patients, but preliminary studies suggest that QOL is similar.
conclusionsConservative management is an important alternative to discuss when counseling patients and families about dialysis. Unlike withdrawal of dialysis in which imminent death is expected, patients who decline dialysis initiation can live for months to years with appropriate supportive care.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.