Observational studyBMC nephrology2018
Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study.
Observational study in BMC nephrology, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03923933 (Chlortalidone and Bumetanide in Advanced Chronic Kidney Disease), which is not on this map. Cited by 37 papers, 4 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.
Chlortalidone and Bumetanide in Advanced Chronic Kidney Disease: HEBE-CKD Trial
Who cites it
37 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Conservative kidney management versus dialysis for stage 5 chronic kidney disease in older people.The Cochrane database of systematic reviews · 2025Pooled 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
- Survival of Older Adults Choosing Dialysis or Conservative Kidney Management, Stratified by Suitability for Dialysis.Kidney medicine · 2026Article
- Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review.Clinical kidney journal · 2026Review
- Personalized Hemodialysis Approaches in Frail Older Individuals.Geriatrics (Basel, Switzerland) · 2026Review
- Supporting Shared Decision-Making in Life-Altering Kidney Therapy Decisions for Older Adults: A Review.JAMA internal medicine · 2025Review
- Outcomes of patients in a pre-dialysis clinic and implications for shared decision making.Clinical kidney journal · 2025Article
- Intending to avoid the treatment burdens only: the doctrine of double effect and withholding or withdrawing life-sustaining treatment.Theoretical medicine and bioethics · 2025Article
- Integrating Clinical Reasoning Into a Patient Decision Aid for People Making Conservative Kidney Management and Dialysis Decisions: A User-Centered Intervention Development Design.Kidney medicine · 2025Article
- Geriatric Assessment in Older Patients with Advanced Kidney Disease: A Key to Personalized Care and Shared Decision-Making-A Narrative Review.Journal of clinical medicine · 2025Review
- The trajectory of functional status of patients with kidney failure choosing conservative kidney management.International urology and nephrology · 2025Article
- Providers' Experiences Discussing Care for Patients with Kidney Failure Who Forgo KRT: A National Qualitative Study.Clinical journal of the American Society of Nephrology : CJASN · 2024Article
- Article
- Absorbents therapy, as a conservative option, can improve kidney function in chronic kidney disease.Archives of Razi Institute · 2024Review
- Care of Adults with Advanced Chronic Kidney Disease.Journal of clinical medicine · 2024Review
- Value-Based Healthcare: A Primer for the Dermatologist.Dermatology (Basel, Switzerland) · 2024Review
- Shared decision making in chronic kidney disease: a qualitative study of the impact of communication practices on treatment decisions for older patients.BMC nephrology · 2023Article
- Economic evaluation of dialysis and comprehensive conservative care for chronic kidney disease using the ICECAP-O and EQ-5D-5L; a comparison of evaluation instruments.Cost effectiveness and resource allocation : C/E · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundConservative care is argued to be a reasonable treatment alternative for dialysis in older patients with advanced chronic kidney disease (CKD). However, comparisons are scarce and generally focus on survival only. Comparative data on more patient-relevant outcomes are needed to truly foster shared decision-making on an individual level, and cost comparison is needed to assess value of care.
methodsWe conducted a retrospective observational single-center cohort study in 366 patients aged ≥70 years with advanced CKD, who chose dialysis (n = 240) or conservative care (n = 126) after careful counselling by a multidisciplinary team in a non-academic teaching hospital in The Netherlands. Using a value-based health care approach (value = outcomes/cost): survival, health-related quality of life-cross-sectionally assessed with the Kidney Disease Quality of Life Short Form™-treatment burden, and treatment costs were evaluated.
resultsThe overall survival benefit of patients on a dialysis pathway compared with patients on conservative care diminished or lost significance in patients aged ≥80 years or with severe comorbidity. There were no differences between patients managed conservatively and dialysis patients on physical and mental health summary scores (all P > 0.1). Patients on conservative care had 352.7 hospital free days per year versus 282.7 in patients on a dialysis pathway, calculated from treatment decision (adjusted incidence rate ratio: 1.15, 95% confidence interval: 1.09 to 1.21, P < 0.001). Annual treatment costs were lower in patients on conservative care (adjusted cost ratio: 0.43, 95% confidence interval: 0.28 to 0.67, P < 0.001).
conclusionsIn this study, conservative care is shown to be a viable treatment option in older patients with advanced CKD, particularly in the oldest old and those with severe comorbidity. By achieving similar outcomes at lower treatment burden and treatment costs, value was generated for older patients choosing conservative care and society.
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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.