ArticlePloS one2020
Exploring the choices and outcomes of older patients with advanced kidney disease.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.
What it found
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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.
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Who cites it
14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- 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
- Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment.The Korean journal of internal medicine · 2022Guideline
- Long-term Outcomes Among Patients With Advanced Kidney Disease Who Forgo Maintenance Dialysis: A Systematic Review.JAMA network open · 2022Pooled it
- Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment.Kidney research and clinical practice · 2021Guideline
- Survival of Older Adults Choosing Dialysis or Conservative Kidney Management, Stratified by Suitability for Dialysis.Kidney medicine · 2026Article
- Shared decision making and dialysis choice: an observational longitudinal cohort study.BMC nephrology · 2025Observational
- Frailty Assessment Tools in Chronic Kidney Disease: A Systematic Review and Meta-analysis.Kidney medicine · 2025Article
- Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study.BMC nephrology · 2024Observational
- Structural equation modeling analysis of factors influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan.BMC nephrology · 2024Article
- Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD.Kidney international reports · 2024Review
- Use of frailty assessment instruments in nephrology populations: a scoping review.BMC geriatrics · 2023Article
- [Long-term physical and psychological consequences of chronic kidney disease].Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz · 2022Review
- Executive Summary of the Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment.Kidney research and clinical practice · 2021Article
- Changing the choice from dialysis to conservative care or vice versa in older patients with advanced chronic kidney disease.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2021Article
Corrections and comments
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
A lack of data on patient choices and outcomes at the time of pre-dialysis planning limits meaningful shared decision making, particularly in older frailer patients. In this large retrospective cohort study of patients aged over 70 seen by the pre-dialysis clinic (2004-2016) of a large single centre in the United Kingdom (1,216 patients), age, sex, comorbidity, poverty and frailty were used to predict choice of renal replacement therapy (RRT) over maximum conservative management (MCM). The impact of patient choice of RRT versus MCM was used to predict survival from the time of choice using multivariable Cox proportional hazards regression. Older age, female sex, greater poverty and greater frailty were associated with choosing MCM, whilst comorbidity had no significant impact on choice. At 5 years of follow up, 49% of all patients had died without receiving RRT. Over 70% of the patients choosing MCM died with better kidney function than the median level at which those starting RRT initiated treatment. Frailty and age were better predictors of survival than comorbidity and in patients with at least moderate frailty, RRT offered no survival benefit over MCM. In conclusion, analysing outcomes from the time of choice may improve shared decision making. Frailty should be routinely assessed and collected and further work may help predict which patients are unlikely to survive or progress to end stage renal disease and may not need to be burdened with making a pre-dialysis choice.
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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.