SynthesisNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2022
Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis.
Synthesis in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 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
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Effect of Exercise on Parathyroid Hormone Levels in Dialysis Patients: A Systematic Review and Meta-Analysis.Hemodialysis international. International Symposium on Home Hemodialysis · 2026Pooled it
- Policy strategies to enhance uptake of conservative kidney management in advanced chronic kidney disease: a systematic review and meta-analysis.BMC nephrology · 2025Pooled 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
- Article
- How do older patients with advanced kidney disease, and their family members, understand kidney function and failure? A qualitative study.BMC nephrology · 2025Article
- Outcomes of patients in a pre-dialysis clinic and implications for shared decision making.Clinical kidney journal · 2025Article
- Article
- How do patient information documents present dialysis and conservative kidney management? A document analysis.Clinical kidney journal · 2025Article
- Article
- 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
- Approximating the Proportion of Individuals With Kidney Failure Who Die Without Kidney Replacement Therapy in Ontario, Canada.Canadian journal of kidney health and disease · 2025Article
- Nephrology providers' perspective and use of mortality prognostic tools in dialysis patients.BMC nephrology · 2024Article
- Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study.BMC nephrology · 2024Observational
- How to make a shared decision with older persons for end-stage kidney disease treatment: the added value of geronto-nephrology.Clinical kidney journal · 2024Review
- Shared decision making in elderly patients with kidney failure.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Review
- Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD.Kidney international reports · 2024Review
- Choosing conservative care in advanced chronic kidney disease: a scoping review of patients' perspectives.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Article
- Spontaneous low-protein intake in older CKD patients: one diet may not fit all.Frontiers in nutrition · 2024Article
- 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
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNon-dialytic conservative care (CC) has been proposed as a treatment option for patients with kidney failure. This systematic review and meta-analysis aims at comparing survival outcomes between dialysis and CC in studies where patients made an explicit treatment choice.
methodsFive databases were systematically searched from origin through 25 February 2021 for studies comparing survival outcomes among patients choosing dialysis versus CC. Adjusted and unadjusted survival rates were extracted and meta-analysis performed where applicable. Risk of bias analysis was performed according to the Cochrane Risk Of Bias In Non-randomized Studies of Interventions.
resultsA total of 22 cohort studies were included covering 21 344 patients. Most studies were prone to selection bias and confounding. Patients opting for dialysis were generally younger and had fewer comorbid conditions, fewer functional impairments and less frailty than patients who chose CC. The unadjusted median survival from treatment decision or an estimated glomerular filtration rate <15 mL/min/1.73 m2 ranged from 20 and 67 months for dialysis and 6 and 31 months for CC. Meta-analysis of 12 studies that provided adjusted hazard ratios (HRs) for mortality showed a pooled adjusted HR of 0.47 (95% confidence interval 0.39-0.57) for patients choosing dialysis compared with CC. In subgroups of patients with older age or severe comorbidities, the reduction of mortality risk remained statistically significant, although analyses were unadjusted.
conclusionsPatients opting for dialysis have an overall lower mortality risk compared with patients opting for CC. However, a high risk of bias and heterogeneous reporting preclude definitive conclusions and results cannot be translated to an individual level.
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