Study: Advanced kidney disease patients can survive, with quality life, without dialysis

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People with advanced kidney disease who opt against dialysis still can experience good quality of life as their symptoms worsen, according to a new study. Photo by Anna Frodesiak/Wikimedia Commons

People with advanced chronic kidney disease who decide against maintenance dialysis treatment still can survive for many years with a high quality of life, an analysis published Monday by JAMA Network Open found.

However, this may change late in the course of their illness, when many of them may require hospitalization or surgical procedures to address complications due to declines in kidney function, the researchers said.

“Many patients who forgo dialysis can live for several years and experience sustained quality of life after their decision,” study co-author Dr. Susan P. Y. Wong told UPI in an email.

“Our study highlights how dialysis shouldn’t be the only option for treating advanced kidney disease, although it can often seem this way to patients,” said Wong, a kidney specialist at the University of Washington and the VA Puget Sound Health Care System in Seattle.

In dialysis, a machine is used to remove excess water and toxins from the blood, according to the National Kidney Foundation.

These are functions normally performed by the kidneys, when they are healthy, the foundation says.

Dialysis treatments can last up to four hours and are often needed several times per week, it says.

Advanced chronic kidney disease, or when the organs’ function has declined enough to be life-threatening, can be a complication of a number of health problems, including Type 2 diabetes and severe heart disease, according to the Mayo Clinic.

However, starting dialysis earlier does not necessarily improve the prognosis in people with advance kidney disease, recent studies suggest, and it may cause side effects, including an increased risk for infections, the National Kidney Foundation says.

As a result, many patients, working with their care team, opt for a more “conservative” approach that includes prescription medications that help manage symptoms and reduce the risk for complications, Wong said.

For this study, she and her colleagues analyzed data from 41 studies that included more than 5,100 patients with advanced kidney disease.

Patients who opted against maintenance dialysis survived four up to four years after forgoing the treatment, the data showed.

Those who skipped the treatments reported improved quality of life and mental well-being, based on results from several commonly used measures, compared with those who decided to pursue dialysis, the researchers said.

However, in a typical year, those who opted against dialysis were admitted to the hospital twice, spent up to 16 days in the hospital, visited a healthcare clinic eight times and needed emergency room care twice due to symptoms and complications of kidney failure, according to the researchers.

“Each option has different pros and cons, and each set of pros and cons will be different for every patient,” Wong said.

“I encourage patients to talk with their clinicians about what is most important to them and their health goals,” she said.

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