QJM Advance Access originally published online on June 17, 2009
QJM 2009 102(8):547-554; doi:10.1093/qjmed/hcp068
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Conservatively managed patients with stage 5 chronic kidney disease—outcomes from a single center experience
From the Sheffield Kidney Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
Address correspondence to T. Ellam, From the Sheffield Kidney Institute, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK. email: timellam{at}doctors.org.uk
Received 23 October 2008 and in revised form 2 May 2009
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Abstract |
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Background: Limited survival data are available on chronic kidney disease stage 5 (CKD 5) patients who opt for conservative management rather than dialysis.
Aim: To measure survival in such patients and investigate potential factors predicting survival.
Design: Retrospective survival analysis of a cohort of conservatively managed CKD 5 patients from a single center.
Methods: Survival was measured in 69 conservatively managed patients from the time they were first known to have CKD 5. Comorbidities, residual renal function and other laboratory parameters (calcium, phosphate, parathyroid hormone, albumin and hemoglobin) and blood pressure were recorded.
Results: Overall median patient survival from the time of first known CKD 5 was 21 months. Patients known to a nephrologist before reaching CKD 5 survived longer (median 32 months) than those presenting with CKD 5 (15 months, P = 0.025). Serum albumin >35 g/l was associated with greater survival, but other biochemical parameters, comorbidity grade and age did not predict survival.
Conclusions: These survival data provide useful information for nephrologists counseling CKD 5 patients considering whether to pursue dialysis or conservative management. Risk factors that correlate with survival in the dialysis population may not predict survival in conservatively managed CKD 5 patients.