Author,
year of publication
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Population
|
Age (years)1
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Intervention, n
|
Comparator, n
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Main outcome measures and results1
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Almutary, 2016 (40)
|
Non-dialysis group (CKD4 & CKM (CKD5))
Dialysis group (HD & PD)
|
Total group 48.29 (±14.86)
CKM (CKD5), 51.84±15.11
HD, 47.71±14.46
PD, 43.08±15.09
|
CKM (CKD5), 38
|
HD, 287
PD, 42
|
Symptom burden (CKD-SBI)
Dialysis vs. CKM (CKD5):
HD: 23.36±16.99; PD: 12.04±6.58, vs. CKM (CKD5): 8.1±8.04; p <0.001
|
Carson, 2009 (23)
|
CKD5
|
Age ≥70 at inclusion
CKM, mean 81.6; median 83
Dialysis, mean 76.4; median 75
|
CKM, 29
|
Dialysis, 173
|
Hospitalization rate
Hospital days/patient days survived:
CKM, 4.3±0.26; RRT, 6.9±0.71
Place of death
Home/hospice: CKM, 40%; Dialysis 21%,
Hospital: CKM, 36%; Dialysis 70%
|
Chandna,
2011 (38)
|
CKD5
|
CKM 77.5±7.6
Dialysis 58.5±15.0
|
CKM, 155
|
Dialysis, 689
|
Mortality
Mortality in patients aged >75:
CKM vs. dialysis, HR: 1.18 (95% CI: 0.79-1.76); p = 0.428.
In patients with comorbidity score>4: Dialysis, 25.8±4.4(SE); CKM, 20.4±2.4(SE); p=0.83.
|
Da Silva-Gane, 2012 (3)
|
CKD4-5
|
HD 60.6±14.9
PD 48.0±15.6
CKM 77.5±6.5
|
CKM, 30
|
HD,80
PD, 44
|
Mortality
HD vs. CKM, HR 0.47 (95% CI: 0.20-1.10); p = 0.08
PD vs. CKM, HR: 0.39 (95% CI: 0.10-1.48); p = 0.17
Quality of life
No difference over time in groups.
|
Hussain,
2013 (37)
|
CKD5
|
Age >70 at inclusion
|
CKM, 172
|
Dialysis, 269
|
Hospitalization
Dialysis vs. CKM, RR 1.6 (95% CI: 1.14-2.25), p <0.05.
|
Iyasere,
2019 (39)
|
CKD5
|
Median age (IQR)
CKM, 83 (80-88)
aAPD, 81 (79-88)
HD, 82 (78-85)
|
CKM, 28
|
HD, 28
PD, 28
|
Quality of life
SF-12, PCS: CKM, 28.9±10.0; dialysis, 29.2±8.3; p = 0.90
SF-12, MCS: CKM, 46.3±12.1; dialysis, 49.9±12.9; p = 0.28
|
Joly,
2003 (22)
|
CKD4-5
|
Age ≥80 at inclusion
CKM 84.1±2.9
Dialysis 83.2±2.9
|
CKM, 43
|
Dialysis, 101
|
Mortality
CKM, 8.9 months (95% CI: 4-10); dialysis, 28.9 months (95% CI: 24-38); p <0.0001
|
Kwok,
2016 (36)
|
CKD5
|
Age ≥65 at inclusion
CKM 79.6±6.8
Dialysis 74.2±6.1
|
CKM, 432
|
Dialysis, 126
|
Mortality
CKM, 10.0 months (95% CI: 8.3-11.7); dialysis, 44.6 months (95% CI: 37.3-51.9); p <0.001.
|
Murtagh,
2007 (28)
|
CKD5
|
Age >75 at inclusion
CKM, 81.36
Dialyse, 78,17
|
CKM, 77
|
Dialysis, 52
|
Mortality
CKM vs. dialysis, HR: 2.90 (95% CI: 1.60-5.26);
In patients with comorbidity score >2: Dialysis vs CKM: log rank statistic <0.001, df 1, p = 0.98, In patients with ischaemic heart disease: Dialysis vs CKM: log rank statistic 1.46, df 1, p < 0.27.
|
Raman,
2018 (21)
|
CKD5
|
Dialysis, 78.9±2.8
CKM, 83.7±4.2
|
CKM, 81
|
Dialysis, 123
|
1-year survival
Dialysis vs. CKM, OR 0.38 (95% CI: 0.09-1.60); p = 0.19
Hospitalization
Number of admission days (median (IQR)):
CKM, 0.8 (0.0-8.7); dialysis, 2.2 (0.7-14.7); p = 0.005.
|
Reindl-Schwaighofer, 2017 (35)
|
CKD5
|
Age >65 at inclusion
HD, 74.06±5.78
CKM, 81.22±7.23
|
CKM, 174
|
HD, 8622
|
Mortality
HD vs. CKM, HR: 0.23 (95% CI: 0.18-0.29); p < 0.001.
|
Shah,
2019 (41)
|
CKD5
|
Age ≥75 at inclusion
Median age (IQR):
Dialysis, 81 (78–84)
CKM, 83 (81–87)
Age ≤81, n (%):
Dialysis 50 (6)
CKM 19 (41)
Age >81, n (%):
Dialysis 33 (40)
CKM 27 (59)
|
CKM, 46
|
Dialysis, 83
|
Quality of life
Dialysis vs. CKM, adjusted differences in KDQOL-36 scores (95% CI):
KDQOL-burden of disease: -28.59 (-41.77 to -15.42); p < .001
KDQOL-symptoms of disease: -5.93 (-14.61 to 2.73); p = 0.18
KDQOL-effects of disease: -16.49 (-25.98 to -6.99); p <0.001
|
Shih,
2014 (34)
|
CKD5
|
Age ≥70 at inclusion
CKM, 82.0±6.4
Dialysis, 78.6±7.1
|
CKM, 2049
|
Dialysis, 6292
|
Mortality
Dialysis vs. CKM, HR: 1.39 (95% CI: 1.30-1.49), p <0.001
|
Shum,
2014 (33)
|
CKD5
|
Age 65-90 at inclusion
Overall age, 73.8±5.4
CKM, 75.3±5.7
PD, 73.4±5.3
|
CKM, 42
|
PD, 157
|
Mortality
PD vs. CKM, HR: 0.46 (95% CI 0.31-0.68), p <0.001.
Hospitalization
Days per person year, median [IQR]
PD, 16.17 [6.29-43.32] vs. CKM, 38.01 [6.75-76.56]; p = 0.03
|
Smith,
2003 (24)
|
CKD5
|
CKM (palliative care population), 71±12; Dialysis, 59±15
|
CKM, 63
|
Dialysis, 258
|
Mortality
Dialysis, median survival 8.3 months; CKM, median survival 6.3 months; N.S.
Place of death
Deaths at home or in a hospice: CKM, 22 of 34 deaths (65%)
Dialysis, 11 of 41 deaths (27%); p = 0.001
|
Tam-Tham,
2018 (32)
|
CKD5
|
Age ≥65 at inclusion
Age 65 to <75 (n, %)
Dialysis, 228 (45.6)
CKM, 45 (13.3)
Age 75 to <85 (n, %)
Dialysis, 220 (44.0)
CKM, 143 (42.3)
Age ≥85 (n, %)
Dialysis, 52 (10.4)
CKM, 150 (44.4)
|
CKM, 338
|
Dialysis, 500
|
Mortality
Dialysis vs. CKM (0-3 years), HR: 0.56 (95% CI: 0.44-0.71); p <0.001
Dialysis vs. CKM (after 3 years), HR: 1.98 (95% CI: 1.16-3.37); p = 0.12
Hospitalization
Dialysis vs. CKM, HR: 1.40 (95% CI: 1.16-1.69), p = 0.001
|
Tan,
2017 (26)
|
CKD5
|
Age >65 at inclusion
CKM, 84
Dialysis, 73
|
CKM, 8
|
Dialysis, 12
|
Symptom burden
Change (improvement) in mean symptom POS-score over 6 months: CKM, 1.5; dialysis, 7.58; p <0.002.
|
Teo,
2010 (25)
|
CKD5
|
CKM, 67.4 ± 11.8
HD, 58.7 ± 12.9
|
CKM, 16
|
HD, 102
|
Mortality
CKM, HR: 2.29 (95% CI: 1.16-4.45); HD, HR: 0.59 (95% CI: 0.33-1.05); p = 0.042
|
Teruel,
2015 (31)
|
CKD5
|
Median age (IQR)
Dialysis, 68 (54,76)
CKM, 83 (78,86)
|
CKM, 90
|
Dialysis, 142
|
Mortality
CKM, 8.2/100 patient months; Dialysis, 0.6/100 patient months;
p <0.001
|
van Loon,
2019 (20)
|
CKD5
|
Age ≥65 at inclusion
CKM, 82±6
Dialysis, 75±7
|
CKM, 89
|
Dialysis, 192
|
12-month survival
CKM vs. dialysis,
HR: 2.12 (95% CI: 1.12-4.03); p = 0.02
In patients < 80 years old,
HR: 5.05 (95% CI: 1.90-13.50); p <0.01
In patients ≥ 80 years old,
HR: 1.30 (95% CI: 0.58-2.91); p = 0.53
Six-month quality of life
EQ-5D Index, mean (SE) change within group:
CKM, 0.047 (0.022); p <0.01
Dialysis, 0.026 (0.014); p = 0.10
Between group difference, p <0.01
Hospitalization
Median number [IQR] of admissions:
CKM, 1 [1-5]; Dialysis, [1-4]; p = 0.27
Hospitalization
Median number [IQR] of admission days:
Dialysis, 7 [3-15]; CKM, 4 [2-12]; p = 0.22
|
Verberne,
2018 (30)
|
CKD5
|
CKM, 82.6±4.5
Dialysis, 76.2±4.4
|
CKM, 126
|
Dialysis, 240
|
Mortality
CKM vs. dialysis, HR: 1.67 (95% CI: 1.19-2.35), p = 0.003
Median [IQR] survival in years in patients ≥70 years old:
CKM, 1.3 [0.5-2.5]; dialysis, 3.1 [1.7-6.4]; p <0.001
Median [IQR] survival in years in patients ≥80 years old:
CKM, 2.3 [1.3-3.7]; dialysis, 2.9 [1.9-6.0]; p = 0.13
Quality of life
No difference between groups
|
Verberne,
2016 (29)
|
CKD5
|
CKM, 83±4.5
Dialysis, 76±4.4
|
CKM, 107
|
Dialysis, 204
|
Mortality
Dialysis vs. CKM, HR: 0.62 (95% CI: 0.42-0.92), p = 0.02.
Median [IQR] survival in years in patients ≥80 years old:
CKM, 1.4 [0.7-3.0]; dialysis, 2.1 [1.5-3.4]; p = 0.08.
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Yong,
2009 (42)
|
CKD5
|
CKM, 73.1 ± 7.1
Dialysis, 58.2 ± 11.4
|
CKM, 45
|
Dialysis, 134
|
Symptom burden
Number of symptoms
CKM, 8.2 ± 3.9; dialysis 9.3 ± 4.7, p = 0.243
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Yuen,
2016 (27)
|
CKD5
|
CKM, 76.8 ± 9.1
Dialysis, 58.6 ± 12.6
|
CKM, 335
|
Dialysis, 265
|
One-year survival (%)
CKM, 57.3 ± 2.9; dialysis, 89.7 ± 2.1
3-year survival (%)
CKM, 16 ± 2.7; dialysis, 74.6% ± 3.4
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