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NDT Advance Access originally published online on November 19, 2007
Nephrology Dialysis Transplantation 2008 23(4):1313-1317; doi:10.1093/ndt/gfm772
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Prolonged conservative treatment for frail elderly patients with end-stage renal disease: the Verona experience

Vincenzo De Biase1, Olga Tobaldini1, Claudia Boaretti2, Cataldo Abaterusso1, Nicoletta Pertica1, Carmelo Loschiavo1, Gaetano Trabucco2, Antonio Lupo1 and Giovanni Gambaro1

1 Division of Nephrology, Department of Biomedical and Surgical Sciences, University Hospital of Verona, Verona, Italy 2 Clinical Psychology Unit, University Hospital of Verona, Verona, Italy

Giovanni Gambaro, Divisione di Nefrologia, Dipartimento di Scienze Biomediche e Chirurgiche, Università di Verona, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy. Tel: +39-045-8122521; Fax: +39-045-915176; E-mail: giovanni.gambaro{at}univr.it



  Abstract

Background. In frail elderly patients, the chronic use of renal replacement therapy sometimes affords no tangible benefits and may even negatively affect their quality of life (Qol), making prolonged conservative management a reasonable option.

Methods. This observational, uncontrolled study was conducted on 11 end-stage renal disease patients over 75 years of age, on prolonged conservative treatment with a follow-up of at least 6 months, to assess compliance with the Italian clinical guidelines concerning the treatment of renal failure, comorbidities, hospital stays, and several psychometric and Qol indicators in the patients and their caregivers.

Results. We found a substantial compliance with the targets recommended in the guidelines, a moderate tendency for disease progression and satisfactory psychometric and Qol parameters, which proved much the same as those observed in a parallel (uncontrolled) group of patients on haemodialysis.

Conclusions. Our study shows that a conservative strategy is feasible for frail uraemic patients, achieving acceptable clinical results and a Qol comparable with patients on haemodialysis. The study also provides indications on how to plan trials on this topic, to obtain the evidence needed to guide the difficult choice of whether to recommend dialysis or conservative treatment for such frail patients.

Keywords: caregiver; conservative treatment; dialysis; frail; quality of life

Received for publication: 4. 5.07
Accepted in revised form: 4.10.07


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R. M. Arnold and M. L. Zeidel
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