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Conservative care in Europe: nephrologists' experience with the decision not to start renal replacement therapy

(2013) NEPHROLOGY DIALYSIS TRANSPLANTATION. 28(10). p.2604-2612
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Abstract
BACKGROUND: For some patients with end-stage renal disease (ESRD), providing conservative care until death may be an acceptable alternative for renal replacement therapy (RRT). We aimed to estimate the occurrence of conservative care in Europe and evaluated opinions about which factors nephrologists consider important in their decision not to offer RRT. METHODS: With a web-based survey sent to nephrologists in 11 European countries, we inquired how often RRT was not started in 2009 and how specific factors would influence the nephrologists' decision to provide conservative care. We compared subgroups by nephrologist and facility characteristics using chi-square tests and Mann-Whitney U tests. RESULTS: We received 433 responses. Nephrologists decided to offer conservative care in 10% of their patients [interquartile range (IQR) 5-20%]. An additional 5% (IQR 2-10%) of the patients chose conservative care as they refused when nephrologists intended to start RRT. Patient preference (93%), severe clinical conditions (93%), vascular dementia (84%) and low physical functional status (75%) were considered extremely or quite important in the nephrologists' decision to provide conservative care. Nephrologists from countries with a low incidence of RRT, not-for-profit centres and public centres more often scored these factors as extremely or quite important than their counterparts from high-incidence countries, for-profit centres and private centres. CONCLUSIONS: Nephrologists estimated conservative care was provided to up to 15% of their patients in 2009. The presence of severe clinical conditions, vascular dementia and a low physical functional status are important factors in the decision-making not to start RRT. Patient preference was considered as a very important factor, confirming the importance of extensive patient education and shared decision-making.
Keywords
dialysis, SURVIVAL, opinions, renal replacement therapy, end-stage renal disease, CHRONIC KIDNEY-DISEASE, ELDERLY-PATIENTS, PRACTICE PATTERNS, PALLIATIVE CARE, PATIENT CHOICE, STAGE, DIALYSIS, MANAGEMENT, OCTOGENARIANS, conservative care

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Citation

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MLA
van de Luijtgaarden, Moniek WM, Marlies Noordzij, Wim Van Biesen, et al. “Conservative Care in Europe: Nephrologists’ Experience with the Decision Not to Start Renal Replacement Therapy.” NEPHROLOGY DIALYSIS TRANSPLANTATION 28.10 (2013): 2604–2612. Print.
APA
van de Luijtgaarden, M. W., Noordzij, M., Van Biesen, W., Couchoud, C., Cancarini, G., Bos, W.-J. W., Dekker, F. W., et al. (2013). Conservative care in Europe: nephrologists’ experience with the decision not to start renal replacement therapy. NEPHROLOGY DIALYSIS TRANSPLANTATION, 28(10), 2604–2612.
Chicago author-date
van de Luijtgaarden, Moniek WM, Marlies Noordzij, Wim Van Biesen, Cecile Couchoud, Giovanni Cancarini, Willem-Jan W Bos, Friedo W Dekker, et al. 2013. “Conservative Care in Europe: Nephrologists’ Experience with the Decision Not to Start Renal Replacement Therapy.” Nephrology Dialysis Transplantation 28 (10): 2604–2612.
Chicago author-date (all authors)
van de Luijtgaarden, Moniek WM, Marlies Noordzij, Wim Van Biesen, Cecile Couchoud, Giovanni Cancarini, Willem-Jan W Bos, Friedo W Dekker, Jose L Gorriz, Christos Iatrou, Christoph Wanner, Patrik Finne, Olivera Stojceva-Taneva, Svjetlana Cala, Vianda S Stel, Charles Tomson, and Kitty J Jager. 2013. “Conservative Care in Europe: Nephrologists’ Experience with the Decision Not to Start Renal Replacement Therapy.” Nephrology Dialysis Transplantation 28 (10): 2604–2612.
Vancouver
1.
van de Luijtgaarden MW, Noordzij M, Van Biesen W, Couchoud C, Cancarini G, Bos W-JW, et al. Conservative care in Europe: nephrologists’ experience with the decision not to start renal replacement therapy. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2013;28(10):2604–12.
IEEE
[1]
M. W. van de Luijtgaarden et al., “Conservative care in Europe: nephrologists’ experience with the decision not to start renal replacement therapy,” NEPHROLOGY DIALYSIS TRANSPLANTATION, vol. 28, no. 10, pp. 2604–2612, 2013.
@article{4301861,
  abstract     = {BACKGROUND: For some patients with end-stage renal disease (ESRD), providing conservative care until death may be an acceptable alternative for renal replacement therapy (RRT). We aimed to estimate the occurrence of conservative care in Europe and evaluated opinions about which factors nephrologists consider important in their decision not to offer RRT.
METHODS: With a web-based survey sent to nephrologists in 11 European countries, we inquired how often RRT was not started in 2009 and how specific factors would influence the nephrologists' decision to provide conservative care. We compared subgroups by nephrologist and facility characteristics using chi-square tests and Mann-Whitney U tests.
RESULTS: We received 433 responses. Nephrologists decided to offer conservative care in 10% of their patients [interquartile range (IQR) 5-20%]. An additional 5% (IQR 2-10%) of the patients chose conservative care as they refused when nephrologists intended to start RRT. Patient preference (93%), severe clinical conditions (93%), vascular dementia (84%) and low physical functional status (75%) were considered extremely or quite important in the nephrologists' decision to provide conservative care. Nephrologists from countries with a low incidence of RRT, not-for-profit centres and public centres more often scored these factors as extremely or quite important than their counterparts from high-incidence countries, for-profit centres and private centres.
CONCLUSIONS: Nephrologists estimated conservative care was provided to up to 15% of their patients in 2009. The presence of severe clinical conditions, vascular dementia and a low physical functional status are important factors in the decision-making not to start RRT. Patient preference was considered as a very important factor, confirming the importance of extensive patient education and shared decision-making.},
  author       = {van de Luijtgaarden, Moniek WM and Noordzij, Marlies and Van Biesen, Wim and Couchoud, Cecile and Cancarini, Giovanni and Bos, Willem-Jan W and Dekker, Friedo W and Gorriz, Jose L and Iatrou, Christos and Wanner, Christoph and Finne, Patrik and Stojceva-Taneva, Olivera and Cala, Svjetlana and Stel, Vianda S and Tomson, Charles and Jager, Kitty J},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {dialysis,SURVIVAL,opinions,renal replacement therapy,end-stage renal disease,CHRONIC KIDNEY-DISEASE,ELDERLY-PATIENTS,PRACTICE PATTERNS,PALLIATIVE CARE,PATIENT CHOICE,STAGE,DIALYSIS,MANAGEMENT,OCTOGENARIANS,conservative care},
  language     = {eng},
  number       = {10},
  pages        = {2604--2612},
  title        = {Conservative care in Europe: nephrologists' experience with the decision not to start renal replacement therapy},
  url          = {http://dx.doi.org/10.1093/ndt/gft287},
  volume       = {28},
  year         = {2013},
}

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