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Conservative Management of Chronic Kidney Disease in Adult Patients: A Review of Clinical Effectiveness and Cost-Effectiveness

Last updated: July 10, 2020
Project Number: RC1276-000
Product Line: Rapid Response
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of conservative management in patients with late or end stage kidney disease?
  2. What is the cost-effectiveness of conservative management in patients with late or end stage kidney disease?

Key Message

This report summarized the evidence regarding the clinical effectiveness and cost-effectiveness of conservative management in advanced chronic kidney disease (CKD) or end stage renal disease (ESRD). Three systematic reviews, seven non-randomized studies and one economic evaluation were included in this report.Conservative care and dialysis were found to have comparable patient outcomes in elderly patients with CKD. Conservative care was associated with shorter survival and increased mortality compared to dialysis in ESRD patients. However, in the presence of severe comorbidities, no differences were found between the two. Quality of life, symptom prevalence and functional outcomes were similar in conservatively managed CKD patients and those receiving dialysis care. Conservatively managed ESRD patients reported a higher burden of kidney disease compared to dialysis although overall quality of life was not different. No evidence regarding repatriation, frailty, renal function and safety outcomes comparing CM and dialysis care were identified.Overall, the body of evidence had several limitations and biases such as differences between patients who receive dialysis and conservative care making objective comparisons between the groups less meaningful, methodological and ethical difficulties in conducting well-designed randomized studies, and potential confounding factors such as age and other comorbidities that could independently affect outcomes.Evidence regarding the cost-effectiveness of conservative management was limited, low to moderate quality and not generalizable to Canadian settings. One cost effective study conducted in Indonesia found that supportive care was the most cost-effective treatment option at willingness to pay threshold of 43 million Indonesian Rupiah.