Survival outcome after decision making for renal replacement therapy in chronic renal failure
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Abstract
Background: Renal replacement therapy (RRT) counseling is an important process in the treatment plan for patients with chronic kidney disease (CKD). Changing decisions of patients will affect the care of physicians and may increase morbidity. We faced treatment challenges due to patient indecisiveness or changing their decisions and sometimes failed to save their lives.
Methods: Data of patients with CKD, receiving RRT counseling in the dialysis unit from 1 October 2015 to 31 March 2020 were recorded until 31 March 2021 used for and analyzed.
Results: Altogether, 602 eligible cases were selected for the study comprising 12.12% stage 4 of CKD, average age 60.80+14.05 years, 48.0% males and mean Charlson Comorbidity Index (CCI) scores of 5.45+1.83. Diabetes was the major underlying disease. After counseling, more than one half of patients with CKD stage 4 were indecisive and 76.75% of patients with stage 5 rejected RRT. Patients who changed their decision totaled 6.37% and mostly in stage 5. In all, 51.66% (311 cases) received dialysis of which 46.6% included hemodialysis. Death presented in 43.85% (264 cases) of all cases for which 33.71% (89 cases) comprised dialysis patients. In both stages of CKD (4 and 5), we found no difference in age, sex, underlying disease, mortality or types of decision, but those informed of RRT in CKD stage 5 accepted more dialysis treatment than those with stage 4 and lower eGFR at onset of dialysis (55.0% vs. 27.4%, P<0.001 and 4.87+2.36 vs. 6.01+2.81 mL/min/1.73 m2, P=0.040 respectively). In stage 4, patients with RRT acceptance received more dialysis treatment and started treatment earlier than those that rejected but without difference in CCI score, mode of dialysis, death or sex. Mortality rate in stage 4 was high among nondialysis patients [83.3% (15 case) and 16.7% (3 cases), P=0.015]. Exactly 76.7% (406 patients) of patients with stage 5 who rejected dialysis were older and experienced higher events in changing decision, death and dialysis treatment than those that accepted (62.22+13.37 yrs vs. 55.55+14.19 yrs, P<0.001, 47.8% vs. 4.9%, P<0.001, 48.5% vs. 31.7%, P<0.001 and 46.3% vs. 35.4%, P<0.001, respectively) but without difference in CCI score, eGFR in dialysis initiation and dialysis methods.
Conclusion: Decision making after RRT counseling affected patient mortality. Patients who accepted experienced more survival than who refused.
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