Global Variation in Predictors of Uptake of Conservative Kidney Management: A Systematic Review and Meta-Analysis
Abstract
Background: For older people and those with more comorbidities, kidney replacement therapy may not offer a mortality benefit. Conservative kidney management represents an alternative treatment pathway for kidney failure without dialysis.
Objectives: To identify the clinical and socioeconomic factors associated with choosing a non-dialysis care pathway and to explore geographical variation.
Methods: MEDLINE, Embase and Web of Science databases were searched. Studies, which included patients with kidney failure choosing non-dialysis care and a comparator group of patients preparing for or receiving kidney replacement therapy, were selected. Exposures included clinical and socioeconomic factors. The outcome was a choice to have non-dialysis care. Random-effects meta-analysis was performed; with subgroup analysis by region.
Results: In total 43 studies, including 51,872 participants, were selected. Female sex was associated with choosing non-dialysis care (pooled OR 1.47, 95% CI 1.26-1.71). There was no overall association between non-white ethnicity and treatment choice in Western countries. However, in North America non-White groups had lower odds of receiving non-dialysis care compared to white patients (OR 0.70, 95% CI 0.60-0.81). Socioeconomic deprivation was associated with choosing non-dialysis care in Asia, as was low educational attainment (OR 2.85, 95% CI 1.54-5.26). There was an overall association between living alone and non-dialysis care (pooled OR 1.55, 95% CI…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 51,872 participants or records.
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