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Titolo Conservative care in Europe-nephrologists' experience with the decision not to start renal replacement therapy
Autore MoniekW.M. van de Luijtgaarden1, Marlies Noordzij1, Wim van Biesen2, Cecile Couchoud3, Giovanni Cancarini4, Willem-JanW. Bos5, FriedoW. Dekker6, Jose L. Gorriz7, Christos Iatrou8, ChristophWanner9, Patrik Finne10,11, Olivera Stojceva-Taneva12, Svjetlana Cala13, Vianda S. Stel1, Charles Tomson14 and Kitty J. Jager1
Referenza Nephrol Dial Transplant 2013; doi: 10.1093/ndt/gft287

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 decisionmaking not to start RRT. Patient preference was considered as a very important factor, confirming the importance of extensive patient education and shared decision-making.

Data 16.09.2013
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