Differences in quality of life between treatment choices in older patients with advanced chronic kidney disease

Abstract

Introduction: As the global population ages, chronic kidney disease (CKD) becomes more common, particularly among older adults. Those with advanced CKD face potential progression to kidney failure, requiring a decision between initiating kidney replacement therapy (KRT) or opting for conservative kidney management (CKM). The aim of this study is to investigate differences in health-related quality of life (HRQoL) between older patients with advanced CKD that have chosen for eventual KRT initiation and those who have chosen for CKM. Methods: Patients aged ≥65 years with an eGFR of 20 – 10 mL/min/1.73m² were included from the prospective multicenter DIALOGICA study. Patients were grouped together based on their first known choice for KRT or CKM with eGFR remaining between 20 and 10 mL/min/1.73m2. HRQoL was measured using the SF-12 questionnaire, which measures Mental Component Summary (MCS)score and Physical Component Summary (PCS) score. Differences in MCS and PCS were assessed at baseline and after 12 months using independent sample T-tests. Results: In total, 809 patients (70% male) were included with a mean age at inclusion of 77±6 years and mean eGFR of 14.8±2.8 mL/min/1.73m2 . 440 patients chose KRT and 151 chose CKM. Patients with choice KRT at baseline had higher MCS (51.2±9.0 versus 48.8±10.7, p-value 0.02) and PCS (39.2±10.4 versus 35.4±10.7, p-value <0.001) than patients with choice CKM. After 12 months, these differences decreased: the MCS declined slightly in both groups (49.8±10.0 versus 48.0±11.7, p-value 0.25), while the PCS remained stable in the group that opted for CKM (38.0±11.0 versus 35.7±10.7, p-value 0.12). Conclusion: HRQoL was significantly higher in patients who chose for KRT at baseline, but not after 12 months. PCS remained stable in patients who chose CKM. These findings may help patients and nephrologists make better informed treatment choices.