Global Variation in Predictors of Uptake of Conservative Kidney Management: A Systematic Review and Meta-Analysis.
Kerry-Lee Rosenberg, Naaheed Mukadam, Gordon Paterson and 5 others
PMID 42400494WHAT IT FOUND
Older age, female sex, higher comorbidity burden, and living alone were associated with receiving non-dialysis care rather than dialysis or transplant.
Diabetes was not associated overall, and socioeconomic factors varied by region.
Key findings
01Female sex was associated with receiving non-dialysis care rather than kidney replacement therapy (pooled OR 1.47, 95% CI 1.26-1.71).
02Higher mean Charlson comorbidity index was associated with receiving non-dialysis care (Hedges g 0.36, 95% CI 0.15-0.57).
03Living alone was associated with receiving non-dialysis care rather than kidney replacement therapy (pooled OR 1.55, 95% CI 1.24-1.93).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only observational studies were included, so the results are associations and cannot show that any factor caused treatment choice. Multivariable analysis was not possible because adjusted odds ratios were reported in only seven studies and those models used different variables. Age could not be pooled because studies used different age cut-offs, and frailty could not be pooled because studies used non-comparable measures. Socioeconomic data were sparse and inconsistently defined: socioeconomic status was reported in 11 of 41 studies, and education was reported in only two Western studies. Publication bias could not be assessed because the included studies were not all designed to report treatment choice. Risk of bias was rated by one assessor, and studies not available in English were excluded.
Declared interests
The authors reported nothing to declare under funding and no conflicts of interest.
The easy way to misread this
Do not read these findings as evidence that conservative kidney management is better or worse than dialysis. This is an observational review of treatment choice, not a trial of kidney treatment. The associations may reflect patient preference, clinician advice, family involvement, or barriers to access, and the review could not adjust for confounding because adjusted odds ratios were reported in only seven heterogeneous studies.