PMID- 24013682
OWN - NLM
STAT- MEDLINE
DCOM- 20140424
LR  - 20220427
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Linking)
VI  - 28
IP  - 10
DP  - 2013 Oct
TI  - Conservative care in Europe--nephrologists' experience with the decision not to 
      start renal replacement therapy.
PG  - 2604-12
LID - 10.1093/ndt/gft287 [doi]
AB  - 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 decision-making not to start RRT. 
      Patient preference was considered as a very important factor, confirming the 
      importance of extensive patient education and shared decision-making.
FAU - van de Luijtgaarden, Moniek W M
AU  - van de Luijtgaarden MW
AD  - ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, 
      University of Amsterdam, Amsterdam, the Netherlands.
FAU - Noordzij, Marlies
AU  - Noordzij M
FAU - van Biesen, Wim
AU  - van Biesen W
FAU - Couchoud, Cecile
AU  - Couchoud C
FAU - Cancarini, Giovanni
AU  - Cancarini G
FAU - Bos, Willem-Jan W
AU  - Bos WJ
FAU - Dekker, Friedo W
AU  - Dekker FW
FAU - Gorriz, Jose L
AU  - Gorriz JL
FAU - Iatrou, Christos
AU  - Iatrou C
FAU - Wanner, Christoph
AU  - Wanner C
FAU - Finne, Patrik
AU  - Finne P
FAU - Stojceva-Taneva, Olivera
AU  - Stojceva-Taneva O
FAU - Cala, Svjetlana
AU  - Cala S
FAU - Stel, Vianda S
AU  - Stel VS
FAU - Tomson, Charles
AU  - Tomson C
FAU - Jager, Kitty J
AU  - Jager KJ
LA  - eng
PT  - Journal Article
DEP - 20130907
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
SB  - IM
MH  - Adult
MH  - Aged
MH  - Data Collection
MH  - *Decision Making
MH  - Europe
MH  - Female
MH  - Humans
MH  - Kidney Diseases/*therapy
MH  - Male
MH  - Middle Aged
MH  - Nephrology/*trends
MH  - Physicians/*trends
MH  - *Practice Patterns, Physicians'
MH  - Prognosis
MH  - *Renal Dialysis
MH  - Renal Replacement Therapy/*trends
OTO - NOTNLM
OT  - conservative care
OT  - dialysis
OT  - end-stage renal disease
OT  - opinions
OT  - renal replacement therapy
EDAT- 2013/09/10 06:00
MHDA- 2014/04/25 06:00
CRDT- 2013/09/10 06:00
PHST- 2013/09/10 06:00 [entrez]
PHST- 2013/09/10 06:00 [pubmed]
PHST- 2014/04/25 06:00 [medline]
AID - gft287 [pii]
AID - 10.1093/ndt/gft287 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2013 Oct;28(10):2604-12. doi: 10.1093/ndt/gft287. Epub 
      2013 Sep 7.