Table 2.
Survival Analyses for Included Studies
| Author | Starting Point of Survival Analysis | Median Survival CKM | IQR | CKM 1-Year Survival (%) | Dialysis 1-Year Survival (%) | CKM 2-Year Survival (%) | Dialysis 2-Year Survival (%) | Median Survival Dialysis | IQR | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Joly20 | Decision date | 9 | 95% CI, 4-10 | 29 | 74 | 15 | 60 | 29 | 95% CI, 24-38 | High number of late presentations in CKM group that may have worsened survival outcomes Long follow-up time of 12 years |
| Smith30 | Putative dialysis start date | 6 | - | - | - | - | - | 8 | - | |
| Murtagh21 | eGFR < 15 | 18 | 0.1-73.1 | 68 | 84 | 47 | 76 | N/A | - | Excluded late presentations 30% of patients in dialysis group did not progress to needing dialysis |
| Carson29 | Threshold eGFR for dialysis initiation based on dialysis cohort (10.8 mL/min/1.73 m2) | 14 | 2-44 | NR | NR | NR | NR | 38 | - | Small numbers of CKM Large numbers of late presentations and emergency-start dialysis patients |
| Ellam48 | eGFR <15 mL/min/1.73 m2 | 21 | 1-100 | - | No dialysis cohort for comparison | |||||
| Wong23 | Decision date | 23 | 65 | N/A | N/A | N/A | N/A | - | No dialysis patients were included in study | |
| Chandna24 | Date of first eGFR 10-15 mL/min/1.73 m2 and subsequently eGFR <15 mL/min/1.73 m2 | 21 | - | 80.2 | - | - | - | 67 | - | No data on functional status |
| Da Silva-Gane11 | Study enrollment, late stage 4/5 CKD attending clinic | 30 | - | 75 | - | - | - | - | - | |
| Hussain33 | eGFR <20, eGFR <15, eGFR <12 | 18 | - | 58 | 72 | 20 | 46 | 38 | - | Complete outcome reporting and no loss to follow-up |
| Seow26 | Study enrollment, eGFR 8-12 | NR | - | NR | - | 62 | - | - | - | Mainly a study dedicated for health-related quality of life outcomes |
| Shum25 | eGFR < 15 | 28 | 14-45 | 80.7 | - | - | - | 45 | 30-63 | Comparison of CKM and Peritoneal dialysis patients |
| Brown35 | Decision date | 16 | (7-39) | 53 | 93 | - | - | 33a | 95% CI, 32-34 | |
| Kwok27 | eGFR <15 mL/min/1.73 m2 | 45 | 95% CI 37.3-51.9 | 40 | 79 | 13 | 54 | 10 | 95% CI, 8.3-11.7 | Limited to patients who were referred specifically for advanced care planning |
| Echevers22 | eGFR <15 mL/min/1.73 m2 | 21 | (7-42) | - | - | - | - | 46 | 27-62 | Patient decision was not documented and was not used to distinguish comparator cohorts. There may have been patients analyzed in the “CKM” group who had simply not progressed to needing dialysis |
| Verberne31 | Decision date | 18 | 8.4-3.6 | - | - | - | - | 37 | 18-82.8 | No data on functional and nutritional status |
| Verberne31 | eGFR <20 mL/min/1.73 m2 | 29 | - | - | - | - | - | 54 | - | - |
| Verberne31 | eGFR <15 mL/min/1.73 m2 | 18 | - | - | - | - | - | 37 | - | - |
| Reindl-Schwaighofer42 | eGFR <10 mL/min/1.73 m2 | 6 | - | - | - | - | - | 33 | - | - |
| Raman32 | eGFR <10 mL/min/1.73 m2 | 1 | 95% CI 0.4-10.8 | - | - | - | - | 27 | 95% CI, 26-28 | Very high mortality in CKM group compared to other studies. Likely related to indication bias and lead time bias |
| Raman32 | eGFR <15 mL/min/1.73 m2 | 31 | 21-41 | 82 | 92 | N/A | N/A | 42 | 33-50 | Excluded comorbidities: NYHA3/4 heart failure, previous cardiac arrest, Solid organ malignancy, Karnofsky performance score <60, dementia High uptake of CKM (48%) |
| Brown35 | eGFR <15 mL/min/1.73 m2 | 13a | 95% CI 9-16 | - | - | - | - | 20a | 95% CI, 19-20 | - |
| Tam-Tham34 | eGFR <10 mL/min/1.73 m2 | NR | - | - | - | - | - | - | - | Registry trial. Dialysis was associated with lower mortality in the first 3 years, HR 0.59 [95% CI 0.46-0.77]. Median survival and 1-year survival rates not reported |
Note: Measures of overall comorbidity –CCI, Charlson Comorbidity Index; Davies, Davies Score; None, Comorbidities not reported; Own: Author utilized own nonvalidated method of reporting; SCG, Stoke's Comorbidity Grade.
Abbreviations: CKM, conservative kidney management; KSC, kidney supportive care; N/A, not applicable; NR, not reported; NYHA, New York Heart Association Classification; SDM, shared decision making.
a Mean survival (months).