- More than 10% of people worldwide suffer from kidney disease.
- Although 78% of people with advanced kidney disease opt for dialysis, it is not always a viable treatment option.
- Researchers from the University of California Irvine show that certain ethnic groups have higher rates of hospitalization when treated with dialysis rather than being treated conservatively.
Kidney disease affects more than 10% of the world’s population, a total of more than 800 million people.
If a person’s kidney disease progresses to the point that one or both kidneys start to fail, treatment options may include a kidney transplant or dialysis, which uses a machine to perform the kidneys’ waste removal functions.
Another treatment option for people with advanced kidney disease is conservative treatment. This treatment does not provide dialysis. Instead, it focuses on treating a person’s symptoms and quality of life.
A research team from the University of California Irvine recently presented a study at the 2022 American Society of Nephrology Kidney Week annual conference showing that certain ethnic groups can achieve better hospital outcomes with conservative treatment treatment than with dialysis.
Conservative Management vs. Dialysis
When a person has kidney disease, their kidneys are no longer able to properly remove waste and excess fluids from the body and put them into urine.
There are five stages of kidney disease. A person reaches stage 5 when one or both of their kidneys fail or are about to fail due to kidney damage. In this case, a person must change their lifestyle to properly remove waste from the body.
One of these lifestyle change options is dialysis. Approximately 78% of people with kidney disease worldwide have dialysis as a treatment option.
Dialysis is a machine where a person’s kidneys pump blood out of a person’s body, purify it of waste, and pump the filtered blood back into the body. Dialysis is carried out either in a hospital, a dialysis center or at home.
Side effects of dialysis
Some people may experience side effects of dialysis, including:
- muscle cramps
- sleep problems
- depressions
- low blood pressure
- itchy skin infection
- at the body’s dialysis access point
Although dialysis is a popular treatment option for advanced kidney disease, it is not for everyone. For example, dialysis patients have an increased risk of heart failure. Previous research shows that dialysis patients may be at increased risk of dementia.
Research shows that dialysis can have a negative impact on a person’s quality of life.
For these reasons, people with advanced kidney disease sometimes opt for non-dialysis-free treatment known as conservative management. This option focuses on treating kidney disease symptoms through lifestyle and diet changes, medications, and support services.
Previous research shows that conservative management is a viable treatment option for older people with kidney disease. Furthermore, studies show that people who receive conservative treatment may be able to live with adequate support for years.
However, research shows that there are many misconceptions about conservative management, and doctors do not always offer it as an alternative for people with kidney disease.
Does race influence kidney disease treatment?
For this study, the researchers compared hospital records of over 309,000 people with advanced kidney disease who were treated with either dialysis or conservative management over a period of 13 years. Within this group, 55% were hospitalized at least once.
In the analysis, the researchers found that non-Hispanic white, non-Hispanic black, and Hispanic people who received dialysis had higher rates of hospital stay than those who had undergone conservative treatment.
Among these ethnic groups, people who started dialysis early when their kidneys were still functioning at a relatively high level had the highest hospital stay rate compared to people who started dialysis when their kidneys were at a low level of function.
The researchers also found that people of Asian descent in the study population group had a higher hospital stay rate when they received dialysis.
In this ethnic group, however, people who started dialysis late had higher hospital stay rates than people who underwent early dialysis, particularly in older age groups.
Of those who reported hospital stays, the most common reasons were:
- congestive heart failure/fluid overload
- breathing problems
- hypertension
“The importance of conservative non-dialytic treatment as an alternative patient is increasingly recognized. Centered treatment strategy for advanced kidney disease,” explains Dr. Connie Rhee, associate professor of medicine, associate professor of public health and deputy Chair of clinical research at the University of California, Irvine Department of Medicine and member of the research team.
“[C] Conservative management is still underused in the USA, which may be due in part to uncertainties as to which patients will benefit the most from dialysis compared to non-dialytic treatment.”
— Dr. Connie Rhee
“We hope that these results and further research can help inform treatment options for patients, care partners and care providers in the joint decision-making process of conservative management versus dialysis,” adds Dr. Rhee.
Encouraging dialysis alternatives
Medical News Today spoke with Jennifer Prescott, nurse and owner of Blue Water Homecare and Hospice, about these findings. She said the study results could encourage doctors to explore alternatives to dialysis in people with advanced chronic kidney disease.
“Other studies have supported the use of conservative care instead of dialysis, resulting in [fewer] inpatient hospital stays, [fewer] doctor visits, and lower overall healthcare system costs,” Prescott continued.
“In my experience, the impact of dialysis on individuals and families can be significant, including the burden on caregivers, reduced quality of life, and reduced use of palliative/hospice care,” she added.
Prescott says the most common misconception is that the only alternative to dialysis is no care or death.
“I think we’re going to see more research on alternatives to dialysis for conservative treatment of advanced kidney disease,” she said.
“Research on quality of life, mortality, and relationships between race/ethnicity and age can encourage doctors and patients to choose alternatives to dialysis. This can help doctors develop care models that focus on improving treatment outcomes and quality of life for people with chronic kidney disease.”