Conservative kidney management versus dialysis for stage 5 chronic kidney disease in older people

作者：Yang JW, Natale P, Kim S, Kim M, Jeon MS, Yi D, Hong YA, Chung S, Park WY, Hyun YY, Kwon SH, Shin SJ, Park DA, Kim J, Jung JH, Strippoli GF, Lee JY, supported by Cochrane Kidney and Transplant · 发表于：The Cochrane database of systematic reviews · 年份：2025 · DOI：10.1002/14651858.CD015151.pub2 · 被引用次数：94 · 研究领域：Renal Dialysis、Conservative Treatment、Kidney Failure, Chronic、Renal Insufficiency, Chronic、Humans、Aged、Randomized Controlled Trials as Topic、Quality of Life、Cardiovascular Diseases、Bias、Cause of Death、Malnutrition

RATIONALE: The prevalence of kidney failure in people aged 65 years and above is gradually increasing. However, there is insufficient evidence to determine which treatment is better for people with kidney failure, conservative kidney management (CKM) or dialysis. OBJECTIVES: We aimed to assess the effects of CKM and dialysis in older people with kidney failure. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies, MEDLINE, Embase, the WHO International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov and regional databases (LILACS, KoreaMed, CADTH), as well as grey literature repositories up to 22 September 2025. ELIGIBILITY CRITERIA: Randomised and non-randomised studies evaluated CKM compared to dialysis in people aged 65 years and above with kidney failure. OUTCOMES: The critical outcomes included death (any cause), cardiovascular death, cardiovascular events, and health-related quality of life (HRQoL). The important outcomes included overall adverse events, hospitalisation, malnutrition, sarcopenia, and residual kidney function. RISK OF BIAS: Two authors independently performed the risk of bias analysis. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I) tool to assess the risk of bias in the included studies. SYNTHESIS METHODS: Treatment estimates were summarised using random effects pair-wise meta-analysis and expressed as a relative risk (RR), mean difference (MD), or standard mean differenc...