Main Article Content
Abstract
Introduction: In recent years, due to the inclusion of increasingly older patients with chronic kidney disease in renal replacement therapy, conservative renal treatment has been offered as another option, with results similar in some series to dialysis treatment.
Objective: To review the existing scientific literature on conservative renal treatment in patients with chronic kidney disease, their survival and quality of life.
Methodology: A systematic review was carried out. The databases PubMed, ProQuest, Scielo and Scopus were searched. We included scientific articles in Spanish and English, and available full text. Articles dealing with renal patients with end-stage renal disease, treated with palliative treatment alone or in comparison with renal replacement therapy were analysed.
Results: Fifteen articles published between 2010 and 2020 were included. Chronic kidney disease is a problem of high prevalence in our population; a fact that conditions renal function replacement treatments. Conservative renal treatment emerges as an option to renal replacement therapy in older patients or those with a short life expectancy. Among the factors to be taken into account are survival and quality of life.
Conclusions: In patients with chronic kidney disease on renal replacement therapy, survival is higher, although with a poorer quality of life, while in the case of conservative renal treatment it is usually the opposite. In patients over 75-80 years of age, survival is equal, and it is necessary to enhance quality of life and palliate the symptoms of the disease.
Keywords
Article Details
Copyright (c) 2022 Julia Martínez-Urbano, Ana Rodríguez-Durán, Lucía Parra-Martos, Rodolfo Crespo-Montero

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References
- Ammirati AL. Chronic Kidney Disease. Rev. Assoc. Med. Bras. 2020;66(Suppl 1):S03-09. https://doi.org/10.1590/1806-9282.66.s1.3. DOI: https://doi.org/10.1590/1806-9282.66.s1.3
- Eknoyan G. Chronic kidney disease definition and classification: the quest for refinements. Kidney Int. 2007;72(10):1183-5. https://doi.org/10.1038/sj.ki.5002576. DOI: https://doi.org/10.1038/sj.ki.5002576
- Gorostidi M, Santamaría R, Alcázar R, Fernández-Fresnedo G, Galcerán JM, Goicoechea M, et al. Documento de la Sociedad Española de Nefrología sobre las guías KDIGO para la evaluación y el tratamiento de la enfermedad renal crónica. Nefrología. 2014;34(3): 302-16. https://doi.org/10.3265/Nefrologia.pre2014.Feb.12464.
- Registro Español de Enfermos Renales. Sociedad Española de Nefrología [Internet]. 2019. [consultado 18 Feb 2021]. Disponible en: https://www.senefro.org/contents/webstructure/INFORME_REER_SEN_2020_WEB_SEN.pdf.
- Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-52. https://doi.org/10.1016/S0140-6736(16)32064-5. DOI: https://doi.org/10.1016/S0140-6736(16)32064-5
- Balogun SA, Balogun R, Philbrick J, Abdel-Rahman E. Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End-Stage Renal Disease: A Systematic Review. J Am Geriatr Soc. 2017;65(4):777-85. https://doi.org/10.1111/jgs.14659. DOI: https://doi.org/10.1111/jgs.14659
- Gorostidi M, Sánchez-Martínez M, Ruilope LM, Graciani A, de la Cruz JJ, Santamaría R et Al. Prevalencia de enfermedad renal crónica en España: impacto de la acumulación de factores de riesgo cardiovascular. Nefrología. 2018;38(6):606-15. https://doi.org/10.1016/j.nefro.2018.04.004. DOI: https://doi.org/10.1016/j.nefro.2018.04.004
- Ren Q, Shi Q, Ma T, Wang J, Li Q, Li X. Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review. Health Qual Life Outcomes. 2019;17(1):78. https://doi.org/10.1186/s12955-019-1146-5. DOI: https://doi.org/10.1186/s12955-019-1146-5
- Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, et al. Executive summary of the KDIGO controversies conference on supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int. 2015;88:447-59. DOI: https://doi.org/10.1038/ki.2015.110
- Murtagh FE, Burns A, Moranne O, Morton RL, Naicker S. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease. Clin J Am Soc Nephrol. 2016;11(10):1909-14. https://doi.org/10.2215/CJN.04840516. DOI: https://doi.org/10.2215/CJN.04840516
- O’Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-35. https://doi.org/10.1089/jpm.2011.0207. DOI: https://doi.org/10.1089/jpm.2011.0207
- García-Maseta R, Bovera J, Segura de la Morena J, Goicoechea Diezhandinoa M, Cebollada del Hoyo J, Escalada San Martín J, et al. Documento de consenso para la detección y el manejo de la enfermedad renal crónica. Nefrologia. 2022;42(3):233-64. DOI: https://doi.org/10.1016/j.nefro.2021.07.010
- Teruel JL, BurgueraVion V, GomisCouto A, Rivera Gorrín M, Fernández-Lucas M, Rodríguez Mendiola N et al. Elección de tratamiento conservador en la enfermedad renal crónica. Nefrología. 2015;35(3): 273-9. Disponible en: https://doi.org/10.1016/j.nefro.2015.05.005. DOI: https://doi.org/10.1016/j.nefro.2015.05.005
- Urrútia G, Bonfill X. La declaración PRISMA: un paso adelante en la mejora de las publicaciones de la Revista Española de Salud Pública [The PRISMA statement: a step in theimprovement of thepublications of the Revista Española de Salud Pública]. Rev Esp Salud Pública. 2013;87(2):99-102. https://doi.org/10.4321/S1135-57 DOI: https://doi.org/10.4321/S1135-57272013000200001
- Von Elm E, Altman Douglas G., Egger M, Pocock SJ., Gøtzsche Peter C., VandenbrouckeJan P. Declaración de la iniciativa STROBE (StrengtheningtheReporting of ObservationalStudies in Epidemiology): directrices para la comunicación de estudios observacionales. Rev. Esp. Salud Pública. 2008;82(3):251-59. DOI: https://doi.org/10.1590/S1135-57272008000300002
- Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP. CKD in elderly patients managed without dialysis: survival, symptoms, and qualityoflife. Clin J Am Soc Nephrol. 2015;10(2):260-8. https://doi.org/10.2215/CJN.03330414. DOI: https://doi.org/10.2215/CJN.03330414
- Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis. Clin J Am Soc Nephrol. 2016;11(4):633-40. https://doi.org/10.2215/CJN.07510715. DOI: https://doi.org/10.2215/CJN.07510715
- Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002-9. https://doi.org/10.2215/CJN.01130112. DOI: https://doi.org/10.2215/CJN.01130112
- Raman M, Middleton RJ, Kalra PA, Green D. Outcomes in dialysis versus conservative care for older patients: A prospective cohort analysis of stage 5 Chronic Kidney Disease. PLoSOne. 2018; 13(10):e0206469. https://doi.org/10.1371/journal.pone.0206469. DOI: https://doi.org/10.1371/journal.pone.0206469
- Morton RL, Webster AC, McGeechan K, Howard K, Murtagh FE, Gray NA, Kerr PG, Germain MJ, Snelling P. Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clin J Am Soc Nephrol. 2016;11(12):2195-2203. https://doi.org/10.2215/CJN.11861115. DOI: https://doi.org/10.2215/CJN.11861115
- Verberne WR, Dijkers J, Kelder JC, Geers ABM, Jellema WT, Vincent HH, van Delden JJM, Bos WJW. Value-based evaluation of dialysis versus conservativecare in older patients with advanced chronic kidney disease: a cohort study. BMC Nephrol. 2018;19(1):205. https://doi.org/10.1186/s12882-018-1004-4. DOI: https://doi.org/10.1186/s12882-018-1004-4
- Martínez Echevers Y, ToapantaGaibor NG, Nava Pérez N, Barbosa Martín F, Montes Delgado R, Guerrero Riscos MA. Supervivencia de pacientes de edad avanzada (≥70 años) con enfermedad crónica estadios 4-5: diálisis vs tratamiento conservador. Nefrología. 2016;36(3):283-91. http://dx.doi.org/10.1016/j.nefro.2015.11.006. DOI: https://doi.org/10.1016/j.nefro.2015.11.006
- Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608-14. https://doi.org/10.1093/ndt/gfq630. DOI: https://doi.org/10.1093/ndt/gfq630
- Van Loon IN,Goto NA, Boereboom FTJ, Verhaar MC, Bots ML, Hamaker ME. Quality of life after the initiation of dialysis or maximal conservative management in elderly patients: a longitudinal analysis of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study. BMC Nephrol. 2019;20(1):108. https://doi.org/10.1186/s12882-019-1268-3. DOI: https://doi.org/10.1186/s12882-019-1268-3
- Kamar FB, Tam-Tham H, Thomas C. A Description of Advanced Chronic Kidney Disease Patients in a Major Urban Center Receiving Conservative Care. Can J Kidney Health Dis. 2017; https://doi.org/10.1177/2054358117718538. DOI: https://doi.org/10.1177/2054358117718538
- Rubio Rubio MV, Lou Arnal LM, Gimeno Orna JA, Munguía Navarro P, Gutiérrez-Dalmau A, Lambán Ibor E et al. Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador, Nefrología. 2019;39(2):141-50. https://doi.org/10.1016/j.nefro.2018.07.009. DOI: https://doi.org/10.1016/j.nefro.2018.07.009
- Iyasere O, Brown EA, Johansson L, Davenport A, Farrington K, Maxwell AP et al. Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clin Kidney J. 2018;12(2):262-8. https://doi.org/10.1093/ckj/sfy059. DOI: https://doi.org/10.1093/ckj/sfy059
- Seow YY, Cheung YB, Qu LM, Yee AC. Trajectory of quality of life for poor prognosis stage 5D chronic kidney disease with and without dialysis. Am J Nephrol. 2013; 37(3):231-8. https://doi.org/10.1159/000347220. DOI: https://doi.org/10.1159/000347220
- Pereira RMP, Batista MA, Meira AS, Oliveira MP, Kusumota L. Quality of life of elderly people with chronic kidney disease in conservative treatment. Rev Bras Enferm. 2017;70(4):851-9. https://doi.org/10.1590/0034-7167-2017-0103. DOI: https://doi.org/10.1590/0034-7167-2017-0103
- Aguilera Flórez AI, Alonso Rojo AC, Linares Fano B, Prieto Fidalgo S, García Martínez L, Prieto Velasco M. Valoración de la elección de tratamiento conservador en la Enfermedad Renal Crónica. Enferm Nefrol. 2019;22(1):52-8. http://dx.doi.org/10.4321/s2254-28842019000100008. DOI: https://doi.org/10.4321/S2254-28842019000100008
- Ellam T, El-Kossi M, Prasanth KC, El-Najas M, Khwaja A. Conservatively managed patients with stage 5 chronic kidney disease-outcomes from a single center experience, QJM: An International Journal of Medicine. 2009;102(8):547-54. https://doi.org/10.1093/qjmed/hcp068. DOI: https://doi.org/10.1093/qjmed/hcp068
- Carson RC, Juszczak M, Davenport A, Burns A. Is máximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol. 2009;(10):1611-9. https://doi.org/10.2215/CJN.00510109. DOI: https://doi.org/10.2215/CJN.00510109
- Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. ¿Diálisis o no? Estudio comparativo de supervivencia de pacientes mayores de 75 años con enfermedad renal crónica en estadio 5. Trasplante de Nephrol Dial. 2007;22(7):1955-62. https://doi.org/10.1093/ ndt/gfm153.
- Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Elección de no dializar: evaluación del manejo planificado no dialítico en una cohorte de pacientes con insuficiencia renal en etapa terminal. Nephron Clin Pract. 2003;95(2):c40-6. https://doi.org/10.1159/000073708. DOI: https://doi.org/10.1159/000073708
- Ruz MC, Andrade C, Urrutia M, Draibe S, Nogueira-Martins LA, SessoRde C. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo). 2011;66(6):991-5. https://doi.org/10.1590/s1807-59322011000600012. DOI: https://doi.org/10.1590/S1807-59322011000600012
- Xavier BLS, Hermógenes JFA, Ribeiro YC, Sá ACS, Ávila FMVP, Flores PVP. Senses and meanings of conservative treatment in people with chronic kidney disease. Aquichan. 2020;20(3):e2035. https://doi.org/10.5294/aqui.2020.20.3.5. DOI: https://doi.org/10.5294/aqui.2020.20.3.5
References
Ammirati AL. Chronic Kidney Disease. Rev. Assoc. Med. Bras. 2020;66(Suppl 1):S03-09. https://doi.org/10.1590/1806-9282.66.s1.3. DOI: https://doi.org/10.1590/1806-9282.66.s1.3
Eknoyan G. Chronic kidney disease definition and classification: the quest for refinements. Kidney Int. 2007;72(10):1183-5. https://doi.org/10.1038/sj.ki.5002576. DOI: https://doi.org/10.1038/sj.ki.5002576
Gorostidi M, Santamaría R, Alcázar R, Fernández-Fresnedo G, Galcerán JM, Goicoechea M, et al. Documento de la Sociedad Española de Nefrología sobre las guías KDIGO para la evaluación y el tratamiento de la enfermedad renal crónica. Nefrología. 2014;34(3): 302-16. https://doi.org/10.3265/Nefrologia.pre2014.Feb.12464.
Registro Español de Enfermos Renales. Sociedad Española de Nefrología [Internet]. 2019. [consultado 18 Feb 2021]. Disponible en: https://www.senefro.org/contents/webstructure/INFORME_REER_SEN_2020_WEB_SEN.pdf.
Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet. 2017;389(10075):1238-52. https://doi.org/10.1016/S0140-6736(16)32064-5. DOI: https://doi.org/10.1016/S0140-6736(16)32064-5
Balogun SA, Balogun R, Philbrick J, Abdel-Rahman E. Quality of Life, Perceptions, and Health Satisfaction of Older Adults with End-Stage Renal Disease: A Systematic Review. J Am Geriatr Soc. 2017;65(4):777-85. https://doi.org/10.1111/jgs.14659. DOI: https://doi.org/10.1111/jgs.14659
Gorostidi M, Sánchez-Martínez M, Ruilope LM, Graciani A, de la Cruz JJ, Santamaría R et Al. Prevalencia de enfermedad renal crónica en España: impacto de la acumulación de factores de riesgo cardiovascular. Nefrología. 2018;38(6):606-15. https://doi.org/10.1016/j.nefro.2018.04.004. DOI: https://doi.org/10.1016/j.nefro.2018.04.004
Ren Q, Shi Q, Ma T, Wang J, Li Q, Li X. Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review. Health Qual Life Outcomes. 2019;17(1):78. https://doi.org/10.1186/s12955-019-1146-5. DOI: https://doi.org/10.1186/s12955-019-1146-5
Davison SN, Levin A, Moss AH, Jha V, Brown EA, Brennan F, et al. Executive summary of the KDIGO controversies conference on supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care. Kidney Int. 2015;88:447-59. DOI: https://doi.org/10.1038/ki.2015.110
Murtagh FE, Burns A, Moranne O, Morton RL, Naicker S. Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease. Clin J Am Soc Nephrol. 2016;11(10):1909-14. https://doi.org/10.2215/CJN.04840516. DOI: https://doi.org/10.2215/CJN.04840516
O’Connor NR, Kumar P. Conservative management of end-stage renal disease without dialysis: a systematic review. J Palliat Med. 2012;15(2):228-35. https://doi.org/10.1089/jpm.2011.0207. DOI: https://doi.org/10.1089/jpm.2011.0207
García-Maseta R, Bovera J, Segura de la Morena J, Goicoechea Diezhandinoa M, Cebollada del Hoyo J, Escalada San Martín J, et al. Documento de consenso para la detección y el manejo de la enfermedad renal crónica. Nefrologia. 2022;42(3):233-64. DOI: https://doi.org/10.1016/j.nefro.2021.07.010
Teruel JL, BurgueraVion V, GomisCouto A, Rivera Gorrín M, Fernández-Lucas M, Rodríguez Mendiola N et al. Elección de tratamiento conservador en la enfermedad renal crónica. Nefrología. 2015;35(3): 273-9. Disponible en: https://doi.org/10.1016/j.nefro.2015.05.005. DOI: https://doi.org/10.1016/j.nefro.2015.05.005
Urrútia G, Bonfill X. La declaración PRISMA: un paso adelante en la mejora de las publicaciones de la Revista Española de Salud Pública [The PRISMA statement: a step in theimprovement of thepublications of the Revista Española de Salud Pública]. Rev Esp Salud Pública. 2013;87(2):99-102. https://doi.org/10.4321/S1135-57 DOI: https://doi.org/10.4321/S1135-57272013000200001
Von Elm E, Altman Douglas G., Egger M, Pocock SJ., Gøtzsche Peter C., VandenbrouckeJan P. Declaración de la iniciativa STROBE (StrengtheningtheReporting of ObservationalStudies in Epidemiology): directrices para la comunicación de estudios observacionales. Rev. Esp. Salud Pública. 2008;82(3):251-59. DOI: https://doi.org/10.1590/S1135-57272008000300002
Brown MA, Collett GK, Josland EA, Foote C, Li Q, Brennan FP. CKD in elderly patients managed without dialysis: survival, symptoms, and qualityoflife. Clin J Am Soc Nephrol. 2015;10(2):260-8. https://doi.org/10.2215/CJN.03330414. DOI: https://doi.org/10.2215/CJN.03330414
Verberne WR, Geers AB, Jellema WT, Vincent HH, van Delden JJ, Bos WJ. Comparative Survival among Older Adults with Advanced Kidney Disease Managed Conservatively Versus with Dialysis. Clin J Am Soc Nephrol. 2016;11(4):633-40. https://doi.org/10.2215/CJN.07510715. DOI: https://doi.org/10.2215/CJN.07510715
Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of life and survival in patients with advanced kidney failure managed conservatively or by dialysis. Clin J Am Soc Nephrol. 2012;7(12):2002-9. https://doi.org/10.2215/CJN.01130112. DOI: https://doi.org/10.2215/CJN.01130112
Raman M, Middleton RJ, Kalra PA, Green D. Outcomes in dialysis versus conservative care for older patients: A prospective cohort analysis of stage 5 Chronic Kidney Disease. PLoSOne. 2018; 13(10):e0206469. https://doi.org/10.1371/journal.pone.0206469. DOI: https://doi.org/10.1371/journal.pone.0206469
Morton RL, Webster AC, McGeechan K, Howard K, Murtagh FE, Gray NA, Kerr PG, Germain MJ, Snelling P. Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clin J Am Soc Nephrol. 2016;11(12):2195-2203. https://doi.org/10.2215/CJN.11861115. DOI: https://doi.org/10.2215/CJN.11861115
Verberne WR, Dijkers J, Kelder JC, Geers ABM, Jellema WT, Vincent HH, van Delden JJM, Bos WJW. Value-based evaluation of dialysis versus conservativecare in older patients with advanced chronic kidney disease: a cohort study. BMC Nephrol. 2018;19(1):205. https://doi.org/10.1186/s12882-018-1004-4. DOI: https://doi.org/10.1186/s12882-018-1004-4
Martínez Echevers Y, ToapantaGaibor NG, Nava Pérez N, Barbosa Martín F, Montes Delgado R, Guerrero Riscos MA. Supervivencia de pacientes de edad avanzada (≥70 años) con enfermedad crónica estadios 4-5: diálisis vs tratamiento conservador. Nefrología. 2016;36(3):283-91. http://dx.doi.org/10.1016/j.nefro.2015.11.006. DOI: https://doi.org/10.1016/j.nefro.2015.11.006
Chandna SM, Da Silva-Gane M, Marshall C, Warwicker P, Greenwood RN, Farrington K. Survival of elderly patients with stage 5 CKD: comparison of conservative management and renal replacement therapy. Nephrol Dial Transplant. 2011;26(5):1608-14. https://doi.org/10.1093/ndt/gfq630. DOI: https://doi.org/10.1093/ndt/gfq630
Van Loon IN,Goto NA, Boereboom FTJ, Verhaar MC, Bots ML, Hamaker ME. Quality of life after the initiation of dialysis or maximal conservative management in elderly patients: a longitudinal analysis of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study. BMC Nephrol. 2019;20(1):108. https://doi.org/10.1186/s12882-019-1268-3. DOI: https://doi.org/10.1186/s12882-019-1268-3
Kamar FB, Tam-Tham H, Thomas C. A Description of Advanced Chronic Kidney Disease Patients in a Major Urban Center Receiving Conservative Care. Can J Kidney Health Dis. 2017; https://doi.org/10.1177/2054358117718538. DOI: https://doi.org/10.1177/2054358117718538
Rubio Rubio MV, Lou Arnal LM, Gimeno Orna JA, Munguía Navarro P, Gutiérrez-Dalmau A, Lambán Ibor E et al. Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador, Nefrología. 2019;39(2):141-50. https://doi.org/10.1016/j.nefro.2018.07.009. DOI: https://doi.org/10.1016/j.nefro.2018.07.009
Iyasere O, Brown EA, Johansson L, Davenport A, Farrington K, Maxwell AP et al. Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis. Clin Kidney J. 2018;12(2):262-8. https://doi.org/10.1093/ckj/sfy059. DOI: https://doi.org/10.1093/ckj/sfy059
Seow YY, Cheung YB, Qu LM, Yee AC. Trajectory of quality of life for poor prognosis stage 5D chronic kidney disease with and without dialysis. Am J Nephrol. 2013; 37(3):231-8. https://doi.org/10.1159/000347220. DOI: https://doi.org/10.1159/000347220
Pereira RMP, Batista MA, Meira AS, Oliveira MP, Kusumota L. Quality of life of elderly people with chronic kidney disease in conservative treatment. Rev Bras Enferm. 2017;70(4):851-9. https://doi.org/10.1590/0034-7167-2017-0103. DOI: https://doi.org/10.1590/0034-7167-2017-0103
Aguilera Flórez AI, Alonso Rojo AC, Linares Fano B, Prieto Fidalgo S, García Martínez L, Prieto Velasco M. Valoración de la elección de tratamiento conservador en la Enfermedad Renal Crónica. Enferm Nefrol. 2019;22(1):52-8. http://dx.doi.org/10.4321/s2254-28842019000100008. DOI: https://doi.org/10.4321/S2254-28842019000100008
Ellam T, El-Kossi M, Prasanth KC, El-Najas M, Khwaja A. Conservatively managed patients with stage 5 chronic kidney disease-outcomes from a single center experience, QJM: An International Journal of Medicine. 2009;102(8):547-54. https://doi.org/10.1093/qjmed/hcp068. DOI: https://doi.org/10.1093/qjmed/hcp068
Carson RC, Juszczak M, Davenport A, Burns A. Is máximum conservative management an equivalent treatment option to dialysis for elderly patients with significant comorbid disease? Clin J Am Soc Nephrol. 2009;(10):1611-9. https://doi.org/10.2215/CJN.00510109. DOI: https://doi.org/10.2215/CJN.00510109
Murtagh FE, Marsh JE, Donohoe P, Ekbal NJ, Sheerin NS, Harris FE. ¿Diálisis o no? Estudio comparativo de supervivencia de pacientes mayores de 75 años con enfermedad renal crónica en estadio 5. Trasplante de Nephrol Dial. 2007;22(7):1955-62. https://doi.org/10.1093/ ndt/gfm153.
Smith C, Da Silva-Gane M, Chandna S, Warwicker P, Greenwood R, Farrington K. Elección de no dializar: evaluación del manejo planificado no dialítico en una cohorte de pacientes con insuficiencia renal en etapa terminal. Nephron Clin Pract. 2003;95(2):c40-6. https://doi.org/10.1159/000073708. DOI: https://doi.org/10.1159/000073708
Ruz MC, Andrade C, Urrutia M, Draibe S, Nogueira-Martins LA, SessoRde C. Quality of life in patients with chronic kidney disease. Clinics (Sao Paulo). 2011;66(6):991-5. https://doi.org/10.1590/s1807-59322011000600012. DOI: https://doi.org/10.1590/S1807-59322011000600012
Xavier BLS, Hermógenes JFA, Ribeiro YC, Sá ACS, Ávila FMVP, Flores PVP. Senses and meanings of conservative treatment in people with chronic kidney disease. Aquichan. 2020;20(3):e2035. https://doi.org/10.5294/aqui.2020.20.3.5. DOI: https://doi.org/10.5294/aqui.2020.20.3.5