Creating more awareness of alternative treatments for end stage renal disease
Professor Eric Finkelstein and his team from Duke-NUS Medical School conducted a study to better understand the primary factors behind the high rate of dialysis, in particular haemodialysis (HD), among elderly end-stage renal disease (ESRD) patients in Singapore.
The team administered a survey with 161 elderly patients with chronic kidney disease, and their family caregivers, at renal clinics in Singapore General Hospital. Their research, concluded in 2017, showed that more than half of the respondents were not aware of alternative treatments such as conservative management (CM), and had little idea of the differences between treatment options.
For elderly ESRD patients who are unlikely to receive a transplant, dialysis is typically the first line treatment. Patients can choose between HD, which takes place in a dialysis centre, or peritoneal dialysis (PD), which can be performed at home but on a more frequent basis.
The goal of CM is to optimize quality of life by using medication to maintain current kidney function, and to treat the symptoms of kidney failure, such as shortness of breath and poor appetite.
For patients aged 75 years and older with multiple comorbidities (additional diseases or disorders), the U.S. Renal Association and other international bodies consider CM to be a viable alternative to dialysis. This is mainly due to the lack of clear evidence showing a superior survival advantage of dialysis for this population subset. Compared to dialysis, CM patients also experience lower rates of hospitalisation, lower costs and a lower burden of disease.
One might therefore expect CM to be a common treatment choice for elderly ESRD patients with multiple comorbidities. Yet, in Singapore, as with many other developed countries, the vast majority receive dialysis due to various reasons such as the lack of knowledge about CM as a viable treatment option, affordability of dialysis due to subsidies, and caregivers overestimating the survival benefits of dialysis.
The team’s research revealed the importance of providing high-quality information tailored for elderly patients in an unbiased and objective manner. As a follow-up, the team is developing educational materials, such as a video and brochures, to aid elderly ESRD patients and their caregivers in making the right decision for treatment. The materials will convey the pros and cons of the different treatment options including CM.