Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients

Bjorg Thorsteinsdottir,1 Victor M Montori,2 Larry J Prokop,3 Mohammad Hassan Murad2 1Division of Primary Care Internal Medicine, 2Division of General Internal Medicine, Knowledge and Evaluation Research Unit, 3Library Services, Mayo Clinic, Rochester, MN, USA Purpose: Treatment intensity for elderl...

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Autores principales:	Thorsteinsdottir B, Montori VM, Prokop LJ, Murad MH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	cost quality of life renal replacement therapy resource utilization survival symptom burden Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/fb82011eef8f4310ae620777905ae090
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spelling	oai:doaj.org-article:fb82011eef8f4310ae620777905ae0902021-12-02T08:27:18ZAgeism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients1178-1998https://doaj.org/article/fb82011eef8f4310ae620777905ae0902013-06-01T00:00:00Zhttps://www.dovepress.com/ageism-vs-the-technical-imperative-applying-the-grade-framework-to-the-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Bjorg Thorsteinsdottir,1 Victor M Montori,2 Larry J Prokop,3 Mohammad Hassan Murad2 1Division of Primary Care Internal Medicine, 2Division of General Internal Medicine, Knowledge and Evaluation Research Unit, 3Library Services, Mayo Clinic, Rochester, MN, USA Purpose: Treatment intensity for elderly patients with end-stage renal disease has escalated beyond population growth. Ageism seems to have given way to a powerful imperative to treat patients irrespective of age, prognosis, or functional status. Hemodialysis (HD) is a prime example of this trend. Recent articles have questioned this practice. This paper aims to identify existing pre-synthesized evidence on HD in the very elderly and frame it from the perspective of a clinician who needs to involve their patient in a treatment decision. Patients and methods: A comprehensive search of several databases from January 2002 to August 2012 was conducted for systematic reviews of clinical and economic outcomes of HD in the elderly. We also contacted experts to identify additional references. We applied the rigorous framework of decisional factors of the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) to evaluate the quality of evidence and strength of recommendations. Results: We found nine eligible systematic reviews. The quality of the evidence to support the current recommendation of HD initiation for most very elderly patients is very low. There is significant uncertainty in the balance of benefits and risks, patient preference, and whether default HD in this patient population is a wise use of resources. Conclusion: Following the GRADE framework, recommendation for HD in this population would be weak. This means it should not be considered standard of care and should only be started based on the well-informed patient's values and preferences. More studies are needed to delineate the true treatment effect and to guide future practice and policy. Keywords: cost, quality of life, renal replacement therapy, resource utilization survival, symptom burdenThorsteinsdottir BMontori VMProkop LJMurad MHDove Medical Pressarticlecostquality of liferenal replacement therapyresource utilization survivalsymptom burdenGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 8, Pp 797-807 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	cost quality of life renal replacement therapy resource utilization survival symptom burden Geriatrics RC952-954.6
spellingShingle	cost quality of life renal replacement therapy resource utilization survival symptom burden Geriatrics RC952-954.6 Thorsteinsdottir B Montori VM Prokop LJ Murad MH Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
description	Bjorg Thorsteinsdottir,1 Victor M Montori,2 Larry J Prokop,3 Mohammad Hassan Murad2 1Division of Primary Care Internal Medicine, 2Division of General Internal Medicine, Knowledge and Evaluation Research Unit, 3Library Services, Mayo Clinic, Rochester, MN, USA Purpose: Treatment intensity for elderly patients with end-stage renal disease has escalated beyond population growth. Ageism seems to have given way to a powerful imperative to treat patients irrespective of age, prognosis, or functional status. Hemodialysis (HD) is a prime example of this trend. Recent articles have questioned this practice. This paper aims to identify existing pre-synthesized evidence on HD in the very elderly and frame it from the perspective of a clinician who needs to involve their patient in a treatment decision. Patients and methods: A comprehensive search of several databases from January 2002 to August 2012 was conducted for systematic reviews of clinical and economic outcomes of HD in the elderly. We also contacted experts to identify additional references. We applied the rigorous framework of decisional factors of the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) to evaluate the quality of evidence and strength of recommendations. Results: We found nine eligible systematic reviews. The quality of the evidence to support the current recommendation of HD initiation for most very elderly patients is very low. There is significant uncertainty in the balance of benefits and risks, patient preference, and whether default HD in this patient population is a wise use of resources. Conclusion: Following the GRADE framework, recommendation for HD in this population would be weak. This means it should not be considered standard of care and should only be started based on the well-informed patient's values and preferences. More studies are needed to delineate the true treatment effect and to guide future practice and policy. Keywords: cost, quality of life, renal replacement therapy, resource utilization survival, symptom burden
format	article
author	Thorsteinsdottir B Montori VM Prokop LJ Murad MH
author_facet	Thorsteinsdottir B Montori VM Prokop LJ Murad MH
author_sort	Thorsteinsdottir B
title	Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
title_short	Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
title_full	Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
title_fullStr	Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
title_full_unstemmed	Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients
title_sort	ageism vs the technical imperative applying the grade framework to the evidence on hemodialysis in very elderly patients
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/fb82011eef8f4310ae620777905ae090
work_keys_str_mv	AT thorsteinsdottirb ageismvsthetechnicalimperativeapplyingthegradeframeworktotheevidenceonhemodialysisinveryelderlypatients AT montorivm ageismvsthetechnicalimperativeapplyingthegradeframeworktotheevidenceonhemodialysisinveryelderlypatients AT prokoplj ageismvsthetechnicalimperativeapplyingthegradeframeworktotheevidenceonhemodialysisinveryelderlypatients AT muradmh ageismvsthetechnicalimperativeapplyingthegradeframeworktotheevidenceonhemodialysisinveryelderlypatients
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Ageism vs the technical imperative applying the GRADE framework to the evidence on hemodialysis in very elderly patients

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