A0650
Title: Target trial emulation to assess the effect of starting dialysis versus continuing medical management
Authors: Maria Montez Rath - Stanford University (United States) [presenting]
I-Chun Thomas - Veterans Affairs Palo Alto (United States)
Vivek Charu - Stanford University (United States)
Michelle Odden - Stanford University (United States)
Carolyn Dacey - Stanford University (United States)
Shipra Arya - Stanford University (United States)
Enrica Fung - Stanford University (United States)
Ann OHare - University of Washington (United States)
Susan Wong - University of Washington (United States)
Manjula Kurella Tamura - Stanford University (United States)
Abstract: For older adults who are not candidates for kidney transplantation, medical management is an alternative to lifelong dialysis, but little evidence is available to inform treatment decisions. As destination treatment, dialysis is intended to extend life and palliate symptoms. However, it also exposes patients to potential harms. In view of the potential risks and burdens of lifelong dialysis, medical management without dialysis is an alternative patient-centered treatment strategy. The national health care databases of the Department of Veterans Affairs are used to emulate a target trial of dialysis versus medical management in older adults with incident kidney failure who were not candidates for kidney transplantation. The restricted mean survival times are compared, and the results are contrasted to the expected number of days at home within three years of trial entry. Inverse probability weighting is used to estimate the analog of intention-to-treat and per-protocol analyses. Evidence of a modest survival benefit of starting dialysis is found compared to continuing medical management at the expense of fewer days at home, underscoring the importance of engaging patients in shared decision-making.
