P1458CONSERVATIVE MANAGEMENT VERSUS DIALYSIS IN ESKD PATIENTS WITH HIGH COMORBIDITY AND FRAILTY

Background and Aims ESKD population is increasingly older, frail and with cumulative comorbidities. Conservative management (CM) is a valid approach in selected cases but less well studied than the dialytic or transplant treatment. The objective of our study was to characterize our CM population and compare it with those who induced dialysis. Method We present a retrospective study from a tertiary hospital, from 2014-2019. A total of 379 patients presented with dialytic indication at hospital admission and out of these 15.3% (G1, n=58) were managed conservatively. They were characterized using the modified Charlson comorbidity index (mCCI) and Clinical Frailty Scale (CFS). A survival comparison was made between CM population (G1), those who were placed on dialysis (G2, n=321) and a subset of these (G3, n=43) who were older (≥75 years) and with higher level of disability (CFS >4 and mCCI > 4). Results CM population was older (G1 vs G2 p Conclusion In our study, dialysis prolonged survival for elderly ESKD patients with significant comorbidity and frailty. The choice between modalities was not an unmodifiable decision as evidenced by the number of patients in the CM group who had a vascular access. Despite these results we still believe that CM is an appropriate treatment option for whom dialytic therapy or transplantation is not expected to bring out benefit. A future focus on quality of life, psychosocial impact, and symptom burden, is needed to establish the true benefits of dialysis in these population.