Table 1 Table with Details of the Primary Studies Selected for Inclusion

Almutary, 2016, Saudi Arabia [42]

Non-dialysis group (CKD4 & CKM (CKD5))

Dialysis group (HD & PD)

Total group, 48.29 (± 14.86)

CKM, (CKD5), 51.84 ± 15.11

HD, 47.71 ± 14.46

PD, 43.08 ± 15.09

CKM (CKD5), 38

HD, 287

PD, 42

Symptom burden (CKD-SBI)

Dialysis vs. CKM (CKD5):

HD: 23.36 ± 16.99; PD: 12.04 ± 6.58, vs. CKM (CKD5): 8.1 ± 8.04; p < 0.001

Brown, 2015, Australia [29]

CKD4 & CKD5

CKM, 82 ± 9

Pre-dialysis, 69 ± 14

CKM, 122

Pre-dialysis, 273

HD, 55

PD, 37

Mortality

Dialysis vs. CKM, HR: 0.30 (95 % CI: 0.13–0.67); p = 0.003.

Symptom burden & Quality of life

No difference over time in groups.

Carson, 2009, UK [24]

CKD5

Age ≥ 70 at inclusion

CKM, mean 81.6; median 83

Dialysis, mean 76.4; median 75

CKM, 29

Dialysis, 173

Hospitalization rate

Hospital days/patient days survived:

CKM, 4.3 ± 0.26; RRT, 6.9 ± 0.71

Place of death

Home/hospice: CKM, 40 %; Dialysis 21 %,

Hospital: CKM, 36 %; Dialysis 70 %

Chandna,

2011, UK [40]

CKD5

CKM, 77.5 ± 7.6

Dialysis, 58.5 ± 15.0

CKM, 155

Dialysis, 689

Mortality

Mortality in patients aged > 75:

CKM vs. dialysis, HR: 1.18 (95 % CI: 0.79–1.76); p = 0.428.

Months of survival in patients with comorbidity score > 4: Dialysis, 25.8 ± 4.4(SE); CKM, 20.4 ± 2.4(SE); p = 0.83.

Da Silva-Gane, 2012, UK [3]

CKD4-5

HD, 60.6 ± 14.9

PD, 48.0 ± 15.6

CKM, 77.5 ± 6.5

CKM, 30

HD,80

PD, 44

Mortality

HD vs. CKM, HR 0.47 (95 % CI: 0.20–1.10); p = 0.08

PD vs. CKM, HR: 0.39 (95 % CI: 0.10–1.48); p = 0.17

Quality of life

No difference over time in groups.

Hussain,

2013, UK [39]

CKD5

Age > 70 at inclusion

CKM, 172

Dialysis, 269

Hospitalization

Dialysis vs. CKM, RR 1.6 (95 % CI: 1.14–2.25), p < 0.05.

Iyasere,

2019, UK [41]

CKD5

Median age (IQR)

CKM, 83 (80–88)

aAPD, 81 (79–88)

HD, 82 (78–85)

CKM, 28

HD, 28

PD, 28

Quality of life

SF-12, PCS: CKM, 28.9 ± 10.0; dialysis, 29.2 ± 8.3; p = 0.90

SF-12, MCS: CKM, 46.3 ± 12.1; dialysis, 49.9 ± 12.9; p = 0.28

Joly,

2003, France [23]

CKD4-5

Age ≥ 80 at inclusion

CKM, 84.1 ± 2.9

Dialysis, 83.2 ± 2.9

CKM, 43

Dialysis, 101

Mortality

CKM, 8.9 months (95 % CI: 4–10); dialysis, 28.9 months (95 % CI: 24–38); p < 0.0001

Kwok,

2016, Hong Kong [38]

CKD5

Age ≥ 65 at inclusion

CKM, 79.6 ± 6.8

Dialysis, 74.2 ± 6.1

CKM, 432

Dialysis, 126

Mortality

CKM, 10.0 months (95 % CI: 8.3–11.7); dialysis, 44.6 months (95 % CI: 37.3–51.9); p < 0.001.

Murtagh,

2007, UK [31]

CKD5

Age > 75 at inclusion

CKM, 81.36

Dialyse, 78,17

CKM, 77

Dialysis, 52

Mortality

CKM vs. dialysis, HR: 2.90 (95 % CI: 1.60–5.26);

In patients with comorbidity score > 2: Dialysis vs. CKM: log rank statistic < 0.001, df 1, p = 0.98, In patients with ischaemic heart disease: Dialysis vs. CKM: log rank statistic 1.46, df 1, p < 0.27.

Raman,

2018, UK [22]

CKD5

Dialysis, 78.9 ± 2.8

CKM, 83.7 ± 4.2

CKM, 81

Dialysis, 123

1-year survival

Dialysis vs. CKM, OR 0.38 (95 % CI: 0.09–1.60); p = 0.19

Hospitalization

Number of admission days (median (IQR)):

CKM, 0.8 (0.0-8.7); dialysis, 2.2 (0.7–14.7); p = 0.005.

Reindl-Schwaighofer, 2017, Austria [37]

CKD5

Age > 65 at inclusion

HD, 74.06 ± 5.78

CKM, 81.22 ± 7.23

CKM, 174

HD, 8622

Mortality

HD vs. CKM, HR: 0.23 (95 % CI: 0.18–0.29); p < 0.001.

Seow, 2013, Singapore [30]

CKD5

Median age (IQR):

CKM, 78 (40–70)

Dialysis, 71 (50–80)

CKM, 63

Dialysis, 38

Quality of life

No difference over time in groups.

Shah,

2019, Australia & UK [43]

CKD5

Age ≥ 75 at inclusion

Median age (IQR):

Dialysis, 81 (78–84)

CKM, 83 (81–87)

Age ≤ 81, n (%):

Dialysis, 50 (6)

CKM, 19 (41)

Age > 81, n (%):

Dialysis, 33 (40)

CKM, 27 (59)

CKM, 46

Dialysis, 83

Quality of life

Dialysis vs. CKM, adjusted differences in KDQOL-36 scores (95 % CI):

KDQOL-burden of disease: -28.59 (-41.77 to -15.42); p < 0.001

KDQOL-symptoms of disease: -5.93 (-14.61 to 2.73); p = 0.18

KDQOL-effects of disease: -16.49 (-25.98 to -6.99); p < 0.001

Shum,

2014, Hong Kong [36]

CKD5

Age 65–90 at inclusion

Overall age, 73.8 ± 5.4

CKM, 75.3 ± 5.7

PD, 73.4 ± 5.3

CKM, 42

PD, 157

Mortality

PD vs. CKM, HR: 0.46 (95 % CI 0.31–0.68), p < 0.001.

Hospitalization

Days per person year, median [IQR]

PD, 16.17 [6.29–43.32] vs. CKM, 38.01 [6.75–76.56]; p = 0.03

Smith,

2003, UK [25]

CKD5

CKM (palliative care population), 71 ± 12; Dialysis, 59 ± 15

CKM, 63

Dialysis, 258

Mortality

Dialysis, median survival 8.3 months; CKM, median survival 6.3 months; N.S.

Place of death

Deaths at home or in a hospice: CKM, 22 of 34 deaths (65 %)

Dialysis, 11 of 41 deaths (27 %); p = 0.001

Tam-Tham,

2018, Canada [35]

CKD5

Age ≥ 65 at inclusion

Age 65 to < 75 (n, %)

Dialysis, 228 (45.6)

CKM, 45 (13.3)

Age 75 to < 85 (n, %)

Dialysis, 220 (44.0)

CKM, 143 (42.3)

Age ≥ 85 (n, %)

Dialysis, 52 (10.4)

CKM, 150 (44.4)

CKM, 338

Dialysis, 500

Mortality

Dialysis vs. CKM (0–3 years), HR: 0.56 (95 % CI: 0.44–0.71); p < 0.001

Dialysis vs. CKM (after 3 years), HR: 1.98 (95 % CI: 1.16–3.37); p = 0.12

Hospitalization

Dialysis vs. CKM, HR: 1.40 (95 % CI: 1.16–1.69), p = 0.001

Tan,

2017, Australia [27]

CKD5

Age > 65 at inclusion

CKM, 84

Dialysis, 73

CKM, 8

Dialysis, 12

Symptom burden

Change (improvement) in mean symptom POS-score over 6 months: CKM, 1.5; dialysis, 7.58; p < 0.002.

Teo,

2010, Singapore [26]

CKD5

CKM, 67.4 ± 11.8

HD, 58.7 ± 12.9

CKM, 16

HD, 102

Mortality

CKM, HR: 2.29 (95 % CI: 1.16–4.45); HD, HR: 0.59 (95 % CI: 0.33–1.05); p = 0.042

Teruel,

2015, Spain [34]

CKD5

Median age (IQR)

Dialysis, 68 (54,76)

CKM, 83 (78,86)

CKM, 90

Dialysis, 142

Mortality

CKM, 8.2/100 patient months; Dialysis, 0.6/100 patient months;

p < 0.001

van Loon,

2019, the Netherlands [21]

CKD5

Age ≥ 65 at inclusion

CKM, 82 ± 6

Dialysis, 75 ± 7

CKM, 89

Dialysis, 192

12-month survival

CKM vs. dialysis,

HR: 2.12 (95 % CI: 1.12–4.03); p = 0.02

In patients < 80 years old,

HR: 5.05 (95 % CI: 1.90–13.50); p < 0.01

In patients ≥ 80 years old,

HR: 1.30 (95 % CI: 0.58–2.91); p = 0.53

Six-month quality of life

EQ-5D Index, mean (SE) change within group:

CKM, 0.047 (0.022); p < 0.01

Dialysis, 0.026 (0.014); p = 0.10

Between group difference, p < 0.01

Hospitalization

Median number [IQR] of admissions:

CKM, 1 [1-5]; Dialysis, [1-4]; p = 0.27

Hospitalization

Median number [IQR] of admission days:

Dialysis, 7 [3-15]; CKM, 4 [2-12]; p = 0.22

Verberne,

2018, the Netherlands [33]

CKD5

CKM, 82.6 ± 4.5

Dialysis, 76.2 ± 4.4

CKM, 126

Dialysis, 240

Mortality

CKM vs. dialysis, HR: 1.67 (95 % CI: 1.19–2.35), p = 0.003

Median [IQR] survival in years in patients ≥ 70 years old:

CKM, 1.3 [0.5–2.5]; dialysis, 3.1 [1.7–6.4]; p < 0.001

Median [IQR] survival in years in patients ≥ 80 years old:

CKM, 2.3 [1.3–3.7]; dialysis, 2.9 [1.9-6.0]; p = 0.13

Quality of life

No difference between groups

Verberne,

2016, the Netherlands [32]

CKD5

CKM, 83 ± 4.5

Dialysis, 76 ± 4.4

CKM, 107

Dialysis, 204

Mortality

Dialysis vs. CKM, HR: 0.62 (95 % CI: 0.42–0.92), p = 0.02.

Median [IQR] survival in years in patients ≥ 80 years old:

CKM, 1.4 [0.7-3.0]; dialysis, 2.1 [1.5–3.4]; p = 0.08.

Yong,

2009, Hong Kong [44]

CKD5

CKM, 73.1 ± 7.1

Dialysis, 58.2 ± 11.4

CKM, 45

Dialysis, 134

Symptom burden

Number of symptoms

CKM, 8.2 ± 3.9; dialysis 9.3 ± 4.7, p = 0.243

Yuen,

2016, Hong Kong [28]

CKD5

CKM, 76.8 ± 9.1

Dialysis, 58.6 ± 12.6

CKM, 335

Dialysis, 265

One-year survival (%)

CKM, 57.3 ± 2.9; dialysis, 89.7 ± 2.1

3-year survival (%)

CKM, 16 ± 2.7; dialysis, 74.6 % ± 3.4