Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis

Non-dialytic conservative care (CC) has been proposed as a treatment option for patients with kidney failure. This systematic review and meta-analysis aims to compare survival outcomes between dialysis and CC in studies where patients made an explicit treatment choice. Five databases were systematically searched from origin up to February 25th, 2021 for studies comparing survival outcomes among patients choosing dialysis versus CC. Adjusted and unadjusted survival rates were extracted and meta-analysis performed where applicable. Risk of bias analysis was performed according to the Cochrane Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I). Twenty-two cohort studies were included covering 21,344 patients. Most studies were prone to selection bias and confounding. Patients opting for dialysis were generally younger, had less comorbid conditions, functional impairments and frailty than patients who chose CC. Unadjusted median survival from treatment decision or eGFR