Background and objectives: There is ongoing growth of elderly populations with ESRD in Western Europe and North America. In our center, we offer an alternative care pathway of 'maximum conservative management' (MCM) to patients who elect not to start dialysis, often because of a heavy burden of comorbid illness and advanced age. The objective of our study was to compare clinical outcomes for patients who had ESRD and chose either MCM or renal replacement therapy (RRT).Design, setting, participants, & measurements: This is an observational study of a single-center cohort in the United Kingdom that evaluating 202 elderly (>70 yr) patients who had ESRD and had chosen either MCM (n ‫؍‬ 29) or RRT (n ‫؍‬ 173). We report survival, hospitalization rates, and location of death for this cohort. Survival was measured from a standardized 'threshold' estimated GFR of 10.

WHAT THIS PAPER ADDSPatients with abdominal aortic aneurysm (AAA) often present with a significant burden of comorbidities and are likely to be frail. Low skeletal muscle mass, a surrogate of sarcopenia and indicator of frailty, has been associated with increased mortality and morbidity after surgery. The prognostic role of low skeletal muscle mass in the survival of patients with AAA undergoing open or endovascular repair was investigated by conducting a metaanalysis of bibliographic data. Patients with low skeletal muscle mass had a significantly higher risk of mortality. Further research is required to validate the use of body composition for risk prediction after aortic surgery.Objective/Background: Low psoas muscle mass is associated with increased mortality and morbidity after surgery. Recent evidence has linked low psoas muscle mass with survival after abdominal aortic aneurysm (AAA) repair. The aim of this study was to investigate the prognostic role of low skeletal muscle mass in survival of patients with AAA undergoing open or endovascular aneurysm repair (EVAR). Methods: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42018107793). The prognostic factor of interest was degenerative loss of skeletal muscle. A time-to-event data meta-analysis was performed for all cause mortality using the inverse variance method and the results were reported as summary hazard ratio (HR) and 95% confidence interval (CI). Pooled estimates of peri-operative outcome data were calculated using the odds ratio (OR) or risk difference (RD) and 95% CI. Random-effects models of meta-analysis were applied. Results: Seven observational cohort studies reporting a total of 1,440 patients were eligible for quantitative synthesis. Patients with low skeletal muscle mass had a significantly higher hazard of mortality than those without low skeletal muscle mass (HR 1.66, 95% CI 1.15e2.40; p ¼ .007). Subgroup analysis including only patients who underwent EVAR showed a marginal survival benefit for patients without low skeletal muscle mass (HR 1.86, 95% CI 1.00e3.43; p ¼ .05). Meta-analysis of two studies found no significant difference in peri-operative mortality (RD 0.04, 95% CI e0.13 to 0.21) and morbidity (OR 1.58, 95% CI 0.90e2.76; p ¼ .11) between patients with and without low skeletal muscle mass. Conclusion:There is a significant link between low skeletal muscle mass and mortality in patients undergoing AAA repair. Prospective studies validating the use of body composition for risk prediction after aortic surgery are required before this tool can be used to support decision making and patient selection.

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