Drug-related problems in older patients with advanced chronic kidney disease identified during pretransplant comprehensive geriatric assessment

Background: In older patients with advanced chronic kidney disease (CKD), the decision of kidney transplantation (KT) is a challenge for nephrologists. The use of comprehensive geriatric assessment (CGA) is increasingly gaining interest into the process of decision-making about treatment modality choice for CKD. The aim of this study was to assess the prevalence of geriatric impairment and frailty in older dialysis and nondialysis patients with advanced CKD using a pretransplant CGA model and to identify geriatric impairments influencing the geriatricians’ recommendations for KT. Methods: An observational study was conducted with retrospective data from July 2017 to January 2020. Patients aged ≥65 years with advanced CKD, treated or not with dialysis, and referred by the nephrologist were included in the study. The CGA assessed comorbidity burden, cognition, mood, nutritional status, (instrumental) activities of daily living, physical function, frailty, and polypharmacy. Geriatric impairments influencing the geriatricians’ recommendations for KT were identified using univariate and multivariate logistic regressions. Results: 156 patients were included (74.2 ± 3.5 years and 62.2% on dialysis). Geriatric conditions were highly prevalent in both dialysis and nondialysis groups. The rate of geriatric impairments was higher in dialysis patients regarding comorbidity burden, symptoms of depression, physical function, autonomy, and frailty. Geriatrician’s recommendations for KT were as follows: favorable (79.5%) versus not favorable or multidisciplinary discussion needed with nephrologists (20.5%). Dependence for Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 3.01 and 95% confidence interval [CI] = 1.30–7.31), physical functions (OR = 2.91 and 95% CI = 1.08–7.87), and frailty (OR = 2.66 and 95% CI = 1.07–6.65) were found to be independent geriatric impairments influencing geriatrician’s recommendations for KT. Conclusions: Understanding the burden of geriatric impairment provides an opportunity to direct KT decision-making and to guide interventions to prevent functional decline and preserve quality of life.

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MO879PROPOSAL OF A GERIATRIC ASSESSMENT TAILORED FOR OLDER CHRONIC KIDNEY DISEASE PATIENTS: RESULTS OF A PRAGMATIC CONSENSUS-BASED APPROACH

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab100.004 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Carlijn Voorend ◽

Hanneke Joosten ◽

Noeleen Berkhout-Byrne ◽

Adry Diepenbroek ◽

Casper Franssen ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Geriatric Assessment ◽

Nurse Practitioners ◽

Older Patients ◽

Selection Criteria ◽

Clinical Care ◽

Consensus Meeting ◽

Advanced Chronic Kidney Disease ◽

Selection Of

Abstract Background and Aims Unidentified cognitive decline and other geriatric impairments are prevalent in older patients with advanced kidney disease. Despite guideline recommendation of geriatric evaluation, routine geriatric assessment is not common in these patients. While high burden of vascular disease and existing pre-dialysis care pathways mandate a tailored geriatric assessment, no consensus exists on which instruments are most suitable in this population to identify geriatric impairments. Therefore, the aim of this study was to propose a geriatric assessment, based on multidisciplinary consensus, for older people with advanced chronic kidney disease. Method A pragmatic approach was chosen to reach agreement on a suitable set of instruments to routinely identify major geriatric impairments in older patients with advanced chronic kidney disease. This approach included focus group meetings to identify criteria for the assessment, literature review to identify potential instruments, questionnaire to inventory currently used instruments, an expert consensus meeting to ensure that the selection of tests was based on input from clinical experience in nephrology and geriatrics, and pilot testing to ensure practicability. In preparation of the consensus meeting we composed a project team and an expert panel (n=33), drafted selection criteria for the selection of instruments, and assessed potential instruments for the test-set. Results Selection criteria related to general geriatric domains, clinical relevance, feasibility and duration of the assessment. The consensus-set contains instruments in functional, cognitive, psychological, somatic, patient preferences, nutritional status, and social domains (Figure 1). Administration of (seven) patient questionnaires and (ten) professional-administered instruments, by nurse (practitioners), takes estimated 20 and 40 minutes, respectively. Results are discussed in a multi-disciplinary meeting including at least nephrology and geriatric expertise, informing nephrology treatment decisions and follow-up interventions amongst which comprehensive geriatric assessment. Conclusion This first multi-disciplinary consensus on nephrology-tailored geriatric assessment intent to benefit clinical care and enhance research comparability for older patients with advanced chronic kidney disease. The proposed geriatric assessment is currently implemented in multiple hospitals and studies. Future initiatives and studies should provide insights on effectiveness, feasibility, patient’s satisfaction and, value for shared treatment decision making and outcome improvement.

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Older patients’ experiences with a shared decision-making process on choosing dialysis or conservative care for advanced chronic kidney disease: a survey study

BMC Nephrology ◽

10.1186/s12882-019-1423-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Wouter R. Verberne ◽

Wanda S. Konijn ◽

Karen Prantl ◽

Janneke Dijkers ◽

Margriet T. Roskam ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Decision Making ◽

Kidney Disease ◽

Shared Decision Making ◽

Older Patients ◽

Survey Study ◽

Decision Making Process ◽

Shared Decision ◽

Advanced Chronic Kidney Disease ◽

Conservative Care

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Comprehensive Geriatric Assessment among demented and non-demented patients with chronic kidney disease

The Egyptian Journal of Geriatrics and Gerontology ◽

10.21608/ejgg.2021.171719 ◽

2021 ◽

Vol 8 (1) ◽

pp. 35-43

Author(s):

ola Amr ◽

M.H El Banouby ◽

M Ibrahim ◽

Walaa W Aly ◽

Suzane Mounir Ali

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment

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Reanalysis of the physical and mental health summary scores of dialysis versus conservative care in older patients with advanced chronic kidney disease: a critical appraisal

BMC Research Notes ◽

10.1186/s13104-019-4765-3 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 1

Author(s):

Wouter R. Verberne ◽

Janneke Dijkers ◽

Johannes C. Kelder ◽

Wilbert T. Jellema ◽

Johannes J. M. van Delden ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Mental Component Summary ◽

Older Patients ◽

Critical Appraisal ◽

Advanced Chronic Kidney Disease ◽

Conservative Care ◽

Patient Cohort ◽

Sf 36 ◽

Scoring Algorithm

Abstract Objective Non-dialytic conservative care is argued to be a reasonable treatment alternative for dialysis in selected older patients with advanced chronic kidney disease. We evaluated patient-relevant outcomes including health-related quality of life in a previous study. However, the scoring algorithm we used to calculate the physical and mental component summary scores of the Short Form-36 (SF-36) turned out to differ from comparable studies on this topic. The aim of this critical appraisal was to reanalyze the SF-36 summary scores in our patient cohort (≥ 70 years) using the more widely used scoring algorithm. Results Patients on conservative care (n = 23) had lower physical and mental component summary scores compared to patients not yet started on dialysis (n = 39), but similar compared to patients on dialysis (n = 34). These findings were similar to our original findings and did not change the conclusions. Several scoring algorithms are used for the SF-36 summary scores. Researchers should be aware of this fact and should use the same scoring algorithm across similar studies in a specific field to increase comparability. Using the more widely used scoring algorithm, the recalculated SF-36 summary scores of our patient cohort can now be compared to other studies.

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Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease

BMC Geriatrics ◽

10.1186/s12877-021-02593-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

C. G. N. Voorend ◽

M. van Oevelen ◽

M. Nieberg ◽

Y. Meuleman ◽

C. F. M. Franssen ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Depressive Symptoms ◽

Kidney Disease ◽

Older Patients ◽

Mental Wellbeing ◽

Emotional Symptoms ◽

Advanced Chronic Kidney Disease ◽

Related Quality

Abstract Background Older patients with advanced chronic kidney disease are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease. Methods An ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May–June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally. Results The 82 included patients had a median age of 77.5 years (interquartile range 73.9–82.1), 77% were male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious about COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic. Compared to pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar. Conclusions Older patients with advanced chronic kidney disease suffered from disease-related anxiety about COVID-19, increased depressive symptoms and reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental wellbeing is important. Trial registration The study is registered at the Netherlands Trial Register (NTR), trial number NL7104. Date of registration: 06-06-2018.

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