scholarly journals Value-based evaluation of dialysis versus conservative care in older patients with advanced chronic kidney disease: a cohort study

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Wouter R. Verberne ◽  
Janneke Dijkers ◽  
Johannes C. Kelder ◽  
Anthonius B. M. Geers ◽  
Wilbert T. Jellema ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Older Patients ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care

scholarly journals 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

2019 ◽  
Vol 12 (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.

scholarly journals Changing the choice for dialysis to conservative care or vice versa in older patients with advanced chronic kidney disease

2021 ◽  
Author(s):  
Carlijn G N Voorend ◽  
Wouter R Verberne ◽  
Mathijs van Oevelen ◽  
Yvette Meuleman ◽  
Marjolijn van Buren ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Older Patients ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care

scholarly journals Predicting mortality risk on dialysis and conservative care: development and internal validation of a prediction tool for older patients with advanced chronic kidney disease

2020 ◽  
Author(s):  
Chava L Ramspek ◽  
Wouter R Verberne ◽  
Marjolijn van Buren ◽  
Friedo W Dekker ◽  
Willem Jan W Bos ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Mortality Risk ◽  
Older Patients ◽  
Treatment Decision ◽  
Prediction Tool ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Ckd Stage

Abstract Background Conservative care (CC) may be a valid alternative to dialysis for certain older patients with advanced chronic kidney disease (CKD). A model that predicts patient prognosis on both treatment pathways could be of value in shared decision-making. Therefore, the aim is to develop a prediction tool that predicts the mortality risk for the same patient for both dialysis and CC from the time of treatment decision. Methods CKD Stage 4/5 patients aged ≥70 years, treated at a single centre in the Netherlands, were included between 2004 and 2016. Predictors were collected at treatment decision and selected based on literature and an expert panel. Outcome was 2-year mortality. Basic and extended logistic regression models were developed for both the dialysis and CC groups. These models were internally validated with bootstrapping. Model performance was assessed with discrimination and calibration. Results In total, 366 patients were included, of which 126 chose CC. Pre-selected predictors for the basic model were age, estimated glomerular filtration rate, malignancy and cardiovascular disease. Discrimination was moderate, with optimism-corrected C-statistics ranging from 0.675 to 0.750. Calibration plots showed good calibration. Conclusions A prediction tool that predicts 2-year mortality was developed to provide older advanced CKD patients with individualized prognosis estimates for both dialysis and CC. Future studies are needed to test whether our findings hold in other CKD populations. Following external validation, this prediction tool could be used to compare a patient’s prognosis on both dialysis and CC, and help to inform treatment decision-making.

Pretransplant Comprehensive Geriatric Assessment in Older Patients with Advanced Chronic Kidney Disease

Nephron ◽  
2021 ◽  
pp. 1-10
Author(s):  
Teddy Novais ◽  
Elodie Pongan ◽  
Frederic Gervais ◽  
Marie-Hélène Coste ◽  
Emmanuel Morelon ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Activities Of Daily Living ◽  
Physical Function ◽  
Comprehensive Geriatric Assessment ◽  
Daily Living ◽  
Older Patients ◽  
Advanced Chronic Kidney Disease ◽  
Comorbidity Burden

<b><i>Background:</i></b> 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. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

scholarly journals Outcomes in dialysis versus conservative care for older patients: A prospective cohort analysis of stage 5 Chronic Kidney Disease

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0206469 ◽  
Author(s):  
Maharajan Raman ◽  
Rachel J. Middleton ◽  
Philip A. Kalra ◽  
Darren Green
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Prospective Cohort ◽  
Older Patients ◽  
Cohort Analysis ◽  
Conservative Care

Management of advanced chronic kidney disease (CKD)

2021 ◽  
pp. 608-688
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Dialysis Patients ◽  
Medical Problems ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Number Of Patients ◽  
Essential Components ◽  
The World ◽  
Patients Experience

The number of patients with advanced kidney disease requiring dialysis is increasing in all parts of the world. Managing patients as they transition onto dialysis and providing support and guidance as they make important treatment choices are essential components of a nephrologist’s job. Ensuring timely preparation for dialysis, allowing patients the opportunity to explore all options, including conservative care, and managing individual expectations of dialysis are increasingly important. All nephrologists will manage patients treated with dialysis and therefore it is imperative that they have a sound understanding of different dialysis modalities, how to assess the adequacy of dialysis, and the commonly encountered medical problems dialysis patients experience.

scholarly journals Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031550 ◽  
Author(s):  
Austin G Stack ◽  
Michelle Elizabeth Johnson ◽  
Betina Blak ◽  
Alyssa Klein ◽  
Lewis Carpenter ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
International Classification Of Diseases ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Advanced Chronic Kidney Disease ◽  
National Cohort

ObjectiveEvaluate the association between gout and risk of advanced chronic kidney disease (CKD).DesignRetrospective matched cohort study.SettingUK Clinical Practice Research Datalink.ParticipantsThe analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged ≥18 years, registered at UK practices, had ≥12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.Primary and secondary outcome measuresAdvanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine from baseline and (4) death associated with CKD.ResultsAdvanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).ConclusionsGout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.

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