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

2019 ◽  
Vol 20 (1) ◽  
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

scholarly journals The transition clinic in chronic kidney disease care

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii4-ii10 ◽  
Author(s):  
Marie Evans ◽  
Kai Lopau
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Patient Involvement ◽  
Decision Making Process ◽  
Shared Decision ◽  
Advanced Chronic Kidney Disease ◽  
Conservative Care ◽  
Transition Clinic ◽  
Chronic Kidney Disease Care

Abstract People with advanced chronic kidney disease and evidence of progression have a high risk of renal replacement therapy. Specialized transition clinics could offer a better option for preparing these patients for dialysis, transplantation or conservative care. This review focuses on the different aspects of such transition clinics. We discuss which patients should be referred to these units and when referral should take place. Patient involvement in the decision-making process is important and requires unbiased patient education. There are many themes, both patient-centred and within the healthcare structure, that will influence the process of shared decision-making and the modality choice. Aspects of placing an access for haemodialysis and peritoneal dialysis are reviewed. Finally, we discuss the importance of pre-emptive transplantation and a planned dialysis start, all with a focus on multidisciplinary collaboration at the transition clinic.

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 The Need for Accurate Risk Prediction Models for Road Mapping, Shared Decision Making and Care Planning for the Elderly with Advanced Chronic Kidney Disease

PRILOZI ◽  
2016 ◽  
Vol 37 (2-3) ◽  
pp. 33-42 ◽  
Author(s):  
Marijke Stryckers ◽  
Evi V Nagler ◽  
Wim Van Biesen
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Kidney Disease ◽  
Shared Decision Making ◽  
Risk Prediction ◽  
Prediction Models ◽  
Shared Decision ◽  
End Stage Kidney Disease ◽  
Risk Prediction Models ◽  
End Stage

AbstractAs people age, chronic kidney disease becomes more common, but it rarely leads to end-stage kidney disease. When it does, the choice between dialysis and conservative care can be daunting, as much depends on life expectancy and personal expectations of medical care. Shared decision making implies adequately informing patients about their options, and facilitating deliberation of the available information, such that decisions are tailored to the individual’s values and preferences. Accurate estimations of one’s risk of progression to end-stage kidney disease and death with or without dialysis are essential for shared decision making to be effective. Formal risk prediction models can help, provided they are externally validated, well-calibrated and discriminative; include unambiguous and measureable variables; and come with readily applicable equations or scores. Reliable, externally validated risk prediction models for progression of chronic kidney disease to end-stage kidney disease or mortality in frail elderly with or without chronic kidney disease are scant. Within this paper, we discuss a number of promising models, highlighting both the strengths and limitations physicians should understand for using them judiciously, and emphasize the need for external validation over new development for further advancing the field.

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 Dialysis or conservative care for frail older patients: ethics of shared decision-making

2013 ◽  
Vol 28 (11) ◽  
pp. 2717-2722 ◽  
Author(s):  
S. Muthalagappan ◽  
L. Johansson ◽  
W. M. Kong ◽  
E. A. Brown
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Conservative Care
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