Ismay N van Loon1,2,3, Namiko A Goto4, Franciscus T J Boereboom5,6, Michiel L Bots7, Ellen K Hoogeveen8, Laila Gamadia9, E F H van Bommel10, P J G van de Ven11, Caroline E Douma12, H H Vincent13, Yvonne C Schrama14, Joy Lips15, Machiel A Siezenga16, Alferso C Abrahams17, Marianne C Verhaar17, Marije E Hamaker18. 1. Dianet Dialysis Center, Utrecht, The Netherlands, i.n.vanloon@gmail.com. 2. Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands, i.n.vanloon@gmail.com. 3. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands, i.n.vanloon@gmail.com. 4. Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands. 5. Dianet Dialysis Center, Utrecht, The Netherlands. 6. Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands. 7. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Internal Medicine Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands. 9. Department of Internal Medicine Tergooi Hospital, Hilversum, The Netherlands. 10. Department of Internal Medicine Albert Schweitzer Hospital, Dordrecht, The Netherlands. 11. Department of Internal Medicine Maasstad Hospital, Rotterdam, The Netherlands. 12. Department of Internal Medicine Spaarne Gasthuis, Hoofddorp, The Netherlands. 13. Department of Internal Medicine Antonius Hospital, Nieuwegein, The Netherlands. 14. Department of Internal Medicine St. Franciscus Hospital, Rotterdam, The Netherlands. 15. Department of Internal Medicine Bernhoven Hospital, Uden, The Netherlands. 16. Department of Internal Medicine Gelderse Vallei Hospital, Ede, The Netherlands. 17. Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands. 18. Department of Geriatrics University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
BACKGROUND AND OBJECTIVES: A geriatric assessment (GA) is a structural method for identifying frail patients. The relation of GA findings and risk of death in end-stage kidney disease (ESKD) is not known. The objective of the GA in OLder patients starting Dialysis Study was to assess the association of GA at dialysis initiation with early mortality and hospitalization. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Patients ≥65 years old were included just prior to dialysis initiation. All participants underwent a GA, including assessment of (instrumental) activities of daily living (ADL), mobility, cognition, mood, nutrition, and comorbidity. In addition, a frailty screening (Fried Frailty Index, [FFI]) was applied. Outcome measures were 6- and 12-month mortality, and 6-month hospitalization. Associations with mortality were assessed with cox-regression adjusting for age, sex, comorbidity burden, smoking, residual kidney function and dialysis modality. Associations with hospitalization were assessed with logistic regression, adjusting for relevant confounders. RESULTS: In all, 192 patients were included, mean age 75 ± 7 years, of whom 48% had ≥3 geriatric impairments and were considered frail. The FFI screening resulted in 46% frail patients. Mortality rate was 8 and 15% at 6- and 12-months after enrolment, and transplantation rate was 2 and 4% respectively. Twelve-month mortality risk was higher in patients with ≥3 impairments (hazard ratio [HR] 2.97 [95% CI 1.19-7.45]) compared to less impaired patients. FFI frail patients had a higher risk of 12-month mortality (HR 7.22 [95% CI 2.47-21.13]) and hospitalization (OR 1.93 [95% CI 1.00-3.72]) compared to fit patients. Malnutrition was associated with 12-month mortality, while impaired ADL and depressive symptoms were associated with 12-month mortality and hospitalization. CONCLUSIONS: Frailty as assessed by a GA is related to mortality in elderly patients with ESKD. Individual components of the GA are related to both mortality and hospitalization. As the GA allows for distinguishing between frail and fit patients initiating dialysis, it is potentially of added value in the decision-making process concerning dialysis initiation.
BACKGROUND AND OBJECTIVES: A geriatric assessment (GA) is a structural method for identifying frail patients. The relation of GA findings and risk of death in end-stage kidney disease (ESKD) is not known. The objective of the GA in OLder patients starting Dialysis Study was to assess the association of GA at dialysis initiation with early mortality and hospitalization. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Patients ≥65 years old were included just prior to dialysis initiation. All participants underwent a GA, including assessment of (instrumental) activities of daily living (ADL), mobility, cognition, mood, nutrition, and comorbidity. In addition, a frailty screening (Fried Frailty Index, [FFI]) was applied. Outcome measures were 6- and 12-month mortality, and 6-month hospitalization. Associations with mortality were assessed with cox-regression adjusting for age, sex, comorbidity burden, smoking, residual kidney function and dialysis modality. Associations with hospitalization were assessed with logistic regression, adjusting for relevant confounders. RESULTS: In all, 192 patients were included, mean age 75 ± 7 years, of whom 48% had ≥3 geriatric impairments and were considered frail. The FFI screening resulted in 46% frail patients. Mortality rate was 8 and 15% at 6- and 12-months after enrolment, and transplantation rate was 2 and 4% respectively. Twelve-month mortality risk was higher in patients with ≥3 impairments (hazard ratio [HR] 2.97 [95% CI 1.19-7.45]) compared to less impaired patients. FFI frail patients had a higher risk of 12-month mortality (HR 7.22 [95% CI 2.47-21.13]) and hospitalization (OR 1.93 [95% CI 1.00-3.72]) compared to fit patients. Malnutrition was associated with 12-month mortality, while impaired ADL and depressive symptoms were associated with 12-month mortality and hospitalization. CONCLUSIONS: Frailty as assessed by a GA is related to mortality in elderly patients with ESKD. Individual components of the GA are related to both mortality and hospitalization. As the GA allows for distinguishing between frail and fit patients initiating dialysis, it is potentially of added value in the decision-making process concerning dialysis initiation.
Authors: M E Hamaker; C Seynaeve; A N M Wymenga; H van Tinteren; J W R Nortier; E Maartense; H de Graaf; F E de Jongh; J J Braun; M Los; J G Schrama; A E van Leeuwen-Stok; S M de Groot; C H Smorenburg Journal: Breast Date: 2013-12-05 Impact factor: 4.380
Authors: Juliette L Parlevliet; Bianca M Buurman; Marja M Hodac Pannekeet; Els M Boeschoten; Lucia ten Brinke; Marije E Hamaker; Barbara C van Munster; Sophia E de Rooij Journal: BMC Nephrol Date: 2012-05-30 Impact factor: 2.388
Authors: Patrick Peeters; Wim Van Biesen; Nic Veys; Wim Lemahieu; Bart De Moor; Johan De Meester Journal: BMC Nephrol Date: 2016-04-07 Impact factor: 2.388