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The trajectory of functional status of patients with kidney failure choosing conservative kidney management.
Doorn, W B; van Loon, I N; Boereboom, F T J; Hamaker, M E; Goto, N A.
Affiliation
  • Doorn WB; Department of Elderly Psychiatry, Altrecht, Utrecht, The Netherlands. wouterdoorn@gmail.com.
  • van Loon IN; Dianet Dialysis Center, Utrecht, The Netherlands.
  • Boereboom FTJ; Dianet Dialysis Center, Utrecht, The Netherlands.
  • Hamaker ME; Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
  • Goto NA; Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands.
Int Urol Nephrol ; 2024 Jul 16.
Article in En | MEDLINE | ID: mdl-39012581
ABSTRACT

PURPOSE:

In older patients with kidney failure (KF) starting dialysis, there is a high rate of functional decline. Not much is known about the functional trajectory of patients receiving conservative kidney management (CKM). Therefore, the aim of this study is to assess this functional trajectory and explore clinical parameters associated with functional decline.

METHODS:

The functional trajectory of patients choosing CKM was evaluated using data from the Geriatric Assessment in Older Patients Starting Dialysis (GOLD) study, which included patients aged ≥ 65 years with KF at the moment of decision-making. Functional status was assessed using a combined score for activities of daily living (ADL) and instrumental activities of daily living (iADL) dependency at baseline and after six months of follow-up. Change in functional status was divided into improvement (gain of one or more domains in functional status), stable (no change), decline (loss of one or more domains in functional status), and death at follow-up. The association between functional status at baseline and functional decline after six months was assessed with chi-squared test or Fisher's exact test. Furthermore, caregiver experiences were explored using self perceived pressure of informal care (SPPIC) at baseline and 6-month follow-up.

RESULTS:

Follow-up data were available for 86 patients. Mean age was 82 ± 6 years and 43% were women. At baseline, 12% of the patients were independent, 55% were mild/moderately dependent, and 34% severely dependent. After 6 months of follow-up, 9% of all patients had improved, 35% remained stable, 41% had declined, and 15% had died. No significant associations were found between baseline characteristics and the composite outcomes.

CONCLUSION:

In patients aged ≥ 65 years receiving CKM, functional decline and death are highly prevalent. No association was found between poor outcome ("decline/death") and different potential risk factors.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Int Urol Nephrol Year: 2024 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Int Urol Nephrol Year: 2024 Document type: Article