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Al-hakeim HK, Twaij BAA, Ahmed MH, Almulla AF, Moustafa SR, Maes M. In end-stage kidney disease, inflammation, erythron abnormalities and declined kidney function tests are accompanied by increased affective symptoms, chronic-fatigue, and fibromyalgia.. [DOI: 10.1101/2023.01.12.23284460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
AbstractBackgroundNumerous neuropsychiatric symptoms, including affective symptoms, chronic fatigue syndrome, and fibromyalgia symptoms, are present in patients with end-stage renal disease (ESRD). This study examines the relationship between neuropsychiatric symptoms and red blood cell (RBC) parameters, kidney function tests, zinc, C-reactive protein, and calcium levels in patients with ESRD.MethodsThe above biomarkers and the Beck-Depression Inventory, the Hamilton Anxiety Rating Scale, and the Fibro-Fatigue Rating Scale were measured in 70 patients with end-stage renal disease (ESRD) and 46 healthy controls.ResultsIncreased scores of depressive, anxious, cognitive, and physiosomatic symptoms (including chronic fatigue, fibromyalgia, and autonomous symptoms) characterise ESRD. One latent vector could be extracted from these diverse symptom domains, which are, therefore, manifestations of a common core referred to as the physio-affective phenome. The combined effects of aberrations in red blood cells (RBC) (number of RBC, hematocrit, and haemoglobin), kidney function tests (glomerular filtration rate, ureum, creatinine, albumin, and total serum protein), C-reactive protein, zinc, and copper explained 85.0% of the variance in the physio-affective phenome. In addition, the effects of kidney function decline on the phenome were partially mediated by RBC aberrations and elevated copper, whereas the effects of dialysis frequency were entirely mediated by decreased zinc and elevated CRP.ConclusionsAffective (depression and anxiety), cognitive, and physiosomatic symptoms due to ESRD are interrelated manifestations of the physio-affective phenome, which is driven by (in descending order of importance) kidney dysfunctions, erythron deficits, inflammation, elevated copper, and decreased zinc.
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Differential item functioning of the CAHPS® In-Center Hemodialysis Survey. Qual Life Res 2019; 28:3117-3135. [PMID: 31350653 DOI: 10.1007/s11136-019-02250-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE End-stage renal disease patients' experience of care is an integral part of the assessment of the quality of the care provided at hemodialysis centers and is needed to promote patient choice, quality improvement, and accountability. The purpose of this study is to evaluate the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS®) survey and its equivalence in different age, gender, race, and education subgroups. METHODS The ICH-CAHPS survey was administered to 1454 patients from 32 dialysis facilities. For the characteristics compared, the sample had 756 participants younger than 65 years old, 739 men, 516 Black, 567 White, and 970 with less than high school diploma. Three different patient experience constructs were studied including nephrologist's communication and caring, quality of care and operations, and providing information to patients. We used item response theory analysis to examine the possibility of differential item functioning (DIF) by patient age, gender, race, and education separately after controlling for the other DIF characteristics and additional confounding variables including survey mode, mental, and general health status as well as duration on dialysis. RESULTS The three constructs studied were unidimensional and no major DIF was observed on the composites. Some non-equivalences were observed when confounders were not controlled for, suggesting that such covariates can be important factors in understanding the possibility of disparity in patients' experience. CONCLUSIONS The ICH-CAHPS is a promising survey to elicit hemodialysis patients' experience that has good psychometric properties and provides a standardized tool for assessing age, gender, race, or education disparity.
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The Relationship between Health Literacy and General Health Level of Hemodialysis Patients: A Case Study in Iran. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.66034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Wang F, Lu X, Zhang J, Xiong R, Li H, Wang S. Effect of Lanthanum Carbonate on All-Cause Mortality in Patients Receiving Maintenance Hemodialysis: a Meta-Analysis of Randomized Controlled Trials. Kidney Blood Press Res 2018; 43:536-544. [PMID: 29627829 DOI: 10.1159/000488700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Hyperphosphatemia is common in patients on hemodialysis. The efficacy of lanthanum carbonate (LC) in the treatment of hyperphosphatemia in these patients remains controversial. The objective of this meta-analysis was to evaluate the effect of LC on all-cause mortality in patients on maintenance hemodialysis. METHODS We electronically searched the PubMed, EMBASE, and Cochrane Library databases for all randomized controlled trials (RCTs) comparing LC with other phosphate binders used in adult hemodialysis patients, including calcium carbonate, calcium acetate, and sevelamer. RESULTS Nine RCTs involving 2813 patients were suitable for inclusion. Our results showed that all-cause mortality was significantly lower in patients who received LC than in those who received standard therapy (odds ratio [OR]: 0.45, 95% confidence interval [CI]: 0.32-0.63, P<0.00001). Compared with the controls, patients who received LC had significantly lower serum calcium and higher serum intact parathyroid hormone levels. However, there was no significant difference between the groups in the cardiovascular event rate (OR: 0.58, 95% CI: 0.31-1.06, P=0.07) or in serum phosphorus levels. CONCLUSION Compared with standard therapy, LC reduced all-cause mortality in patients on hemodialysis but did not decrease the risk of cardiovascular events. The decrease in serum phosphorus level was similar between LC and the other phosphate binders, but the risk of hypercalcemia was lower in patients who received LC.
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Affiliation(s)
- Fang Wang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingli Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ruifang Xiong
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Bahall M. Use of complementary and alternative medicine by patients with end-stage renal disease on haemodialysis in Trinidad: A descriptive study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:250. [PMID: 28472987 PMCID: PMC5418726 DOI: 10.1186/s12906-017-1755-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 04/26/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Despite the paucity of scientific evidence, complementary and alternative medicine (CAM) is widely used for the prevention and treatment of illness, holistic care, and counteracting the adverse effects of conventional medicine (CM). This study investigates the use of CAM by patients with end-stage renal disease (ESRD) on haemodialysis. METHODS This quantitative study was conducted from November 1, 2014 to December 31, 2014 in the haemodialysis unit at San Fernando General Hospital (San Fernando, Trinidad). Face-to-face questionnaire-based interviews were held with101of 125 eligible patients (response rate, 80.5%) at the chairside during haemodialysis. The completed questionnaires were entered into a secure computer database. Data analysis included descriptive analysis, χ2 tests, and binary logistic regression analysis. RESULTS A minority of the patients were CAM users (n = 19; 18.8%). All 19 CAM users took medicinal herbs, 78.9% (n = 15) used spiritual therapy, and 10.5% (n = 2) used alternative systems. Medicinal tea (n = 15; 78.9%), garlic (Allium sativum) (n = 17; 73.7%), and ginger (Zingiber officinale roscoe) (n = 13; 68.4%) were the most commonly used medicinal herbs. Seven (36.8%) patients used Chinese herbal medicines and 3 (15.8%) patients used Aloe vera. All CAM users were willing to use CAM without supervision or monitoring by their doctors while receiving CM. The use of CAM could not be predicted by age, sex, ethnicity, education, religion, marital status, or employment. Nearly all (98%) patients were satisfied with CAM. More than one-third (36.8%) of patients did not disclose their use of CAM to their doctors, who were generally indifferent to such therapy. CONCLUSIONS The use of CAM by patients with ESRD was relatively infrequent. All patients used medicinal herbs, most patients used spiritual therapy, and a minority of patients used alternative systems. Complementary and alternative medicine was primarily used for spiritual reasons and the likelihood of its use was influenced by family, friends, and other patients. Patients continued using CM with one or more CAM therapies without informing their healthcare providers, which is a major health risk.
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Affiliation(s)
- Mandreker Bahall
- Arthur Lok Jack Graduate School of Business, University of the West Indies, St. Augustine, Trinidad and Tobago.
- School of Medicine, University of the West Indies, St. Augustine, Trinidad and Tobago.
- , House #57 , Calcutta Road Number 3, McBean, Couva, Trinidad, LP 62, Trinidad and Tobago.
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Stengel B, Combe C, Jacquelinet C, Briançon S, Fouque D, Laville M, Frimat L, Pascal C, Herpe YÉ, Morel P, Deleuze JF, Schanstra JP, Pisoni RL, Robinson BM, Massy ZA. Cohorte française Chronic Kidney Disease–Réseau Épidémiologie et Information en Néphrologie (CKD-REIN) : mieux connaître la maladie rénale chronique. Nephrol Ther 2016; 12 Suppl 1:S49-56. [DOI: 10.1016/j.nephro.2016.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kahrass H, Strech D, Mertz M. The Full Spectrum of Clinical Ethical Issues in Kidney Failure. Findings of a Systematic Qualitative Review. PLoS One 2016; 11:e0149357. [PMID: 26938863 PMCID: PMC4777282 DOI: 10.1371/journal.pone.0149357] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/29/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND When treating patients with kidney failure, unavoidable ethical issues often arise. Current clinical practice guidelines some of them, but lack comprehensive information about the full range of relevant ethical issues in kidney failure. A systematic literature review of such ethical issues supports medical professionalism in nephrology, and offers a solid evidential base for efforts that aim to improve ethical conduct in health care. AIM To identify the full spectrum of clinical ethical issues that can arise for patients with kidney failure in a systematic and transparent manner. METHOD A systematic review in Medline (publications in English or German between 2000 and 2014) and Google Books (with no restrictions) was conducted. Ethical issues were identified by qualitative text analysis and normative analysis. RESULTS The literature review retrieved 106 references that together mentioned 27 ethical issues in clinical care of kidney failure. This set of ethical issues was structured into a matrix consisting of seven major categories and further first and second-order categories. CONCLUSIONS The systematically-derived matrix helps raise awareness and understanding of the complexity of ethical issues in kidney failure. It can be used to identify ethical issues that should be addressed in specific training programs for clinicians, clinical practice guidelines, or other types of policies dealing with kidney failure.
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Affiliation(s)
- Hannes Kahrass
- Institute for History, Ethics and Philosophy in Medicine, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- Institute for History, Ethics and Philosophy in Medicine, Hannover Medical School, Hannover, Germany
| | - Marcel Mertz
- Institute for History, Ethics and Philosophy in Medicine, Hannover Medical School, Hannover, Germany
- Center for Ethics, University Hospital Cologne, Cologne, Germany
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Rezaiee O, Shahgholian N, Shahidi S. Assessment of hemodialysis adequacy and its relationship with individual and personal factors. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 21:577-582. [PMID: 28194196 PMCID: PMC5301063 DOI: 10.4103/1735-9066.197673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Hemodialysis is the most common renal replacement therapy in the world, and hemodialysis adequacy is an important and influencial factor in the reduction of various complications experienced by these patients. Multiple factors influence hemodialysis adequacy. This study was conducted to determine hemodialysis adequacy and its relationship with individual and personal factors in patients undergoing hemodialysis in three hemodialysis centers of Isfahan, Iran. Materials and Methods: This descriptive, cross-sectional study was conducted in partnership with 202 patients undergoing hemodialysis in three hemodialysis centers of Isfahan. The data were collected using a researcher-made questionnaire, and hemodialysis adequacy was measured using the urea reduction ratio (URR). Data analysis was conducted using Spearman's correlation coefficient, Mann–Whitney and Kruskal–Wallis tests, and descriptive statistics (frequency distribution). In this study, the level of significance was considered to be 0.05. Results: Hemodialysis adequacy in 56.4% of patients was optimal, in 29.7% near optimum, and in 13.9% less than optimal. Statistical tests showed a significant correlation between hemodialysis adequacy and age (P = 0.05), prehemodialysis systolic blood pressure (BP) (P = 0.02) and diastolic BP (P = 0.04), the duration of hemodialysis in months (P = 0.02), and patients’ sex (P = 0.01). There was no significant correlation between hemodialysis adequacy and the number of hemodialysis cessations per week (P = 0.20), interdialytic weight gain (P = 0.40), prehemodialysis blood urea nitrogen (P = 0.40), creatinine (P = 0.10), hemoglobin (P = 0.20), hematocrit (P = 0.08), venous access type (P = 0.30), needle distance and direction (P = 0.70), underlying causes of end-stage renal disease (P = 0.50), and personnel's shift (P = 0.90). Conclusions: The results of the study showed that approximately half of the patients did not have an optimal level of hemodialysis adequacy, and multiple individual and personnel factors affect hemodialysis adequacy directly or conversely.
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Affiliation(s)
- Ozra Rezaiee
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Shahgholian
- Department of Critical Care Nursing, Isfahan Kidney Diseases Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahrzad Shahidi
- Isfahan Kidney Diseases Research Center, School of Medicine, Isfahan, Iran
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Thorsteinsdottir B, Swetz KM, Albright RC. The Ethics of Chronic Dialysis for the Older Patient: Time to Reevaluate the Norms. Clin J Am Soc Nephrol 2015; 10:2094-9. [PMID: 25873266 DOI: 10.2215/cjn.09761014] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent research highlights the potential burdens of hemodialysis for older patients with significant comorbidities, for whom there is clinical equipoise regarding the net benefits. With the advent of accountable care and bundled payment, previous incentives to offer hemodialysis to as many patients as possible are being replaced with a disincentive to dialyze high-risk patients. While this may offset the harm of overtreatment for some elderly patients, some voice concerns that the pendulum will swing too far back, with a return to ageist rationing of hemodialysis. Nephrologists should ensure that the patient's rights to be informed about the potential benefits and burdens of hemodialysis are respected, particularly because age, functional status, nutritional status, and comorbidities affect the net balance between benefits and burdens. Nephrologists are also called on to help patients make a decision, for which the patient's goals of care guide determination of potential benefit from hemodialysis. This article addresses concerns about present overtreatment and future risk of undertreatment of older adults with ESRD. It also discusses ways in which providers can ethically approach the question of initiation of hemodialysis in the elderly patient by including patient-specific estimates of prognosis, shared decision-making, and the use of specialist palliative care clinicians or ethics consultants for complex cases.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Department of Medicine, Division of Primary Care Internal Medicine, Biomedical Ethics Program, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Keith M Swetz
- Division of General Internal Medicine, Biomedical Ethics Program, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Stengel B, Combe C, Jacquelinet C, Briançon S, Fouque D, Laville M, Frimat L, Pascal C, Herpe YE, Deleuze JF, Schanstra J, Pisoni RL, Robinson BM, Massy ZA. The French Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort study. Nephrol Dial Transplant 2014; 29:1500-7. [PMID: 24064325 PMCID: PMC4106639 DOI: 10.1093/ndt/gft388] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/05/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND While much has been learned about the epidemiology and treatment of end-stage renal disease (ESRD) in the last 30 years, chronic kidney disease (CKD) before the end-stage has been less investigated. Not enough is known about factors associated with CKD progression and complications, as well as its transition to ESRD. We designed the CKD-renal epidemiology and information network (REIN) cohort to provide a research platform to address these key questions and to assess clinical practices and costs in patients with moderate or advanced CKD. METHODS A total of 46 clinic sites and 4 renal care networks participate in the cohort. A stratified selection of clinic sites yields a sample that represents a diversity of settings, e.g. geographic region, and public versus for-profit and non-for-profit private clinics. In each site, 60-90 patients with CKD are enrolled at a routine clinic visit during a 12-month enrolment phase: 3600 total, including 1800 with Stage 3 and 1800 with Stage 4 CKD. Follow-up will continue for 5 years, including after initiation of renal replacement therapy. Data will be collected from medical records at inclusion and at yearly intervals, as well as from self-administered patient questionnaires and provider-level questionnaires. Patients will also be interviewed at baseline, and at 1, 3 and 5 years. Healthcare costs will also be determined. Blood and urine samples will be collected and stored for future studies on all patients at enrolment and at study end, and at 1 and 3 years in a subsample of 1200. CONCLUSIONS The CKD-REIN cohort will serve to improve our understanding of the biological, clinical and healthcare system determinants associated with CKD progression and adverse outcomes as well as of international variations in collaboration with the CKD Outcome and Practice Pattern Study (CKDopps). It will foster CKD epidemiology and outcomes research and provide evidence to improve the health and quality of life of patients with CKD and the performances of the healthcare system in this field.
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Affiliation(s)
- Bénédicte Stengel
- Inserm, U1018, CESP Centre for Research in Epidemiology and Population Health, Team 10, Diabetes, Obesity, and Chronic Kidney Disease Epidemiology Team, Villejuif, France
- Paris Sud Univ, UMRS 1018, Villejuif, France
| | - Christian Combe
- Department of Nephrology Transplantation Dialysis, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- Inserm, U1026, Univ Bordeaux Segalen, Bordeaux, France
| | | | - Serge Briançon
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
| | - Denis Fouque
- Nephrology Department, Centre Hospitalier LYON-SUD, Pierre-Bénite, France
- CarMeN, CENS and Univ Lyon, Lyon, France
| | - Maurice Laville
- Nephrology Department, Centre Hospitalier LYON-SUD, Pierre-Bénite, France
- CarMeN, CENS and Univ Lyon, Lyon, France
| | - Luc Frimat
- Clinical Epidemiology, Inserm CIC-EC, CHU de Nancy, Vandoeuvre-lès-Nancy, France
- Nephrology Department, CHU de Nancy, Vandoeuvre-lès-Nancy
| | - Christophe Pascal
- Jean Moulin Lyon 3 University, The Institute for Education and Research in Health Care and Social Service, Lyon, France
| | - Yves-Edouard Herpe
- Biobanque de Picardie, Amiens, France
- Centre Hospitalier Universitaire, Amiens, France
| | | | - Joost Schanstra
- Institute of Cardiovascular and Metabolic Disease, Inserm U1048, Toulouse, France
- Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Ron L. Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | - Ziad A. Massy
- Centre Hospitalier Universitaire, Amiens, France
- Inserm U1088, Amiens University Hospital, Amiens, France
- Nephrology Department, CHU Ambroise Pare, Boulogne, France
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Somma C, Trillini M, Kasa M, Gentile G. Managing end-stage renal disease in the elderly: state-of-the-art, challenges and opportunities. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/ahe.13.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Thorsteinsdottir B, Montori VM, Prokop LJ, Murad MH. Ageism vs. the technical imperative, applying the GRADE framework to the evidence on hemodialysis in very elderly patients. Clin Interv Aging 2013; 8:797-807. [PMID: 23847412 PMCID: PMC3700780 DOI: 10.2147/cia.s43817] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Treatment intensity for elderly patients with end-stage renal disease has escalated beyond population growth. Ageism seems to have given way to a powerful imperative to treat patients irrespective of age, prognosis, or functional status. Hemodialysis (HD) is a prime example of this trend. Recent articles have questioned this practice. This paper aims to identify existing pre-synthesized evidence on HD in the very elderly and frame it from the perspective of a clinician who needs to involve their patient in a treatment decision. Patients and methods A comprehensive search of several databases from January 2002 to August 2012 was conducted for systematic reviews of clinical and economic outcomes of HD in the elderly. We also contacted experts to identify additional references. We applied the rigorous framework of decisional factors of the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) to evaluate the quality of evidence and strength of recommendations. Results We found nine eligible systematic reviews. The quality of the evidence to support the current recommendation of HD initiation for most very elderly patients is very low. There is significant uncertainty in the balance of benefits and risks, patient preference, and whether default HD in this patient population is a wise use of resources. Conclusion Following the GRADE framework, recommendation for HD in this population would be weak. This means it should not be considered standard of care and should only be started based on the well-informed patient’s values and preferences. More studies are needed to delineate the true treatment effect and to guide future practice and policy.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Knowledge and Evaluation Research Unit, MN 55905, USA.
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Williams ME. Tough Choices: Dialysis, Palliative Care, or a Third Option for Elderly ESRD. Semin Dial 2012; 25:633-9. [DOI: 10.1111/sdi.12018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Dousdampanis P, Trigka K, Fourtounas C. Diagnosis and management of chronic kidney disease in the elderly: a field of ongoing debate. Aging Dis 2012; 3:360-72. [PMID: 23185717 PMCID: PMC3501392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 05/13/2024] Open
Abstract
Chronic kidney disease (CKD) is rather common in elderly adults who comprise the fastest growing subset of patients with end-stage renal disease (ESRD). At present, there are no specific guidelines and recommendations regarding early identification and management of elderly with CKD and the current CKD classification system may overestimate its exact prevalence. Screening strategies based either in a more accurate formula of estimation of GFR alone, or preferably in combination with proteinuria are urgently needed in order to raise awareness and to promote early diagnosis of CKD in the elderly. The number of elderly dialysis patients is also increasing and may lead to severe socio-economic problems worldwide. Both hemodialysis and peritoneal dialysis can sustain life, but present various disadvantages. There is a trend for home based dialysis therapies but the results are based on a small number of patients. Recent reports indicate that dialysis may not provide a clear benefit over non-dialysis regarding survival and quality of life issues, especially in the presence of extensive comorbidities. Current practices around the world regarding access to dialysis in the elderly are rather controversial, reflecting each country's health policies and ethical patterns. Although advanced age should not be considered as an absolute contraindication for kidney transplantation, it is not frequently offered in elderly ESRD patients due to the shortage of renal grafts. Global judgment of all physical and mental/psychological issues and full informed consent regarding possible complications are mandatory before listing elderly ESRD patients for kidney transplantation. As scientific evidence is rather scarce, there is an urgent need for prospective studies and an individualized approach for the diagnosis and treatment of the elderly CKD patients, in order to optimize care and improve quality of life in this special population.
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Affiliation(s)
| | | | - Costas Fourtounas
- Department of Internal Medicine- Nephrology, Patras University Hospital, Patras, Greece
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