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The Factors Affecting Survival in Geriatric Hemodialysis Patients. Int J Nephrol 2018; 2018:5769762. [PMID: 30112210 PMCID: PMC6077547 DOI: 10.1155/2018/5769762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/27/2018] [Accepted: 06/21/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction The number of geriatric patients is increasing in hemodialysis population over the years and mortality is higher in this group of patients. This study evaluated the factors affecting geriatric hemodialysis patient survival. Materials and Methods This retrospective cohort study enrolled patients discharged from our nephrology clinic from 2009 to 2014. Data collected included demographics, Eastern Cooperative Oncology Group-Performance Status, vascular access type, and metabolic parameters. Comorbidity was quantified using the modified Liu comorbidity index. The outcome measure was mortality. Results The study enrolled 99 elderly dialysis patients (42.4% women (n = 42); mean age 75 ± 7 years). The mean follow-up duration was 19.7 ± 11 months. The mortality rate over the four years was 47.5% (n = 46). The modified Liu comorbidity index score, patient age, and Eastern Cooperative Oncology Group-Performance Status were significantly related to mortality in univariate and multivariate analyses. Conclusion The present study revealed that comorbidities and low performance status at the onset of dialysis had shortened the survival time in the geriatric hemodialysis patient group.
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Effiong A, Shinn L, Pope TM, Raho JA. Advance care planning for end-stage kidney disease. Hippokratia 2016. [DOI: 10.1002/14651858.cd010687.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andem Effiong
- United States Department of Health and Human Services; 10903 New Hampshire Avenue Silver Spring Maryland USA 20993
- Georgetown University School of Medicine; Washington DC USA
- Union Graduate College - Icahn School of Medicine at Mount Sinai; Mount Sinai New York USA
| | - Laura Shinn
- Rowan University; Political Science and Economics; Glassboro New Jersey USA
| | - Thaddeus M Pope
- Hamline University School of Law; Health Law Institute; MS-D2017 1536 Hewitt Ave Saint Paul Minnesota USA 55104-1237
| | - Joseph A Raho
- Universita di Pisa; Department of Philosophy; Visa Fabio Filzi, 35 Pisa Italy 56123
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van Biesen W, van de Luijtgaarden MWM, Brown EA, Michel JP, van Munster BC, Jager KJ, van der Veer SN. Nephrologists' perceptions regarding dialysis withdrawal and palliative care in Europe: lessons from a European Renal Best Practice survey. Nephrol Dial Transplant 2015; 30:1951-8. [PMID: 26268713 DOI: 10.1093/ndt/gfv284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is a variation in dialysis withdrawal rates, but reasons for this variation across European countries are largely unknown. We therefore surveyed nephrologists' perceptions of factors concerning dialysis withdrawal and palliative care and explored relationships between these perceptions and reports of whether withdrawal actually occurred in practice. METHODS We developed a 33-item electronic survey, disseminated via an email blast to all European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) members. In our data analyses, we distinguished those respondents who reported occurrence from those reporting no dialysis withdrawal in their unit. With multilevel logistic regression, we investigated the association between respondents' characteristics and perceptions and whether they reported occurrence of dialysis withdrawal or not. RESULTS Five hundred and twenty-eight nephrologists from 45 countries completed the questionnaire; 42% reported occurrence of withdrawal in their unit in the past year, and 56% perceived that stopping life-prolonging treatment in terminally ill patients was allowed. Few respondents reported presence in their unit of protocols on withdrawal decision making (7%) or palliative care (10%) or the common involvement of a geriatrician in withdrawal decisions (10%). The majority stated that palliative care had not been part of their core curriculum (74%) and that they had not recently attended continuous medical education sessions on this topic (73%). Respondents from Eastern and Southern Europe had a 42 and 40% lower probability, respectively, of reporting withdrawal compared with those from North European countries. Working in a public centre [odds ratio (OR), 2.41; 95% confidence interval (CI), 1.36-4.25] and respondents' perception that stopping life-prolonging treatment in terminally ill patients was allowed (OR, 1.96; 95% CI, 1.23-3.12), that withdrawal decisions were commonly shared between doctor and patient (OR, 1.97; 95% CI, 1.26-3.08) and that palliative care was reimbursed (OR, 1.81; 95% CI, 1.16-2.83) increased the odds of reporting occurrence of withdrawal. CONCLUSION Reports of dialysis withdrawal occurrence varied between European countries. Occurrence reports were more likely if respondents worked in a public centre, if stopping life-prolonging treatments was perceived as allowed, if withdrawal decisions were considered shared between doctors and patients and if reimbursement of palliative care was believed to be in place. There is room for improvement regarding protocols on withdrawal and palliative care processes and regarding nephrologists' training and education on end-of-life care.
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Affiliation(s)
- Wim van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium European Renal Best Practice (ERBP) Methods Support Team, Ghent University Hospital, Ghent, Belgium
| | - Moniek W M van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Jean-Pierre Michel
- Département de Réhabilitation et Gériatrie, Hôpitaux Universitaires de Genève-Suisse, Geneva, Switzerland
| | - Barbara C van Munster
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands Department of Geriatric Medicine, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sabine N van der Veer
- European Renal Best Practice (ERBP) Methods Support Team, University Hospital Ghent, Ghent, Belgium Health e-Research Centre, Institute of Population Health, University of Manchester, Manchester, UK
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Noble HR, Agus A, Brazil K, Burns A, Goodfellow NA, Guiney M, McCourt F, McDowell C, Normand C, Roderick P, Thompson C, Maxwell AP, Yaqoob MM. PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis. BMC Nephrol 2015; 16:104. [PMID: 26163382 PMCID: PMC4499188 DOI: 10.1186/s12882-015-0084-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/04/2015] [Indexed: 11/23/2022] Open
Abstract
Background The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. Methods In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to ‘opt-in’ with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. Discussion The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.
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Affiliation(s)
- Helen Rose Noble
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK.
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Medical Biology Centre: 97 Lisburn Rd, BT9 7BL, Belfast, UK
| | - Aine Burns
- Royal Free Hospital, Pond Street, London, NW3 2QN, UK.
| | - Nicola A Goodfellow
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Mary Guiney
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Fiona McCourt
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, 1st Floor Elliott Dynes Building, Royal Hospitals, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Charles Normand
- Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Paul Roderick
- University of Southampton, Mailpoint 805, C floor, South Academic Block, Southampton General Hospital, Southampton, SO166YD, UK.
| | | | - A P Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast & Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK.
| | - M M Yaqoob
- William Harvey Research Institute, Queen Mary University of London, London & Renal Unit, The Royal London Hospital, London, E1 1BB, UK.
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Kan WC, Wang JJ, Wang SY, Sun YM, Hung CY, Chu CC, Lu CL, Weng SF, Chio CC, Chien CC. The new comorbidity index for predicting survival in elderly dialysis patients: a long-term population-based study. PLoS One 2013; 8:e68748. [PMID: 23936310 PMCID: PMC3735534 DOI: 10.1371/journal.pone.0068748] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 06/03/2013] [Indexed: 12/21/2022] Open
Abstract
Background The worldwide elderly (≥65 years old) dialysis population has grown significantly. This population is expected to have more comorbid conditions and shorter life expectancies than the general elderly population. Predicting outcomes for this population is important for decision-making. Recently, a new comorbidity index (nCI) with good predictive value for patient outcomes was developed and validated in chronic dialysis patients regardless of age. Our study examined the nCI outcome predictability in elderly dialysis patients. Methods and Findings For this population-based cohort study, we used Taiwan's National Health Insurance Research Database of enrolled elderly patients, who began maintenance dialysis between January 1999 and December 2005. A total of 21,043 incident dialysis patients were divided into 4 groups by nCI score (intervals ≤3, 4–6, 7–9, ≥10) and followed nearly for 10 years. All-cause mortality and life expectancy were analyzed. During the follow-up period, 11272 (53.55%) patients died. Kaplan-Meier curves showed significant group difference in survival (log-rank: P<0.001). After stratification by age, life expectancy was found to be significantly longer in groups with lower nCI scores. Conclusion The nCI, even without the age component, is a strong predictor of mortality in elderly dialysis patients. Because patients with lower nCI scores may predict better survival, more attention should paid to adequate dialysis rather than palliative care, especially in those without obvious functional impairments.
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Affiliation(s)
- Wei-Chih Kan
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
- Southern Taiwan University, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan
| | - Shuo-Yu Wang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yih-Min Sun
- Department of Occupational Safety and Health, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chien-Ya Hung
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Li Lu
- Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurological Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chih-Chiang Chien
- Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
- * E-mail:
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