Abstract: SA-PO710
Trajectories of Distress in Older Patients at Initiation of Haemodialysis
Session Information
- Geriatric Nephrology
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1100 Geriatric Nephrology
Authors
- Alston, Helen, Royal Free Hospital, London, LoNDON, United Kingdom
- Burns, Aine, Centre for Nephrology Royal Free NHS Trust, London, LONDON, United Kingdom
Background
Previous studies examined trajectories of functional status (Kurella Tamura et al, 2010; Murtagh et al, 2011) and trajectories of quality of life (da Silva Gane et al, 2012) at dialysis initiation.
We compared trajectories of functional status and distress in older patients before and after dialysis initiation.
Methods
We obtained records for 316 CKD4/5 patients aged <70 with ≥3 DTs and KPSs in their patient record. 23 started haemodialysis during the study period.
Linear regression analysed distress, KPS and other factors of interest at baseline. Multi-level regression analysed changes in DT and KPS score over time. Visual Graphical Analysis (VGA) assessed the trajectories of patients who started dialysis in the study period.
Results
For each 10% loss of functional performance on the KPS, DT score fell by 0.47 (p<0.001). The relationship between DT scores and factors such as gender, eGFR and age, was not statistically significant.
We identified 5 categories of DT trajectory:
1: increase in distress around the time of starting dialysis, returning to baseline levels of distress (psychological adaptation) after a couple of months
2: increase in distress around the time of starting dialysis, but with no return to baseline
3: unaffected by the start of dialysis – reported no distress at all
4: unaffected by start of dialysis because they were so distressed all the time that dialysis made no difference to their DT scores
5: unaffected by start of dialysis but experienced a rise in distress at other times.
Conclusion
A majority of participants experienced a rise in DT score around start of dialysis, and for some this did not return to baseline even after six months. However low eGFR was not associated with higher levels of distress. How do we reconcile this?
We found an association between functional status and distress, suggesting that the distressing aspects of dialysis initiation may be unrelated to declining kidney function, instead due to the impact of haemodialysis on their previous life.
Funding
- Private Foundation Support