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Kidney Week

Abstract: SA-PO742

Prognostic Value of a Geriatric Assessment in Older Patients Starting Dialysis

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

  • Van Loon, Ismay N., Dianet Dialysis Center, Utrecht, Netherlands
  • Goto, Namiko Anna, University Medical Center Utrecht, Utrecht, Netherlands
  • Boereboom, Frans T.J., Dianet Dialysis Center, Utrecht, Netherlands
  • Verhaar, Marianne C., University Medical Center Utrecht, Utrecht, Netherlands
  • Hamaker, Marije, Diakonessenhuis, Utrecht, Netherlands
Background

A geriatric assessment (GA) is a structural method for identifying frail patients. The prognostic value of a GA in end-stage kidney disease (ESKD) is not known. The subject of the GOLD (Geriatric assessment in OLder patients starting Dialysis) Study was to assess the relation of GA at dialysis initiation with poor outcome.

Methods

Patients ≥65 years old were included just prior to dialysis initiation. All underwent a GA, including assessment of ADL, instrumental (i)ADL, mobility, cognition, mood, nutrition, comorbidity, and a frailty screening (Fried Frailty Index, FFI). Quality of life (QoL) was scored with the visual analogue scale of the EuroQol-D5 (ranging from 0 [poor] to 10 [good]). Outcome measures were 6-and 12-months mortality, and 6-month hospitalization and change in QoL. Mortality was assessed with cox-regression and hospitalization with logistic regression, adjusting for age, sex and comorbidity.

Results

192 patients were included, mean age 75±7 years, of whom 48% had ≥ 3 geriatric impairments and were considered frail. Mortality rate was 8% and 15% for 6-and 12-months. ADL, depressive symptoms and malnutrition were significantly related to 1-year mortality. Compared to non-frail patients, 1-year mortality risk was higher in patients with ≥ 3 impairments (HR 2.61 [95%CI 1.14-5.98]). Frailty was associated with lower baseline QoL (6.0±1.4 vs. 6.6±1.4, p=0.01), but not with 6-month change (overall improvement +0.3±1.4, p<0.01). Depressive symptoms, ADL and iADL were associated with hospitalization, but overall GA was not. Screening for frailty with the FFI resulted in 44% frail patients and FFI was related to mortality (HR 4.5 [95%CI 1.44-14.36) and hospitalization (OR 1.93 [95%CI 1.00-3.72]).

Conclusion

Geriatric impairment at dialysis initiation is related to mortality, hospitalization and QoL. A GA offers the advantage of both risk assessment and identification of potential targets for intervention and improving QoL. Whether these results contribute to decision-making in the pre-dialysis population should be the subject of further research.

Funding

  • Private Foundation Support