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Kidney Week

Abstract: SA-PO743

Quality of Life After Initiation of Dialysis or Maximal Conservative Management

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

Maximal conservative management (MCM) may be an appropriate option for dialysis in some elderly patients with end stage kidney disease (ESKD). Whether MCM offers a better quality of life (QoL) compared to dialysis is not known. In the GOLD (Geriatric assessment in OLder patients starting Dialysis) Study the trajectory of QoL was assessed in patients starting dialysis or MCM.

Methods

Patients ≥65 years old were included just prior to dialysis initiation or after decision for MCM. Baseline data included demographics, QoL (EuroQol-D5 visual analogue scale [VAS], 0[poor]-10[good]) and geriatric impairment: mobility, (instrumental)ADL, mood, cognition, nutrition and comorbidity. Six-months follow-up data included QoL, mortality and hospitalizations. In both groups, logistic regression was used to assess the relation between impairment and deterioration of QoL (≥1 point), adjusting for age, sex, comorbidity and baseline QoL.

Results

The cohort comprised 192 dialysis (23% PD) and 88 MCM patients. The MCM patients were older (mean age 82±6 vs. 75±7 years, p< 0.01) and mean kidney function was better (eGFR 11.5±4.0 vs. 8.0±2.9 ml/min/1.73m2, p<0.01). In both groups, poorer QoL was significantly associated with impairment in (i)ADL, mobility and mood; in dialysis patients also with comorbidity. Baseline QoL did not differ between dialysis and MCM (6.3±1.3 vs.6.3±1.4 respectively; p=0.91) and change in QoL was +0.3±1.4 (p< 0.01) and -0.4±1.4 (p<0.01) respectively. At 6 months follow-up, 8% of patients starting dialysis had died and Qol in 23% deteriorated, while 40% showed improved QoL. This was 18%, 31% and 15% respectively in MCM. Impairments were not associated with deterioration in QoL in both groups. Hospitalization differed relevantly (24% in MCM vs. 51% in dialysis; p< 0.01).

Conclusion

QoL was comparable for patients starting dialysis and MCM. Small improvement of QoL after dialysis start was seen. For MCM, QoL slightly decreased after six months. Geriatric impairment is associated with baseline QoL, but not with deterioration after start of dialysis or MCM.

Funding

  • Private Foundation Support