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Kidney Week

Abstract: SA-PO714

Health Outcome Priorities of Older Adults with Advanced CKD and Concordance with Their Nephrology Providers’ Perceptions

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

  • Ramer, Sarah, Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Robinson-Cohen, Cassianne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Bian, Aihua, Vanderbilt University, Nashville, Tennessee, United States
  • Stewart, Thomas G., Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Lipworth, Loren, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background

Nephrology providers must understand their patients’ priorities before recommending treatments, especially in older adults, for whom the tradeoffs in risks and benefits become more salient. We therefore elicited the health outcome priorities (HOPs) of older adults with advanced non-dialysis-dependent CKD; examined the association between priorities, self-reported health, and acceptance of common end-of-life scenarios; and measured concordance between patients’ priorities and providers’ perceptions of these priorities.

Methods

Patients > 60 years old with non-dialysis-dependent CKD stages 4-5 recruited from a US nephrology clinic completed a validated HOP tool, self-rated health question, and end-of-life scenarios tool. For each enrolled patient, the nephrology provider completed the same HOP tool.

Results

Among 271 patients, 46% women, with median age 71, 49% chose maintaining independence as their top HOP, followed by staying alive (35%), reducing pain (9%), and reducing other symptoms (6%) (Figure). 49% ranked staying alive as their 3rd or 4th priority. There was no association between patients’ self-rated health and top priority ranking (P=0.33), but for 6 of 13 common end-of-life scenarios (e.g., “are an emotional or financial burden to family”), reported acceptance significantly differed by top HOP. Patient-provider concordance on HOPs was overall poor (weighted kappa <0.1 for all 4 choices at any rank).

Conclusion

Nearly half of a group of older adults with advanced CKD ranked maintaining independence as their top HOP. Almost as many ranked staying alive as their last or second-to-last HOP. Nephrology providers demonstrated limited knowledge of their patients’ priorities.

Patients' 1st (main bars) and 2nd (sub-bars) HOP choices

Funding

  • Private Foundation Support