Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019;143(2):108-119.
doi: 10.1159/000501277. Epub 2019 Aug 13.

Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis

Ismay N van Loon  1   2   3 , Namiko A Goto  4 , Franciscus T J Boereboom  5   6 , Michiel L Bots  7 , Ellen K Hoogeveen  8 , Laila Gamadia  9 , E F H van Bommel  10 , P J G van de Ven  11 , Caroline E Douma  12 , H H Vincent  13 , Yvonne C Schrama  14 , Joy Lips  15 , Machiel A Siezenga  16 , Alferso C Abrahams  17 , Marianne C Verhaar  17 , Marije E Hamaker  18
Affiliations
Multicenter Study

Geriatric Assessment and the Relation with Mortality and Hospitalizations in Older Patients Starting Dialysis

Ismay N van Loon et al. Nephron. 2019.

Abstract

Background and objectives: A geriatric assessment (GA) is a structural method for identifying frail patients. The relation of GA findings and risk of death in end-stage kidney disease (ESKD) is not known. The objective of the GA in OLder patients starting Dialysis Study was to assess the association of GA at dialysis initiation with early mortality and hospitalization.

Design, setting, participants, and measurements: Patients ≥65 years old were included just prior to dialysis initiation. All participants underwent a GA, including assessment of (instrumental) activities of daily living (ADL), mobility, cognition, mood, nutrition, and comorbidity. In addition, a frailty screening (Fried Frailty Index, [FFI]) was applied. Outcome measures were 6- and 12-month mortality, and 6-month hospitalization. Associations with mortality were assessed with cox-regression adjusting for age, sex, comorbidity burden, smoking, residual kidney function and dialysis modality. Associations with hospitalization were assessed with logistic regression, adjusting for relevant confounders.

Results: In all, 192 patients were included, mean age 75 ± 7 years, of whom 48% had ≥3 geriatric impairments and were considered frail. The FFI screening resulted in 46% frail patients. Mortality rate was 8 and 15% at 6- and 12-months after enrolment, and transplantation rate was 2 and 4% respectively. Twelve-month mortality risk was higher in patients with ≥3 impairments (hazard ratio [HR] 2.97 [95% CI 1.19-7.45]) compared to less impaired patients. FFI frail patients had a higher risk of 12-month mortality (HR 7.22 [95% CI 2.47-21.13]) and hospitalization (OR 1.93 [95% CI 1.00-3.72]) compared to fit patients. Malnutrition was associated with 12-month mortality, while impaired ADL and depressive symptoms were associated with 12-month mortality and hospitalization.

Conclusions: Frailty as assessed by a GA is related to mortality in elderly patients with ESKD. Individual components of the GA are related to both mortality and hospitalization. As the GA allows for distinguishing between frail and fit patients initiating dialysis, it is potentially of added value in the decision-making process concerning dialysis initiation.

Keywords: Conservative care; Dialysis; Elderly; Geriatric assessment; Quality of life.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest. This manuscript had not been published and is not under consideration for publication elsewhere.

References

    1. United States renal data system. USRDS. Atlas of ESRD Chapter 1 incidence prevalence patient characteristics & modality. vol 2 Available from http://www.usrds.org/2012/view/v2_01.aspx. Accessed 22-08-2016.
    1. Kurella M, Covinsky KE, Collins AJ, Chertow GM. Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med. 2007 Feb;146((3)):177–183. - PubMed
    1. Peeters P, Van Biesen W, Veys N, Lemahieu W, De Moor B, De Meester J. External Validation of a risk stratification model to assist shared decision making for patients starting renal replacement therapy. BMC Nephrol. 2016 Apr;17((1)):41. - PMC - PubMed
    1. van Loon IN, Wouters TR, Boereboom FT, Bots ML, Verhaar MC, Hamaker ME, The Relevance of Geriatric Impairments in Patients Starting Dialysis A Systematic Review. Clin J Am Soc Nephrol. 2016 Jul;11((7)):1245–59. - PMC - PubMed
    1. Swidler M. Considerations in starting a patient with advanced frailty on dialysis complex biology meets challenging ethics. Clin J Am Soc Nephrol. 2013 Aug;8((8)):1421–8. - PMC - PubMed

Publication types