A review of supportive care for older people with advanced chronic kidney disease

Fitzgerald, Ted J; Joosten, Hanneke; Buren, Marjolijn van; Vinen, Katie; Brown, Edwina A.

doi:10.1093/ckj/sfac256

Cited by 7 publications

(3 citation statements)

References 78 publications

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“…Additionally, the prevalence of comorbid conditions may be higher in older patients compared to younger ones. These factors may lead to challenges in adhering to PD treatment regimens, resulting in suboptimal therapy and poorer outcomes [19]. Collectively, these factors may have contributed, at least partially, to the observed scenario.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

Venegas-Ramírez,

Barrios-Mora,

Ríos-Bracamontes

et al. 2023

JCM

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In patients with end-stage kidney disease (ESKD), peritoneal dialysis (PD) is increasingly being adopted in developing nations due to its cost-effectiveness and advantages as a home-based treatment. However, the survival outcomes of chronic PD patients in Mexico, where the burden of ESKD is high, remain poorly understood. This study aimed to assess the survival experience of long-term PD patients and evaluate its determinants. A single-center cohort study collected clinical and epidemiological data for long-term PD initiations between February 2013 and January 2023. The analysis, which utilized Kaplan–Meier and Cox proportional hazard regression methods, included data from 370 patients. The overall mortality rate was 4.7 per 1000 person-months, with a significant decrease in survival rates observed between months 24 and 36 post-PD initiation. Older age at PD initiation and the use of continuous ambulatory peritoneal dialysis, as compared to the automated modality, were associated with an increased risk of mortality. The study provides valuable insights into the survival outcomes of chronic PD patients in Mexico and suggests the need to optimize treatment strategies to enhance long-term prognoses for patients with ESKD. Further research is needed to better understand the factors influencing survival in this population.

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Section: Discussionmentioning

confidence: 99%

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

Venegas-Ramírez,

Barrios-Mora,

Ríos-Bracamontes

et al. 2023

JCM

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“…Outcomes in the elderly undergoing RRT has been examined with more pain, immobility and anxiety present in those over age 75 compared to those age 55-75 years and with a worse QOL than age and sex-matched population controls. Understanding goals of care in the elderly is particularly important, as QOL is frequently more valued over longevity [75].…”

Section: Andandmentioning

confidence: 99%

Quality of life after acute kidney injury

McNicholas,

Akcan Arikan,

Ostermann

2023

Current Opinion in Critical Care

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Purpose of review Deciphering the effect of acute kidney injury (AKI) during critical illness on long-term quality of life versus the impact of conditions that brought on critical illness is difficult. Recent findings Reports on patient-centred outcomes such as health-related quality of life (HRQOL) have provided insight into the long-lasting impact of critical illness complicated by AKI. However, these data stem from observational studies and randomized controlled trials, which have been heterogeneous in their patient population, timing, instruments used for assessment and reporting. Recent studies have corroborated these findings including lack of effect of renal replacement therapy compared to severe AKI on outcomes and worse physical compared to cognitive dysfunction. Summary In adults, more deficits in physical than mental health domains are found in survivors of AKI in critical care, whereas memory deficits and learning impairments have been noted in children. Further study is needed to understand and develop interventions that preserve or enhance the quality of life for individual patients who survive AKI following critical illness, across all ages.

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“…Furthermore, it is important to maintain electrolyte balance and prevent fluid overload in patients with kidney failure. Dietary sodium and potassium restrictions, along with vitamin D supplementation and phosphate restriction, are suggested to prevent fluid overload, hyperkalemia and calcium-phosphate balance disorders [ 35 ]. If dietary counselling fails to improve patients’ nutrition status, oral nutritional supplements can be considered as effective alternatives for restoring protein and energy resources.…”

Section: Which Choice Between Ckm and Dialysis?mentioning

confidence: 99%

Shared decision making in elderly patients with kidney failure

Kanbay,

Basile,

Battaglia

et al. 2023

Nephrology Dialysis Transplantation

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‘Elderly’ is most commonly defined as an individual aged 65 years or older. However, this definition fails to account for the differences in genetics, lifestyle and overall health that contribute to significant heterogeneity among the elderly beyond chronological age. As the world population continues to age, the prevalence of chronic diseases, including chronic kidney disease (CKD), is increasing and CKD frequently progresses to kidney failure. Moreover, frailty represents a multidimensional clinical entity highly prevalent in this population, which needs to be adequately assessed to inform and support medical decisions. Selecting the optimal treatment pathway for the elderly and frail kidney failure population, be it hemodialysis, peritoneal dialysis, or conservative kidney management is complex, because of the presence of comorbidities associated with low survival rates and impaired quality of life. Management of these patients should involve a multidisciplinary approach including doctors from various specialties, nurses, psychologists, dieticians, and physiotherapists. Studies are mostly retrospective and observational, lacking adjustment for confounders or address selection and indication biases, making it difficult to use these data to guide treatment decisions. Throughout this review we discuss the difficulty of making a one-size-fits-all recommendation for the clinical needs of older patients with kidney failure. We advocate that a research agenda for optimization of the critical issues we present in this review be implemented. We recommend prospective studies that address these issues, and systematic reviews incorporating the complementary evidence of both observational and interventional studies. Furthermore, we strongly support a shared decision making process matching evidence with patient preferences to ensure that individualized choices are made regarding dialysis vs. conservative kidney management, dialysis modality, and optimal vascular access.

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A review of supportive care for older people with advanced chronic kidney disease

Cited by 7 publications

References 78 publications

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

Ten-Year Single-Center Study Examining Patient Survival after Commencing Long-Term Peritoneal Dialysis

Quality of life after acute kidney injury

Shared decision making in elderly patients with kidney failure

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