A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients

Jonge, Peter de; Ruinemans, G. Maarten-Friso; Huyse, Frits J.; Wee, Piet M. ter

doi:10.1093/ndt/gfg453

Cited by 36 publications

(25 citation statements)

References 21 publications

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“…A recent single-centre retrospective study showed no significant survival advantage among patients ≥80 years of age choosing RRT over a conservative approach [44]. Several parameters have been identified to be associated with a better survival of elderly patients on dialysis [18, 26, 45–49]. In the present study the survival probability was closely linked to the baseline 47-item FACT-An score (see Figure 2).…”

Section: Discussionsupporting

confidence: 47%

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

Seckinger

Dschietzig²,

Leimenstoll³

et al. 2016

Clin Kidney J

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BackgroundThe physical–functional and social–emotional health as well as survival of the elderly (≥75 years of age) haemodialysis patient is commonly thought to be poor. In a prospective, multicentre, non-interventional, observational study, the morbidity, mortality and quality of life (QoL) in this patient group were examined and compared with a younger cohort.MethodsIn 92 German dialysis centres, 2507 prevalent patients 19–98 years of age on haemodialysis for a median of 19.2 months were included in a drug monitoring study of darbepoetin alfa. To examine outcome and QoL parameters, 24 months of follow-up data in the age cohorts <75 and ≥75 years were analysed. Treatment parameters, adverse and intercurrent events, hospitalizations, morbidity and mortality were assessed. QoL was evaluated by means of the 47-item Functional Assessment of Chronic Illness Therapy–Anaemia score (FACT-An, version 4).ResultsThe 2-year mortality rate was 34.7% for the older cohort and 15.8% for the younger cohort. The mortality rate for the haemodialysed elderly patients was 6.2% higher in absolute value compared with the age-matched background population. A powerful predictor of survival was the baseline FACT-An score and a close correlation with the 20-item anaemia subscale (AnS) was demonstrated. While the social QoL in the elderly patients was more stable than in the younger cohort (leading to equivalent values at the end of the study period), a pronounced deterioration of physical and functional status was observed. The median number of all-cause hospital days per patient-year was 12.3 for the elderly cohort and 8.9 for the younger patient population. The overall 24-month hospitalization rate was only marginally higher in the elderly cohort (34.0 versus 33.3%).ConclusionsIn this observational study, the mortality rate of elderly haemodialysis patients was not exceedingly high compared with the age-matched background population. Furthermore, the hospitalization rate was only slightly higher compared with the younger age group and the median yearly hospitalization time trended lower compared with registry data. The social well-being of elderly haemodialysis patients showed a less pronounced decline over time and was equal to the score of the younger cohort at the end of the study period. The physical and functional status in the elderly patients was lower and showed a sharper decline over time. The baseline FACT-An score correlated closely with the 24-month survival probability.

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Section: Discussionsupporting

confidence: 47%

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

Seckinger

Dschietzig²,

Leimenstoll³

et al. 2016

Clin Kidney J

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show abstract

“…Both nature of the disease and the type of treatment involve side effects such as cardiovascular diseases, metabolic disorders etc. So, it is not far-fetched that role limitations are more seen in this group of patients due to physical problems and pain (34), and the majority of hemodialysis patients has inactive lifestyle (35).…”

Section: Discussionmentioning

confidence: 99%

The outcomes of stress exposure in hemodialysis patients

Naderifar¹,

Tafreshi²,

Ilkhani³

et al. 2017

J Renal Inj Prev

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Nurses and policy makers should have special attention to consequences of stress in patients undergoing hemodialysis. It plays an important role to provide a framework for appropriate supportive measures and gives the opportunity for nurses to manage the problems facing these patients. Please cite this paper as: Introduction:Chronic renal failure (CRF) is a common problem in today's world. Patients with hemodialysis are subjected to stress even more severe than others. Objectives: This study aimed to explain patients' perception with hemodialysis about stress exposure and its consequences. Patients and Methods:This study is a qualitative approach based on directed content analysis. The data were collected using semi-structured in-depth interviews with patients treated with hemodialysis. Participants were selected using purposive sampling method and data saturation was reached by conducting 11 interviews so that, the new finding was not added. Data analysis was simultaneously conducted based on Grant's model of the consequence of exposure to stress. The validity and reliability of the data was confirmed using peer review method and results were also confirmed by participants. Results: Four themes, including support, psychological outcomes, adherence to treatment and physical trouble, 12 categories and 33 sub-categories were obtained during data analysis process. According to the results, "support" was added. Conclusion:The results showed that patients, with the help of available supportive resources, confront with the difficulties that lie ahead and reduce the hemodialysis-related stress in themselves. Support resources including; family, medical personnel, similar patients, friends and community resources.

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“…When used by trained health care professionals from different backgrounds, the validity and reliability of the tool has been demonstrated in a variety of medical populations17,18,26,27, including liver transplant recipients 16. The utility of the INTERMED has been demonstrated for detecting complex, medically ill patients at risk for poor HRQOL and decreased response to medical treatment28; it has also proven to be a case-finder for early and beneficial psychosocial interventions 29,30,31Table 1) classifies information into four domains: biological, psychological, social and health care.…”

Section: Methodsmentioning

confidence: 99%

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

Michaud¹,

Ludwig²,

Berney³

et al. 2016

Pharm Pract (Granada)

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Background:Lack of adherence to medication is a trigger of graft rejection in solid-organ transplant (SOT) recipients.Objective:This exploratory study aimed to assess whether a biopsychosocial evaluation using the INTERMED instrument before transplantation could identify SOT recipients at risk of suboptimal post-transplantation adherence to immunosuppressant drugs. We hypothesized that complex patients (INTERMED>20) might have lower medication adherence than noncomplex patients (INTERMED≤20).Methods:Each patient eligible for transplantation at the University Hospital of Lausanne, Switzerland, has to undergo a pre-transplantation psychiatric evaluation. In this context the patient was asked to participate in our study. The INTERMED was completed pre-transplantation, and adherence to immunosuppressive medication was monitored post-transplantation by electronic monitors for 12 months. The main outcome measure was the implementation and persistence to two calcineurin inhibitors, cyclosporine and tacrolimus, according to the dichotomized INTERMED score (>20 or ≤20).Results:Among the 50 SOT recipients who completed the INTERMED, 32 entered the study. The complex (N=11) and noncomplex patients (N=21) were similar in terms of age, sex and transplanted organ. Implementation was 94.2% in noncomplex patients versus 87.8% in complex patients (non-significant p-value). Five patients were lost to follow-up: one was non-persistent, and four refused electronic monitoring. Of the four patients who refused monitoring, two were complex and withdrew early, and two were noncomplex and withdrew later in the study.Conclusion:Patients identified as complex pre-transplant by the INTERMED tended to deviate from their immunosuppressant regimen, but the findings were not statistically significant. Larger studies are needed to evaluate this association further, as well as the appropriateness of using a nonspecific biopsychosocial instrument such as INTERMED in highly morbid patients who have complex social and psychological characteristics.

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A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients

Abstract: A simple risk score based on INTERMED, age (> or =65) and comorbid diabetes (yes/no) can be used to detect patients at risk of poor QoL and non-survival at an early stage of treatment.

Cited by 36 publications

References 21 publications

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study

The outcomes of stress exposure in hemodialysis patients

Immunosuppressive therapy after solid-organ transplantation: does the INTERMED identify patients at risk of poor adherence?

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