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

Abstract

<b><i>Background and Objectives:</i></b> 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. <b><i>Design, Setting, Participants, and Measurements:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis

“…Seven studies assessed the association between functional impairment and mortality in elderly haemodialysis patients [ 9 , 11 , 16 , 18 , 22 , 31 , 35 ]. A random-effect model was used to analyse these data because there was heterogeneity between the studies ( p = 0.0006, I 2 = 75%).…”

“…Functional impairment is considered to be a contributor to subsequent disability, recurrent hospitalization, and decreased survival rate [ 18 , 31 , 40 ]. Loss of independent functioning has been recognized in geriatric dialysis patients [ 41 – 43 ].…”

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project

“…Notably, all patients experienced problems with IADLs. Previous studies have demonstrated a high prevalence of problems with IADLs in advanced CKD [28][29][30] and an association between problems with IADLs and hospitalisation and mortality [27]. Given the high prevalence of problems with IADLs, the high proportion of patients considered at risk of future falls is unsurprising.…”

“…Geriatric impairments are associated with increased mortality risk in patients starting dialysis [ 27 ]. Within our cohort, there was a high prevalence of geriatric impairments identified during GA, suggesting appropriate patients were referred to the GA service.…”

Nutrition assessment and geriatric associated conditions among community dwelling Iranian elderly people

“…Evaluation and nutritional interventions are very important in this population with high prevalence of chronic diseases including depression, dementia, functional disorders, polypharmacy [9,10]. Malnutrition in elderly can lead to multiple health concerns, including weak immune system, increased risk of infections, muscle weakness and bone-loss followed by an increase in falls and higher risks of hospitalization and death [11,12].…”