Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease

Mayes, Juliet; Young, Hannah; Blacklock, Rochelle; Lightfoot, Courtney J; Chilcot, Joseph; Nixon, Andrew

doi:10.3390/kidneydial2020025

Cited by 8 publications

(7 citation statements)

References 136 publications

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“…Creation of these subdomains has allowed enhanced application of the EFS assessment by identifying areas within the assessment that can be targeted by support and intervention strategies. Novel approaches like this are necessary in order to advance the care and management of frailty in older patients with ESKD once it has been identified ( 18 ). It should also be noted that the KTOP study is purposely focused on exploring the experiences of older people awaiting kidney transplantation and so younger people (aged <60) are excluded, despite the increased prevalence of frailty well described in ESKD patients even at younger ages.…”

Section: Discussionmentioning

confidence: 99%

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Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

Thind

Levy²,

Wellsted³

et al. 2023

Front. Nephrol.

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BackgroundOlder people with end-stage kidney disease (ESKD) are vulnerable to frailty, which impacts on clinical and experiential outcomes. With kidney transplantation in older people increasing, a better understanding of patient experiences is necessary for guiding decision making. The Kidney Transplantation in Older People (KTOP):impact of frailty on outcomes study aims to explore this. We present a secondary analysis of the Edmonton Frail Scale (EFS) and its relationship with patient experience scores.MethodsThe KTOP study is a single centre, prospective study, which began in October 2019. All ESKD patients aged ≥60 considered for transplantation at Imperial College Renal and Transplant Centre were eligible. Frailty was assessed using the EFS and 5 questionnaires assessed patient experience and quality of life (QoL) (Short Form-12(v2), Palliative Care Outcome Scale–Symptoms Renal, Depression Patient Health Questionnaire-9, Illness Intrusiveness Ratings Scale, Renal Treatment Satisfaction Questionnaire). The EFS was divided into 4 subdomains (psychosocial, physical function, medical status, and general health) and then compared with the questionnaire scores.Results210 patients have been recruited (aged 60-78), 186 of whom completed EFS assessments. 118 (63.4%) participants were not frail, 36 (19.4%) vulnerable, and 32 (17.2%) were frail. Worse frailty scores were associated with poorer patient experience and QoL scores across all questionnaires. Severe deficits in the EFS psychosocial subdomain showed a statistically significant association with higher depression screen scores (coefficient 4.9, 95% CI 3.22 to 6.59), lower physical (coefficient -4.35, 95% CI -7.59 to -1.12) and mental function scores (coefficient -8.33, 95% CI -11.77 to -4.88) from the Short Form-12(v2), and lower renal treatment satisfaction scores (coefficient -5.54, 95% CI -10.70 to -0.37). Deficits in the physical function and medical status EFS subdomians showed some association with patient experience scores.ConclusionIn the KTOP study cohort at recruitment vulnerable and frail candidates reported worse QoL and patient experiences. Severe deficits in the psychosocial subdomains of the EFS showed a strong association with patient experience and QoL, whilst physical function and medical status deficits showed a lesser association. This has highlighted specific EFS domains that may be suitable for targeted interventions to improve experiences and optimise outcomes.

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Section: Discussionmentioning

confidence: 99%

“…With the impact of frailty on clinical outcomes and QoL in patients with ESKD well established, current research has shifted towards exploring strategies to address and manage frailty ( 2 , 9 , 17 , 18 ). Integral to this is understanding the specific components of frailty which may be impacting on patient experiences.…”

Section: Introductionmentioning

confidence: 99%

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

Thind

Levy²,

Wellsted³

et al. 2023

Front. Nephrol.

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“…However, the timely identification of those with poor physical performance levels followed by arrangement of individualized and goal-based exercise programs showed promise [ 33 ]. Furthermore, non-pharmacological treatment to aid mood and manage depression has shown positive effects as well [ 34 ]. Though malnutrition is often associated with frailty and regular dietary assessments are recommended, there remains a paucity of studies examining the benefits of nutritional supplementation on frailty outcomes in the haemodialysis population at present [ 34 ].…”

Section: Risk Factors For Poor Clinical Outcomes In Elderly Haemodial...mentioning

confidence: 99%

“…Furthermore, non-pharmacological treatment to aid mood and manage depression has shown positive effects as well [ 34 ]. Though malnutrition is often associated with frailty and regular dietary assessments are recommended, there remains a paucity of studies examining the benefits of nutritional supplementation on frailty outcomes in the haemodialysis population at present [ 34 ]. Understanding the potential mechanisms of how acute COVID-19 infection affects the elderly dialysis-dependent population may bring further light into the impact of comorbidity and frailty status in this process.…”

Section: Risk Factors For Poor Clinical Outcomes In Elderly Haemodial...mentioning

confidence: 99%

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

McDonnell

Kalra

et al. 2023

Biomedicines

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There is an increased incidence of elderly adults diagnosed with kidney failure as our global aging population continues to expand. Hence, the number of elderly adults indicated for kidney replacement therapy is also increasing simultaneously. Haemodialysis initiation is more commonly observed in comparison to kidney transplantation and peritoneal dialysis for the elderly. The onset of the coronavirus 2019 (COVID-19) pandemic brought new paradigms and insights for the care of this patient population. Elderly patients receiving haemodialysis have been identified as high-risk groups for poor COVID-19 outcomes. Age, immunosenescence, impaired response to COVID-19 vaccination, increased exposure to sources of COVID-19 infection and thrombotic risks during dialysis are key factors which demonstrated significant associations with COVID-19 incidence, severity and mortality for this patient group. Recent findings suggest that preventative measures such as regular screening and, if needed, isolation in COVID-19-positive cases, alongside the fulfillment of COVID-19 vaccination programs is an integral strategy to reduce the number of COVID-19 cases and consequential complications from COVID-19, particularly for high-risk groups such as elderly haemodialysis patients. The COVID-19 pandemic brought about the rapid development and repurposing of a number of medications to treat patients in the viral and inflammatory stages of their disease. However, elderly haemodialysis patients were grossly unrepresented in many of these trials. We review the evidence for contemporary treatments for COVID-19 in this population to provide clinicians with an up-to-date guide. We hope our article increases awareness on the associations and impact of COVID-19 for the elderly haemodialysis population, and encourage research efforts to address knowledge gaps in this topical area.

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“…Frailty is an emerging area of research in CKD [18]. Mayes et al [19] provide a review of the evidence addressing the assessment of frailty in people living with CKD, and the non-pharmacological management strategies to address frailty.…”

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confidence: 99%

The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease

Castle

Greenwood

Müller

2023

Kidney and Dialysis

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Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease

Cited by 8 publications

References 136 publications

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

Frailty and the psychosocial components of the edmonton frail scale are most associated with patient experience in older kidney transplant candidates – a secondary analysis within the kidney transplantation in older people (KTOP) study

COVID-19 in Elderly Patients Receiving Haemodialysis: A Current Review

The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease

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