Pugh Julia, Aggett Justine, Goodland Annwen, Prichard Alison, Thomas Nerys, Donovan Kieron, Roberts Gareth
Directorate of Nephrology and Transplantation , University Hospital of Wales , Cardiff CF14 4XW , UK.
Clin Kidney J. 2016 Apr;9(2):324-9. doi: 10.1093/ckj/sfv150. Epub 2016 Jan 29.
The incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education.
We performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015.
The CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death.
A relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease.
慢性肾脏病（CKD）的发病率正在上升，并且在可预见的未来可能会继续上升，其中75岁及以上成年人的增长速度最快。晚期CKD老年患者可能合并症负担和虚弱程度更高，这两者都可能影响其疾病转归。对于这些患者，治疗决策可能很复杂，目前缺乏可靠的预后工具阻碍了共同决策过程。本研究旨在评估合并症和虚弱对接受透析前教育患者结局的影响。
我们对2010年至2012年间转诊接受透析前教育的患者（n = 283）进行了一项单中心研究。分别使用Charlson合并症指数（CCI）和临床虚弱量表（CFS）评估合并疾病负担和虚弱程度。收集随访数据至2015年2月。
转诊至透析前服务时的CCI和CFS评分是死亡率的独立预测因素。在研究随访期内，透析前教育时CFS评分高的患者中有76%死亡，其中63%的患者在死亡前未开始透析。
一个相对简单的虚弱量表和合并症评分可用于预测生存，并为晚期肾病患者的共同决策过程提供更好的信息。
