Samso Sophie, Loko Marc-Arthur, Jamet Amélie, Bouthier-Quintard Françoise, Paccalin Marc, Liuu Evelyne
Service de gériatrie, CHG de Niort, Niort, France.
Pôle de gériatrie, CHU de Poitiers, Poitiers, France.
Geriatr Psychol Neuropsychiatr Vieil. 2018 Dec 1;16(4):376-382. doi: 10.1684/pnv.2018.0756.
Over three million French people present a severe chronic kidney disease, among which there is a high prevalence of elder subjects. We conducted a prospective monocentric study in a geriatric acute care ward. The aims were to determine the short-term prognosis of patients with severe chronic kidney disease and to determine the factors associated with mortality at six-months.
Patients 75 years of age and older, with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m (chronic kidney disease epidemiology CKD-EPI) were recruited. A comprehensive geriatric assessment was performed at hospital discharge. Comprehensive geriatric assessment was performed: Activities of daily livings and Instrumental activities of daily livings scores, of the risk of pressure sore with Exton-Smith scale, the cognitive status with MMSE score, nutritional status according to Mini-nutritional assessment short form and albuminemia, comorbidities with Cumulative illness rating scale, number of drugs in presciption and living status. Six months follow-up was performed to assess vital status and evolution of the eGFR.
Sixty-seven patients were included, mean age 88.6±4.82 years with a mean eGFR of 21.3±6 mL/min. Mortality rate at six months was 36%. Multivariate analysis showed that a high CIRS score (RR=1.52; IC 95% 1.05-2.19) and a decline of creatinine clearance≥ 2 mL/min (4.72; 1.27-17.52) were predictive of mortality. On the opposite, a high MNA-SF score was protective (0.76; 0.62-0.94).
Prognosis of geriatric patients with severe chronic kidney disease is poor. Comprehensive geriatric assessment helps to assess short-term prognosis, in a focus of person-centered care.
超过三百万法国人患有严重的慢性肾病，其中老年患者的患病率很高。我们在一个老年急性护理病房进行了一项前瞻性单中心研究。目的是确定严重慢性肾病患者的短期预后，并确定与六个月死亡率相关的因素。
招募年龄在75岁及以上、估计肾小球滤过率（eGFR）<30 mL/min/1.73 m²（慢性肾病流行病学协作组[CKD-EPI]公式）的患者。在出院时进行全面的老年综合评估。进行了全面的老年综合评估：日常生活活动和工具性日常生活活动评分、使用埃克斯顿-史密斯量表评估压疮风险、使用简易精神状态检查表（MMSE）评分评估认知状态、根据微型营养评定简表和白蛋白血症评估营养状况、使用累积疾病分级量表评估合并症、处方药物数量和生活状况。进行了六个月的随访以评估生命状态和eGFR的变化。
纳入67例患者，平均年龄88.6±4.82岁，平均eGFR为21.3±6 mL/min。六个月时的死亡率为36%。多变量分析显示，高累积疾病分级量表（CIRS）评分（RR=1.52；95%置信区间1.05-2.19）和肌酐清除率下降≥2 mL/min（4.72；1.27-17.52）可预测死亡率。相反，高微型营养评定简表（MNA-SF）评分具有保护作用（0.76；0.62-0.94）。
老年严重慢性肾病患者的预后较差。全面的老年综合评估有助于在以患者为中心的护理重点中评估短期预后。
