老年慢性肾脏病晚期患者移植前综合老年评估。

Pretransplant Comprehensive Geriatric Assessment in Older Patients with Advanced Chronic Kidney Disease.

机构信息

Pharmaceutical Unit, Lyon Institute for Elderly, Charpennes Hospital, University Hospital of Lyon, Lyon, France.

EA-7425 HESPER, Health Services and Performance Research, University Lyon, Lyon, France.

出版信息

Nephron. 2021;145(6):692-701. doi: 10.1159/000517342. Epub 2021 Jul 14.

DOI:10.1159/000517342

PMID:34261074

Abstract

BACKGROUND

In older patients with advanced chronic kidney disease (CKD), the decision of kidney transplantation (KT) is a challenge for nephrologists. The use of comprehensive geriatric assessment (CGA) is increasingly gaining interest into the process of decision-making about treatment modality choice for CKD. The aim of this study was to assess the prevalence of geriatric impairment and frailty in older dialysis and nondialysis patients with advanced CKD using a pretransplant CGA model and to identify geriatric impairments influencing the geriatricians' recommendations for KT.

METHODS

An observational study was conducted with retrospective data from July 2017 to January 2020. Patients aged ≥65 years with advanced CKD, treated or not with dialysis, and referred by the nephrologist were included in the study. The CGA assessed comorbidity burden, cognition, mood, nutritional status, (instrumental) activities of daily living, physical function, frailty, and polypharmacy. Geriatric impairments influencing the geriatricians' recommendations for KT were identified using univariate and multivariate logistic regressions.

RESULTS

156 patients were included (74.2 ± 3.5 years and 62.2% on dialysis). Geriatric conditions were highly prevalent in both dialysis and nondialysis groups. The rate of geriatric impairments was higher in dialysis patients regarding comorbidity burden, symptoms of depression, physical function, autonomy, and frailty. Geriatrician's recommendations for KT were as follows: favorable (79.5%) versus not favorable or multidisciplinary discussion needed with nephrologists (20.5%). Dependence for Instrumental Activities of Daily Living (IADL) (odds ratio [OR] = 3.01 and 95% confidence interval [CI] = 1.30-7.31), physical functions (OR = 2.91 and 95% CI = 1.08-7.87), and frailty (OR = 2.66 and 95% CI = 1.07-6.65) were found to be independent geriatric impairments influencing geriatrician's recommendations for KT.

CONCLUSIONS

Understanding the burden of geriatric impairment provides an opportunity to direct KT decision-making and to guide interventions to prevent functional decline and preserve quality of life.

摘要

背景

在患有晚期慢性肾脏病（CKD）的老年患者中，肾移植（KT）的决策对肾病医生来说是一个挑战。综合老年评估（CGA）的使用越来越受到关注，有助于决策选择 CKD 的治疗方式。本研究旨在使用预移植 CGA 模型评估使用透析和不使用透析的晚期 CKD 老年患者的老年损伤和虚弱的患病率，并确定影响老年医生推荐 KT 的老年损伤。

方法

这是一项观察性研究，回顾性收集了 2017 年 7 月至 2020 年 1 月的数据。纳入了年龄≥65 岁、患有晚期 CKD、接受或未接受透析且由肾病医生转介的患者。CGA 评估了合并症负担、认知、情绪、营养状况、（工具）日常生活活动、身体功能、虚弱和多种药物治疗。使用单变量和多变量逻辑回归确定影响老年医生推荐 KT 的老年损伤。

结果

共纳入 156 例患者（74.2±3.5 岁，62.2%接受透析）。两组患者的老年状况均高度普遍。在合并症负担、抑郁症状、身体功能、自主性和虚弱方面，透析患者的老年损伤发生率更高。老年医生对 KT 的推荐如下：有利（79.5%）与不利或需要与肾病医生进行多学科讨论（20.5%）。需要依赖工具性日常生活活动（IADL）（比值比[OR]为 3.01，95%置信区间[CI]为 1.30-7.31）、身体功能（OR 为 2.91，95%CI 为 1.08-7.87）和虚弱（OR 为 2.66，95%CI 为 1.07-6.65）被认为是影响老年医生推荐 KT 的独立老年损伤。