Sarel Erez, Nacasch Naomi, Rozenberg Ilan, Ayzenfeld Rachel Heffez, Benchetrit Sydney, Feldman Jacob, Cohen-Hagai Keren
Department of Anesthesiology, Pain and Intensive Care, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel.
Aging Clin Exp Res. 2022 Jun;34(6):1399-1406. doi: 10.1007/s40520-021-02055-y. Epub 2022 Mar 3.
As the geriatric population is growing rapidly, so is the prevalence of chronic kidney disease (CKD). Suitable rehabilitation programs are needed to decrease disability and improve functionality to maintain independence in activities of daily life.
To assess the impact of CKD on the efficacy of rehabilitation in the geriatric population.
Retrospective single-center cohort study, demographic and clinical data of 190 elderly, non-dialysis dependent CKD patients, who underwent rehabilitation, during 2016-2020 were analyzed.
Early CKD patients had longer duration of rehabilitation as compared with advanced CKD (32.6 ± 19.5 vs. 25.1 ± 17.6 days, p = 0.011) and tended to be more independent at discharge (37.2% vs. 27.9%, respectively; p < 0.001). Duration of rehabilitation, Mini-Mental State Examination (MMSE), Functional Independence Measurement (FIM) admission and estimated GFR were important predictors of FIM at discharge. Age was negatively correlated with admission FIM, eGFR, MMSE, and discharge FIM. The odds ratio for mortality among patients with advanced as compared to early CKD was 2.197 (CI 95% 1.159-4.166, p = 0.015).
Existing rehabilitation programs raise questions of suitability for the consistently aging population, play an indispensable part in the goal of achieving functional independence in the elderly and should promote further investigation of the efficacy of rehabilitation for CKD patients.
Advanced CKD was associated with lower FIM at admission and discharge, shorter duration of rehabilitation and more dependence at discharge, as compared to patients with early CKD. Implementing a multidisciplinary team, focused on the specific needs of geriatric CKD patients, with clear, objective parameters and goals may lead to better rehabilitative outcomes, with decreased public and private costs of ongoing care.
随着老年人口的迅速增长，慢性肾脏病（CKD）的患病率也在上升。需要合适的康复项目来减少残疾并改善功能，以维持日常生活活动的独立性。
评估CKD对老年人群康复效果的影响。
回顾性单中心队列研究，分析了2016年至2020年期间190例接受康复治疗的老年非透析依赖性CKD患者的人口统计学和临床数据。
与晚期CKD患者相比，早期CKD患者的康复时间更长（32.6±19.5天对25.1±17.6天，p = 0.011），且出院时往往更独立（分别为37.2%对27.9%；p < 0.001）。康复时间、简易精神状态检查表（MMSE）、功能独立性测量（FIM）入院评分和估计肾小球滤过率（eGFR）是出院时FIM的重要预测因素。年龄与入院FIM、eGFR、MMSE和出院FIM呈负相关。晚期CKD患者与早期CKD患者相比，死亡的优势比为2.197（95%置信区间1.159 - 4.166，p = 0.015）。
现有的康复项目引发了对持续老龄化人群适用性的质疑，在实现老年人功能独立的目标中发挥着不可或缺的作用，并且应该促进对CKD患者康复效果的进一步研究。
与早期CKD患者相比，晚期CKD患者入院和出院时的FIM较低，康复时间较短，出院时依赖性更强。组建一个多学科团队，关注老年CKD患者的特定需求，制定明确、客观的参数和目标，可能会带来更好的康复效果，同时降低持续护理的公共和私人成本。
