School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia.
Princess Alexandra Hospital, Metro South Health and Hospital Service, Brisbane, Queensland, Australia.
Nephron. 2024;148(1):34-42. doi: 10.1159/000531872. Epub 2023 Jul 10.
Chronic kidney disease (CKD) affects people across their lifespan. Kidney supportive care (KSC) is typically offered for older people for symptom management, education, and/or advance care planning (ACP). However, younger people may also benefit from KSC. This study sought to explore characteristics of working-age adults with CKD accessing KSC.
Using a cross-sectional design, working-age adults (18-64 years) with CKD referred to a KSC service from February 2016 to July 2021 were included. Demographic and clinical data were extracted from patients' hospital records. Self-reported symptoms (Integrated Palliative Care Outcome Scale renal [IPOS-renal]) and health-related quality of life (European quality of life [EQ-5D-5L]) were assessed. Reasons for referral to KSC, kidney replacement therapy (KRT) pathway at referral, and comorbidity calculated using the Charlson Comorbidity Index were also assessed.
One Hundred Fifty-six working-age adults attended the KSC service. Median age was 57 years, with more than half receiving KRT. Weakness (92.2%), poor mobility (83.3%), and pain (82.5%) were the most prevalent and severe symptoms. The majority were referred for symptom management (n = 83, 53.2%) and 27% for ACP (n = 42). The ACP completion rate was low (28.9%). Those on dialysis had significantly higher symptom scores than those not receiving dialysis (p < 0.05).
Working-age adults with CKD experience a significant and debilitating symptom burden and need to consider options for treatment. This study provides new understanding about working-age adults with CKD that may help provide the specific support needed to meet their end-of-life care needs.
慢性肾脏病（CKD）影响着各个年龄段的人群。肾脏支持性护理（KSC）通常为老年人提供，用于症状管理、教育和/或预先护理计划（ACP）。然而，年轻人也可能受益于 KSC。本研究旨在探讨接受 KSC 的工作年龄成年人 CKD 的特征。
使用横断面设计，纳入 2016 年 2 月至 2021 年 7 月期间因 CKD 就诊于 KSC 服务的工作年龄成年人（18-64 岁）。从患者的医院记录中提取人口统计学和临床数据。评估自我报告的症状（综合姑息治疗结果量表肾脏[IPOS-renal]）和健康相关生活质量（欧洲生活质量[EQ-5D-5L]）。还评估了转诊至 KSC 的原因、转诊时的肾脏替代治疗（KRT）途径以及使用 Charlson 合并症指数计算的合并症。
共有 156 名工作年龄成年人参加了 KSC 服务。中位年龄为 57 岁，超过一半的人接受 KRT。最常见和最严重的症状是乏力（92.2%）、活动能力差（83.3%）和疼痛（82.5%）。大多数人因症状管理（n = 83，53.2%）和 27%的人因 ACP（n = 42）而转诊。ACP 完成率较低（28.9%）。接受透析的患者的症状评分明显高于未接受透析的患者（p < 0.05）。
患有 CKD 的工作年龄成年人经历着显著且使身体虚弱的症状负担，需要考虑治疗选择。本研究提供了有关工作年龄成年人 CKD 的新认识，这可能有助于提供满足其临终关怀需求的具体支持。
