Geriatric assessment for therapeutic decision-making regarding renal replacement in elderly patients with advanced chronic kidney disease.
In patients older than 75 years with advanced chronic kidney disease (CKD), the decision between treatment with dialysis [intention to treat with dialysis (ITD)] or conservative care (CC) is a challenge. Geriatric assessment can be helpful. The aim was to identify which factors had had an influence on decision-making.


METHODS
We recruited 56 patients. At baseline we analyzed age, frailty (defined following the criteria of Fried et al. [J Gerontol A Biol Sci Med Sci 2001;56:146-156]), dependence for activities of daily living (ADL), cognitive impairment, depression, comorbidity, cardiovascular disease, and diabetes. After full information about prognosis and treatment options, the preferences of the patients and families were taken into consideration as determinants in the decision-making process. During the follow-up, we evaluated clinical and laboratory parameters, hospitalization, mortality and reevaluated frailty.


RESULTS
Twenty patients opted for CC, and 36 patients opted for ITD. On univariate analysis, the predictive factors of the election of CC were age, prefrailty, cognitive impairment, and dependence for ADL. In the multivariate analysis, age and prefrailty remained as predictors for the choice of CC. Hospitalizations were more frequent in CC. Survival was similar in both groups (p = 0.098).


CONCLUSIONS
Frailty assessment could be useful for decision-making about the treatment in elderly patients with CKD. CC may be a good treatment option.
Division of Nephrology, Hospital Severo Ochoa, Leganes/Madrid, Spain.
Isabel
I
Rodriguez Villarreal
Olimpia
O
Ortega
Julie
J
Hinostroza
Gabriela
G
Cobo
Paloma
P
Gallar
Carmen
C
Mon
Juan Carlos
JC
Herrero
Milagros
M
Ortiz
Cristina
C
Di Giogia
Aniana
A
Oliet
Ana
A
Vigil
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index