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- Title
Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD.
- Authors
Chesnaye, Nicholas C; Caskey, Fergus J; Dekker, Friedo W; Rooij, Esther N M de; Evans, Marie; Heimburger, Olof; Pippias, Maria; Torino, Claudia; Porto, Gaetana; Szymczak, Maciej; Drechsler, Christiane; Wanner, Christoph; Jager, Kitty J; investigators, the EQUAL study
- Abstract
Background We explore longitudinal trajectories of clinical indicators, patient-reported outcomes, and hospitalizations, in the years preceding death in a population of older patients with advanced chronic kidney disease (CKD). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR <20 ml/min per 1.73 m2 and ≥65 years of age. The evolution of each clinical indicator was explored using generalized additive models during the 4 years preceding death. Results We included 661 decedents with a median time to death of 2.0 years (IQR 0.9–3.2). During the years preceding death, eGFR, Subjective Global Assessment score, and blood pressure declined, with accelerations seen at 6 months preceding death. Serum hemoglobin, hematocrit, cholesterol, calcium, albumin, and sodium values declined slowly during follow-up, with accelerations observed between 6 and 12 months preceding death. Physical and mental quality of life declined linearly throughout follow-up. The number of reported symptoms was stable up to 2 years prior to death, with an acceleration observed at 1 year prior to death. The rate of hospitalization was stable at around one hospitalization per person year, increasing exponentially at 6 months preceding death. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began ∼6 to 12 months prior to death, which are likely multifactorial in nature, but correlate with a surge in hospitalizations. Further research should focus on how to effectively use this knowledge to inform patient and family expectations, to benefit the planning of (end-of-life) care, and to establish clinical alert systems.
- Subjects
OLDER patients; CHRONIC kidney failure; BLOOD pressure; PATIENT reported outcome measures
- Publication
Nephrology Dialysis Transplantation, 2023, Vol 38, Issue 11, p2494
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfad091