Survival and quality of life in elderly patients in conservative management
Introduction: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). Objective: Establish predictive variab...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2019-03-01
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| Series: | Nefrología (English Edition) |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2013251419300537 |
| _version_ | 1818681572988026880 |
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| author | María Victoria Rubio Rubio Luis Miguel Lou Arnal José Antonio Gimeno Orna Paula Munguía Navarro Alex Gutiérrez-Dalmau Elena Lambán Ibor Javier Paúl Ramos Raquel Pernaute Lavilla Belén Campos Gutiérrez Alberto San Juan Hernández-Franch |
| author_facet | María Victoria Rubio Rubio Luis Miguel Lou Arnal José Antonio Gimeno Orna Paula Munguía Navarro Alex Gutiérrez-Dalmau Elena Lambán Ibor Javier Paúl Ramos Raquel Pernaute Lavilla Belén Campos Gutiérrez Alberto San Juan Hernández-Franch |
| author_sort | María Victoria Rubio Rubio |
| collection | DOAJ |
| description | Introduction: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). Objective: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. Patients and methods: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. Results: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1000 patients per month, with a homogeneous mortality rate after 6 months.Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p = 0.028), Charlson score ≥ 10 (42 vs. 17; p = 0.002), functional status (48.4 vs. 19; p = 0.002) and fragility (27 vs. 10; p = 0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. Conclusions: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality. Resumen: Introducción: El tratamiento renal conservador (TRC) se ha convertido en una opción terapéutica en la enfermedad renal crónica avanzada en ancianos. Se sabe poco sobre la evolución pronóstica de estos pacientes en términos de supervivencia y calidad de vida relacionada con la salud (CVRS). Objetivo: Establecer variables predictivas de mortalidad y analizar la CVRS en los pacientes en TRC. Pacientes y métodos: Estudio de cohortes prospectivo. Se realizó una valoración de parámetros de función renal y evaluación geriátrica integral: análisis de comorbilidad, situación funcional, cognitiva, fragilidad, nutricional, social y CVRS. Resultados: Se evaluaron 82 pacientes, con una edad media de 84 años e importante pluripatología: el 56% tenía antecedentes de evento vascular y Charlson > 8. La tasa de mortalidad fue de 23/1.000 pacientes-mes, con un ritmo de mortalidad homogéneo a partir de los 6 meses.La supervivencia difirió significativamente si presentaban evento vascular previo (36,7 vs. 14,8; p = 0,028), Charlson ≥ 10 (42 vs. 17; p = 0,002), grado de dependencia (48,4 vs. 19; p = 0,002) y fragilidad (27 vs. 10; p = 0,05).Fueron predictores de mortalidad: eFG y proteinuria, presencia de evento vascular previo, comorbilidad de Charlson, parámetros de malnutrición-inflamación (albúmina y puntuación MNA), grado de dependencia, CVRS física y aumento de PTH. La presencia de evento vascular previo, comorbilidad, albúmina descendida y elevación de PTH fueron predictores independientes de mortalidad. La CVRS se mantuvo estable y no se produjo empeoramiento significativo durante el tratamiento. Conclusiones: El conocimiento de los factores asociados con mortalidad y la evaluación de la CVRS puede ser útil como herramienta en la toma de decisiones en TRC. La presencia de evento vascular previo, comorbilidad, albúmina disminuida y el aumento de PTH fueron predictores independientes de mortalidad. Keywords: Conservative management, Survival, Elderly, Advanced chronic kidney disease, Palabras clave: Manejo conservador, Supervivencia, Ancianos, Enfermedad renal crónica avanzada |
| first_indexed | 2024-12-17T10:05:05Z |
| format | Article |
| id | doaj.art-c173185f1f3b4cb482964490c4e0f91c |
| institution | Directory Open Access Journal |
| issn | 2013-2514 |
| language | English |
| last_indexed | 2024-12-17T10:05:05Z |
| publishDate | 2019-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología (English Edition) |
| spelling | doaj.art-c173185f1f3b4cb482964490c4e0f91c2022-12-21T21:53:11ZengElsevierNefrología (English Edition)2013-25142019-03-01392141150Survival and quality of life in elderly patients in conservative managementMaría Victoria Rubio Rubio0Luis Miguel Lou Arnal1José Antonio Gimeno Orna2Paula Munguía Navarro3Alex Gutiérrez-Dalmau4Elena Lambán Ibor5Javier Paúl Ramos6Raquel Pernaute Lavilla7Belén Campos Gutiérrez8Alberto San Juan Hernández-Franch9Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Corresponding author.Servicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Endocrinología, Hospital Universitario Lozano Blesa, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Medicina Interna, Hospital Ernest Lluch, Calatayud, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainServicio de Nefrología, Hospital Universitario Miguel Servet, Zaragoza, SpainIntroduction: Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL). Objective: Establish predictive variables associated with mortality and analyse HRQoL in CM patients. Patients and methods: Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status. Results: 82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1000 patients per month, with a homogeneous mortality rate after 6 months.Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p = 0.028), Charlson score ≥ 10 (42 vs. 17; p = 0.002), functional status (48.4 vs. 19; p = 0.002) and fragility (27 vs. 10; p = 0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment. Conclusions: Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality. Resumen: Introducción: El tratamiento renal conservador (TRC) se ha convertido en una opción terapéutica en la enfermedad renal crónica avanzada en ancianos. Se sabe poco sobre la evolución pronóstica de estos pacientes en términos de supervivencia y calidad de vida relacionada con la salud (CVRS). Objetivo: Establecer variables predictivas de mortalidad y analizar la CVRS en los pacientes en TRC. Pacientes y métodos: Estudio de cohortes prospectivo. Se realizó una valoración de parámetros de función renal y evaluación geriátrica integral: análisis de comorbilidad, situación funcional, cognitiva, fragilidad, nutricional, social y CVRS. Resultados: Se evaluaron 82 pacientes, con una edad media de 84 años e importante pluripatología: el 56% tenía antecedentes de evento vascular y Charlson > 8. La tasa de mortalidad fue de 23/1.000 pacientes-mes, con un ritmo de mortalidad homogéneo a partir de los 6 meses.La supervivencia difirió significativamente si presentaban evento vascular previo (36,7 vs. 14,8; p = 0,028), Charlson ≥ 10 (42 vs. 17; p = 0,002), grado de dependencia (48,4 vs. 19; p = 0,002) y fragilidad (27 vs. 10; p = 0,05).Fueron predictores de mortalidad: eFG y proteinuria, presencia de evento vascular previo, comorbilidad de Charlson, parámetros de malnutrición-inflamación (albúmina y puntuación MNA), grado de dependencia, CVRS física y aumento de PTH. La presencia de evento vascular previo, comorbilidad, albúmina descendida y elevación de PTH fueron predictores independientes de mortalidad. La CVRS se mantuvo estable y no se produjo empeoramiento significativo durante el tratamiento. Conclusiones: El conocimiento de los factores asociados con mortalidad y la evaluación de la CVRS puede ser útil como herramienta en la toma de decisiones en TRC. La presencia de evento vascular previo, comorbilidad, albúmina disminuida y el aumento de PTH fueron predictores independientes de mortalidad. Keywords: Conservative management, Survival, Elderly, Advanced chronic kidney disease, Palabras clave: Manejo conservador, Supervivencia, Ancianos, Enfermedad renal crónica avanzadahttp://www.sciencedirect.com/science/article/pii/S2013251419300537 |
| spellingShingle | María Victoria Rubio Rubio Luis Miguel Lou Arnal José Antonio Gimeno Orna Paula Munguía Navarro Alex Gutiérrez-Dalmau Elena Lambán Ibor Javier Paúl Ramos Raquel Pernaute Lavilla Belén Campos Gutiérrez Alberto San Juan Hernández-Franch Survival and quality of life in elderly patients in conservative management Nefrología (English Edition) |
| title | Survival and quality of life in elderly patients in conservative management |
| title_full | Survival and quality of life in elderly patients in conservative management |
| title_fullStr | Survival and quality of life in elderly patients in conservative management |
| title_full_unstemmed | Survival and quality of life in elderly patients in conservative management |
| title_short | Survival and quality of life in elderly patients in conservative management |
| title_sort | survival and quality of life in elderly patients in conservative management |
| url | http://www.sciencedirect.com/science/article/pii/S2013251419300537 |
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