Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD

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 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 1 hospitalization per person year, increasing exponentially at 6 months preceding death. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began approximately 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.

Sixty years of European Renal Association (ERA) Registry data on kidney disease: visualizing differences in clinical practice

“…This added value of renal registries will also be illustrated by the selected ERA Registry articles in the special collection of NDT and CKJ . This collection contains the latest summaries of the ERA Registry annual report [ 4 , 5 ] as well as other scientific publications based on the ERA Registry database [ 6–12 ], the ESPN/ERA Registry database [ 3 , 13 ], the EQUAL database [ 14 , 15 ] and other data collections [ 16–19 ]. In addition, the special collection includes several highly cited methodological papers because we believe they belong in the compilation alongside the Registry's expertise [ 20–22 ].…”

“…One of the publications from the EQUAL study on elderly patients with advanced CKD disclosed clinically relevant physiological accelerations in patient trajectories that started ∼6 to 12 months prior to death [ 14 ]. These findings can help to better inform patients and families about expectations and (end-of-life) care, and for setting up clinical alert systems.…”