Comprehensive geriatric assessment in nephrology

Abstract

In Portugal, in 2018, 64.5% of dialysis patients were elderly and nearly a quarter were older than 80 years. Aging is a heterogeneous process: in some patients, there is a marked clinical improvement under renal replacement therapy (RRT) although others show an inexorable functional decline. Despite advances in dialysis, patient mortality rates remain high. These two phenomena have been difficult to understand and it may be difficult to decide which patients may benefit from RRT or conservative care. Comprehensive Geriatric Assessment (CGA) is an instrument used by geriatricians to evaluate functionality and geriatric syndromes, allowing recognition of problems that would not otherwise be identified. It has been used to individualize and tailor therapies. CGA allows frailty identification (the major geriatric syndrome) and might better predict clinical prognosis and interventions' effectiveness. Physical frailty is a multifactorial condition that is common in chronic kidney disease (CKD) patients and its reversibility is hardly predictable when RRT is started so CGA might contribute to a better understanding of frailty in these patients. Therefore, it is possible that CGA application to CKD older patients would contribute to the selection of patients who might benefit the most from RRT and to improve patient clinical condition. This article aims to review geriatric syndromes and frailty in CKD patients, CGA potential to evaluate them and possible models to apply it.

El impacto de la educación en ciencias biológicas en pacientes con enfermedad renal en un contexto de epidemia por COVID-19

“…Por otra parte, factores como la mayor edad, la fragilidad y la presencia de otras comorbilidades son habituales en pacientes con enfermedad renal, y esto puede obstaculizar la implementación del autocuidado. Por lo tanto, no es infrecuente encontrar un paciente que sea parcialmente dependiente y con un perfil de polimedicación en el que estos aspectos sean difíciles de manejar 27,28 .…”