Significance of Frailty among Dialysis Patients

Johansen, Kirsten L.; Chertow, Glenn M.; Jin, Chengshi; Kutner, Nancy G.

doi:10.1681/asn.2007020221

Cited by 570 publications

(656 citation statements)

References 15 publications

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“…The data showed an inverse relationship between the prevalence rates for frailty and the level of renal function, and dialysis patients have been shown to experience one of the highest prevalence rates for frailty in any single population. In the Dialysis Morbidity and Mortality Study (DMMS) Wave II study, a total of 67.7% of patients of all ages met collective criteria for frailty (14). While the prevalence was maximal in the oldest age category (78.8% of those who were older than 80 yr were considered frail), a significant number of younger individuals fulfilled criteria for frailty (66.4% of those aged 50 to 60 yr).…”

Section: Frailtymentioning

confidence: 99%

Dialysis in Late Life

Jassal¹,

Watson²

2009

Clinical Journal of the American Society of Nephrology

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As a result of the changing dialysis demographics, nephrologists are increasingly faced with problems traditionally considered to be geriatric issues. The specialty of nephrology has often been seen as using intensive, expensive, and complex technologies for patient care. Dialysis programs have evolved into highly efficient, fast-paced units that accommodate a rapid turnover of patients. They are in direct contrast to geriatric programs, which use geriatric principles to offer simple, multidimensional, holistic care to frail older patients. Finding the balance between nephrology and geriatric skill sets is a particular challenge for up-and-coming nephrologists who have an interest in geriatric nephrology. This mini-review addresses some of the challenges, increases awareness of specific issues, and highlights new opportunities in this field.

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Section: Frailtymentioning

confidence: 99%

Dialysis in Late Life

Jassal¹,

Watson²

2009

Clinical Journal of the American Society of Nephrology

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“…The mean age 6 standard deviation of the cohort was 57 6 10 years. Sixty-three percent of the cohort were men, with a median MELD score of 17 (interquartile range [13][14][15][16][17][18][19][20][21]. Alcohol was the most common cause of cirrhosis (44%).…”

Section: Patient and Admission Characteristicsmentioning

confidence: 99%

“…(8)(9)(10) One of these is its inability to account for an individual's performance status. Performance status and the linked concept of frailty are known robust predictors of adverse outcomes in diverse populations (11)(12)(13)(14)(15)(16)(17) including cirrhosis, (18)(19)(20)(21) often outperforming traditional prognostic markers. (22,23) Developed in 1948, the Karnofsky Performance Status (KPS) is one of the oldest performance status scales.…”

mentioning

confidence: 99%

A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

et al. 2017

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Identification of patients with cirrhosis at risk for death within 3 months of discharge from the hospital is essential to individualize postdischarge plans. The objective of the study was to identify an easy-to-use prognostic model based on the Karnofsky Performance Status (KPS). The North American Consortium for the Study of End-Stage Liver Disease consists of 16 tertiary-care hepatology centers that prospectively enroll nonelectively admitted cirrhosis patients. Patients enrolled had KPS assessed 1 week postdischarge. KPS was categorized into low (score 10-40), intermediate , and high (80-100). Of 954 middle-aged patients (57 6 10 years, 63% men) with a median Model for End-Stage Liver Disease (MELD) score of 17 (interquartile range 13-21), the mortality rates for the low, intermediate, and high performance status groups were 23% (36/ 159), 11% (55/489), and 5% (15/306), respectively. Low, intermediate, and high performance status was seen in 17%, 51%, and 32% of the cohort, respectively. Low performance status was associated with older age, dialysis, hepatic encephalopathy, longer length of stay, and higher white blood cell count or MELD score at discharge. A model was derived using the three independent predictors of 3-month mortality: KPS, age, and MELD score. This score had better discrimination (area under the receiver operating characteristic curve 5 0.74) than a model using MELD (area under the receiver operating characteristic curve 5 0.62) or MELD and age (area under the receiver operating characteristic curve 5 0.67) to predict 3-month mortality. Conclusions: Cirrhosis patients at risk for 3-month postdischarge mortality can be identified using a novel KPS-based score; this score may be adopted in practice to guide postdischarge early interventions, including the integrated provision of active and palliative management strategies. (HEPATOLOGY 2017;65:217-224).P atients with cirrhosis can experience sudden deteriorations in health that lead to increased morbidity, repeated hospitalizations, and mortality. (1)(2)(3) Hospitalization is a marker for a variety of poor outcomes including readmission and death. Although we are gaining a better understanding of risk factors for readmission in discharged patients, (1,(4)(5)(6) we lack a practical prognostic model to identify those at highest risk for 3-month postdischarge mortality.Identifying this group would facilitate interventions that include more intensive follow-up and consideration of early liver transplant when available. Moreover, an estimation of the probability of survival can help to inform the type of integrated palliative support that is provided to patients.To date, mortality prediction in patients with cirrhosis has been predominated by liver-specific and kidney-specific prognostic indicators such as the Abbreviations: AUC, area under the receiver operating characteristic curve; CI, confidence interval; HE, hepatic encephalopathy; KAM, KPS, age, MELD (model); KPS, Karnofsky Performance Status; MELD, Model for End-Stage Liver Disease; OR, odd...

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“…Johansen et al reported a higher rate of frailty in older patients with ESRD (age , 40 years, 44.4%; age 60-70 years, 74.2%; age .80 years, 78.8%) (4). For those with frailty, after 1 year adjusted HRs were 2.24 (95% CI, 1.60-3.15) for mortality and 1.56 (95% CI, 1.36-1.79) for hospitalization (4).…”

Section: Frailtymentioning

confidence: 99%

Renal Replacement Therapy in the Elderly Population

Berger¹,

Hedayati

2012

Clinical Journal of the American Society of Nephrology

100

101

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Summary ESRD has become an important problem for elderly patients. The segment of the ESRD population age 65 years or older has grown considerably, and this growth is expected to accelerate in coming years. Nephrologists caring for the elderly with advanced kidney disease will encounter patients with comorbid conditions common in younger patients, as well as physical, psychological, and social challenges that occur with increased frequency in the aging population. These challenging factors must be addressed to help inform decisions regarding the option to initiate dialysis, the choice of dialysis modality, whether to pursue kidney transplantation, and end-of-life care. This article will highlight some common problems encountered by elderly patients with ESRD and review data on the clinical outcomes of elderly patients treated with different modalities of dialysis, outcomes of kidney transplantation in the elderly, and nondialytic management of CKD stage 5.

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Significance of Frailty among Dialysis Patients

Cited by 570 publications

References 15 publications

Dialysis in Late Life

Dialysis in Late Life

A Karnofsky performance status–based score predicts death after hospital discharge in patients with cirrhosis

Renal Replacement Therapy in the Elderly Population

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