Tailoring Vascular Access for Dialysis: Can Frailty Assessment Improve the Fit?

Kuningas, Kulli; Inston, Nicholas

doi:10.1053/j.ajkd.2021.12.003

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…No such interactions were observed. Given recent evidence linking frailty to vascular access difficulty [ 31–33 ], sensitivity analyses were run on all final regression models with addition of vascular access type.…”

Section: Methodsmentioning

confidence: 99%

Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

Anderson

Qasim

Correa

et al. 2022

Clinical Kidney Journal

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Background Frailty and depression are highly prevalent in haemodialysis recipients, exhibit a reciprocal relationship, and are associated with increased mortality, hospitalisation, and lower quality of life. Despite this, there has been little exploration of the relationship between depression and frailty upon patient outcomes. We aimed to explore the relationship between depression and frailty and their associations with mortality, hospitalisation, and quality of life (QOL). Methods We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalisation. Depression was assessed using PHQ-9, frailty using Clinical Frailty Scale (CFS), and quality of life using EuroQol EQ-5D Summary Index. Results 485 prevalent haemodialysis recipients were recruited, with 111 deaths and 1241 hospitalisations during follow-up. CFS was independently associated with mortality (HR 1.31; 95% C.I. 1.08, 1.59; P = 0.006), hospitalisation (IRR 1.13; 95% C.I. 1.03, 1.25; P = 0.010), and lower QOL (Coef. -0.401; 95% C.I. -0.511, -0.292; P<0.001). PHQ-9 score was independently associated with lower QOL (Coef. -0.042; 95% C.I. -0.063, -0.021; P<0.001), but not mortality (HR 1.00; 95% C.I. 0.96, 1.04; P = 0.901), or hospitalisation (IRR 0.99; 95% C.I. 0.97, 1.01; P = 0.351). In an adjusted model including CFS, moderate depression was associated with reduced hospitalisation (IRR 0.72; 95% C.I. 0.56, 0.93; P = 0.013). Conclusions With addition of frailty, depression was associated with lower hospital admissions, but poorer quality of life. The relationship between frailty and depression, and their influence on outcomes is complex, requiring further study.

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Section: Methodsmentioning

confidence: 99%

Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

Anderson

Qasim

Correa

et al. 2022

Clinical Kidney Journal

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“…In light of evidence that frailty portends poor vascular access outcomes and the need for more frequent interventions to maintain patency, the KDOQI (Kidney Disease Outcomes Quality Initiative) guideline for vascular access now recommends a ‘patient first’ approach to such decisions [ 55 ], and tunnelled venous catheters may represent a reasonable first-line option in older individuals living with frailty.…”

Section: Conservative Kidney Management and Supportive Dialysis In Th...mentioning

confidence: 99%

A review of supportive care for older people with advanced chronic kidney disease

Fitzgerald

Joosten

Buren

et al. 2022

Clinical Kidney Journal

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Supportive care (SC) is a multidimensional and person-centred approach to managing advanced CKD that engages the person and their caregivers in shared decision making from the outset. Rather than focussing on disease-specific therapies, SC is a collection of adjuvant interventions and adaptations to conventional treatments that can be used to improve the individual's quality of life. Recognising that frailty, multi-morbidity, and polypharmacy are more common among older people with advanced chronic kidney disease (CKD) and that people in this group tend to prioritise quality of life over survival as a goal of care, SC represents an important adjunct to disease-specific therapies in CKD management. This review provides an overview of SC in the older person with advanced CKD.

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Tailoring Vascular Access for Dialysis: Can Frailty Assessment Improve the Fit?

Cited by 2 publications

References 13 publications

Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

A review of supportive care for older people with advanced chronic kidney disease

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