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Chesnaye, Nicholas C; Caskey, Fergus J; Dekker, Friedo W; de Rooij, Esther N M; Evans, Marie; Heimburger, Olof; Pippias, Maria; Torino, Claudia; Porto, Gaetana; Szymczak, Maciej; Drechsler, Christiane; Wanner, Christoph; Jager, Kitty J; Schneider, Andreas; Torp, Anke; Iwig, Beate; Perras, Boris; Marx, Christian; Drechsler, Christiane; Blaser, Christof; Wanner, Christoph; Emde, Claudia; Krieter, Detlef; Fuchs, Dunja; [...]

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

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  • Media type: E-Article
  • Title: Clinical and patient-reported trajectories at end-of-life in older patients with advanced CKD
  • Contributor: Chesnaye, Nicholas C; Caskey, Fergus J; Dekker, Friedo W; de Rooij, Esther N M; Evans, Marie; Heimburger, Olof; Pippias, Maria; Torino, Claudia; Porto, Gaetana; Szymczak, Maciej; Drechsler, Christiane; Wanner, Christoph; Jager, Kitty J; Schneider, Andreas; Torp, Anke; Iwig, Beate; Perras, Boris; Marx, Christian; Drechsler, Christiane; Blaser, Christof; Wanner, Christoph; Emde, Claudia; Krieter, Detlef; Fuchs, Dunja; [...]
  • imprint: Oxford University Press (OUP), 2023
  • Published in: Nephrology Dialysis Transplantation
  • Language: English
  • DOI: 10.1093/ndt/gfad091
  • ISSN: 0931-0509; 1460-2385
  • Keywords: Transplantation ; Nephrology
  • Origination:
  • Footnote:
  • Description: <jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>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 chronic kidney disease (CKD).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The EQUAL study is a European observational prospective cohort study with an incident eGFR &amp;lt;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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 one hospitalization per person year, increasing exponentially at 6 months preceding death.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>We identified clinically relevant physiological accelerations in patient trajectories that began ∼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.</jats:p> </jats:sec>