Kidney replacement therapies in the older person: challenges to decide the best option

Clinical Kidney Journal, Год журнала: 2025, Номер 18(2)

Опубликована: Янв. 22, 2025

ABSTRACT A multitude of challenges exist when supporting older adults in deciding on the optimal kidney replacement therapy (KRT), including frailty, comorbidity, cognitive impairment, dialysis modality, as well local availability services. The combination these factors can determine treatment outcomes and quality life (QoL), such care people should be tailored to take into account. Frailty with chronic disease (CKD) leads higher rates hospitalization, increased mortality, a diminished QoL, while present up 50% CKD, exacerbates affects decision making. Dialysis, particularly haemodialysis, accelerate physical decline frail adults. Conversely, peritoneal (PD) presents home-based alternative that may better support for wanting prioritize flexibility independence. Assisted PD programmes have emerged valuable option who cannot manage independently, improving access KRT. Ultimately shared making employed discussing KRT, incorporating patient goals, prognostic awareness, QoL measures. There is also emerging role geriatrician need an integrated Comprehensive Geriatric Assessment. These elements make informed choices align individuals’ values health needs. In designing future services meet needs increasing numbers people, there assisted multidisciplinary working ensure patient-focused surrounding KRT

Язык: Английский

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Associations of Pretransplant Patient-Reported Outcomes Measurement Information System Physical Function Score With Kidney Transplant Outcomes

Transplant International, Год журнала: 2025, Номер 38

Опубликована: Янв. 29, 2025

Simple and validated physical function measures are needed for kidney transplant candidates because pretransplant low is a common potentially modifiable risk factor. This single-center retrospective study investigated the associations between assessed by Patient-Reported Outcomes Measurement Information System ® Physical Function (PROMIS-PF) computer adaptive testing early posttransplant outcomes. We analyzed 154 adult kidney-alone recipients. The median PROMIS-PF score was 43 (interquartile range, 39–47). Patient characteristics were not significantly different across category (normal, ≥45; mild, of 40–45; moderate/severe, <40). associated with length hospital stay, delayed graft function, 6-month 12-month or patient survival. However, lower higher emergency room visits [adjusted odds ratios compared to normal: 1.68 (95% confidence interval, 0.76–3.83); 3.23 (1.34–7.79)] rehospitalization ratios: 2.61 (1.16–5.90); 2.53 (1.07–6.00)] within 1 month posttransplant. Results suggest that practical tool assessing in candidates. Larger studies confirm utility identify who would benefit from prehabilitation.

Язык: Английский

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The prevalence of frailty according to kidney function and its association with cognitive impairment, nutritional status, and clinical outcome

BMC Nephrology, Год журнала: 2025, Номер 26(1)

Опубликована: Фев. 10, 2025

Frailty is a state of vulnerability to poor homeostatic resolution after stressful event. The prevalence frailty in patients with chronic kidney disease (CKD) more common than the general population. associated clinical prognosis, malnutrition, and cognitive impairment; however, studies on these factors CKD are lacking. Therefore, we aimed evaluate relationship between frailty, nutritional status, impairment their influence outcomes. We prospectively enrolled participants from June 2019 December 2020 divided them into three groups according function (CKD G1-2, G3-4, G5D). Clinical outcomes were defined as composite all-cause death, hospitalization, cardiovascular outcomes, including nonfatal myocardial infarction, revascularization, or stroke. To calculate relative risk impairment, outcome, odds ratios (ORs) 95% confidence intervals (CIs) calculated using logistic regression analysis. A total 83 included, whom 31.3% had 18.1% impairment. In G5D group, (56.7%, n = 17) was significantly higher, quotient score lower other groups. Korean-Montreal Cognitive Assessment group; did not differ among group. older age higher BMI. Well-nourished status BMI Patients group likely have adverse increased stage progressed. Particularly, correlated leading

Язык: Английский

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Incremental Hemodialysis: Review of Clinical Trials Focused on Patients Undergoing Once-Weekly Hemodialysis

Nutrients, Год журнала: 2025, Номер 17(4), С. 713 - 713

Опубликована: Фев. 17, 2025

Background/objectives: The implementation of appropriate hemodialysis treatment in the transition from end-stage kidney disease to reduced frequency schedules represents a major challenge. aim our work is report only protocols that used once-weekly hemodialysis. Methods: benefits and risks 1WHD were explored this systematic review. A search MEDLINE, Scopus, Cochrane Central Register was conducted identify publications relating trials performed between June 1981 December 2024 assess clinical impact, duration, safety, mortality. Items, including age, causes chronic (CKD), creatinine levels, Blood Urea Nitrogen GFR values, diuresis, nutritional supplementation, drop-out, survival, benefit or drawbacks, data eventual control groups higher weekly HD sessions included. Outcome at end regimen represented by death twice/thrice-weekly rhythms. Results: total 1238 articles focused on IHD included review, 1226 excluded as they referred either twice-weekly (2WHD) failed meet eligibility criteria, whilst another two based incomplete outcome patient recruitment issues. eight comprising 254 patients undergoing ultimately identified evaluated. Only three studies comparison with schedule, 107 thrice-weekly (3WHD) 15 2WHD). This choice demonstrated possibility slowing down progression CKD studied. Daily amino acid supplementation also proved be beneficial. However, milestone which protocol low-protein diet. Conclusions: has been shown safe may result improved outcomes, particularly appropriately selected patients. Large-scale randomized controlled should carried out confirm these potential advantages. standard techniques applied tended prevent suitably transitioning into less frequent potentially long-lasting schedules.

Язык: Английский

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Enhancing treatment adherence in dialysis patients through digital health interventions: a systematic review and meta-analysis of randomized controlled trials

Renal Failure, Год журнала: 2025, Номер 47(1)

Опубликована: Март 26, 2025

Objective To systematically assess the efficacy of digital health interventions (DHIs) for improving treatment adherence among dialysis patients through a meta-analysis randomized controlled trials (RCTs).

Язык: Английский

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Influence of Frailty on Health-Related Quality of Life Trajectories in Chronic Kidney Disease Patients in India

Journal of Clinical Medicine, Год журнала: 2025, Номер 14(8), С. 2753 - 2753

Опубликована: Апрель 17, 2025

Background: Frailty is a critical concern for chronic kidney disease (CKD) patients, contributing to increased vulnerability adverse health outcomes and diminished quality of life. However, there limited research on frailty’s impact health-related life (HRQOL) among dialysis pre-dialysis patients in the Indian context. Methods: This study involved participants aged 18 above with CKD stages 3–5. was assessed using Morley FRAIL questionnaire, HRQOL measured RAND version KDQOL-36 Survey. Data were analyzed SPSS 29, focusing association between frailty domains. Results: Among 147 56.46% frail, 43.56% non-frail. Significant differences noted frail non-frail groups age (p = 0.036), < 0.001), nutritional status Charlson comorbidity index BMI GFR CRP 0.006), serum albumin 0.002). significantly associated lower physical 0.001) mental Negative associations domains, especially symptom problems, PCS, MCS, established. Conclusions: Our findings emphasize importance screening patients. Early identification may help guide targeted strategies support HRQOL. longitudinal studies are needed assess progression potential interventions.

Язык: Английский

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Thoracic spinal anesthesia for laparoscopic peritoneal dialysis catheter placement in older high-risk end-stage kidney disease patients

Peritoneal Dialysis International, Год журнала: 2025, Номер unknown

Опубликована: Апрель 23, 2025

Peritoneal dialysis (PD) catheter placement is considered a controversial procedure in patients with history of abdominal surgeries or peritonitis. In these subjects, video laparoscopic (VLS)-assisted under general anesthesia (GA) the gold standard procedure. However, older multimorbid are at high risk for complications GA. our opinion, thoracic spinal (TSA) instead GA could also be used undergoing PD. Here, we report five cases end-stage kidney disease (ESKD) aged 79.6 ± 3.5 years surgery peritonitis needing renal replacement therapy. Overall comorbidity was (Cumulative Illness Rating Scale (CIRS) index 4.0 1.2 and CIRS severity 2.1 0.5). We placed PD using VLS-assisted TSA. All subjects underwent TSA performed T9-T10 level, obtaining optimal pain control no periprocedural side effects. This first attempt to utilize VLS very old patients. Further studies useful confirm whether can successfully placement, especially ineligible such as frailty

Язык: Английский

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Patient perspectives and preferences for rehabilitation among people living with frailty and chronic kidney disease: a qualitative evaluation

BMC Nephrology, Год журнала: 2024, Номер 25(1)

Опубликована: Сен. 13, 2024

Abstract Background Understanding the patient perspective of frailty is critical to offering holistic patient-centred care. Rehabilitation strategies for patients with advanced chronic kidney disease (CKD) and are limited in their ability overcome patient-perceived barriers participation, resulting high rates drop-out non-adherence. The aim this study was explore perspectives preferences regarding experiences rehabilitation inform a CKD/Frailty model. Methods This qualitative involved two focus groups, six individual semi-structured interviews three caregiver lived experience frailty. Interviews were recorded, transcribed, coded meaningful concepts analysed using inductive thematic analysis constant comparative method data employing Social Cognitive Theory. Results Six major themes emerged including accommodating an act resilience, exercise endorsed but existing programs have failed meet end-users’ needs. goals framed around return normative behaviours should social dimension, understanding “people like us”. Participants reported on disruptors CKD context. valued peer-to-peer education, camaraderie socialisation benefit feedback maintaining motivation. Patients undertaking dialysis described commodity time burden unresolved symptoms as participation. difficulty envisioning rehabilitation, immediate avoidance future uncertainty. Conclusions Frailty efforts leverage shared experiences, address comorbidity symptom value.

Язык: Английский

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Cardiovascular disease as a risk factor for frailty in dialysis patients

Kidney International, Год журнала: 2024, Номер 106(3), С. 537 - 538

Опубликована: Авг. 20, 2024

Язык: Английский

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Navigating the Global Economic Landscape of Dialysis: A Summary of Expert Opinions from The 4th International Congress of Chinese Nephrologists

Kidney Diseases, Год журнала: 2024, Номер 10(5), С. 384 - 397

Опубликована: Июль 24, 2024

Background: Chronic kidney disease (CKD) continues to be a significant global public health issue. The escalating burden of CKD is probably driven by the aging population and rising prevalence diabetes. not only adversely impacts an individual’s well-being, but also poses challenge on economy society. Summary: Experts from ten countries regions around world (Australia, Canada, China, Hong Kong, Malaysia, New Zealand, Singapore, Taiwan, United Kingdom, States) convened in 4th International Congress Chinese Nephrologists December 1, 2023 discuss dialysis burden. Although cost replacement therapy (KRT) accounts for 2–3% total healthcare expenditure developed countries, patients with end stage (ESKD) represent small percentage (<0.5%) population. Importantly, economic impact ESKD limited direct medical costs, extends indirect societal such as productivity loss caregivers. Primary prevention CKD, early screening treatment delay progression (where costs rise dramatically), utilization home-based (including peritoneal home hemodialysis) shall implemented part cost-containment strategy. Kidney transplant provides better outcomes than cost-effective long run, whereas conservative management should considered elderly frail patients. Key Messages: Implementation preventive measures strategies are cornerstone combat epidemic.

Язык: Английский

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