Prognosis of geriatric patients with severe kidney disease

Geriatr Psychol Neuropsychiatr Vieil. 2018 Dec 1;16(4):376-382. doi: 10.1684/pnv.2018.0756.

Abstract

Over three million French people present a severe chronic kidney disease, among which there is a high prevalence of elder subjects. We conducted a prospective monocentric study in a geriatric acute care ward. The aims were to determine the short-term prognosis of patients with severe chronic kidney disease and to determine the factors associated with mortality at six-months.

Methods: Patients 75 years of age and older, with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 (chronic kidney disease epidemiology CKD-EPI) were recruited. A comprehensive geriatric assessment was performed at hospital discharge. Comprehensive geriatric assessment was performed: Activities of daily livings and Instrumental activities of daily livings scores, of the risk of pressure sore with Exton-Smith scale, the cognitive status with MMSE score, nutritional status according to Mini-nutritional assessment short form and albuminemia, comorbidities with Cumulative illness rating scale, number of drugs in presciption and living status. Six months follow-up was performed to assess vital status and evolution of the eGFR.

Results: Sixty-seven patients were included, mean age 88.6±4.82 years with a mean eGFR of 21.3±6 mL/min. Mortality rate at six months was 36%. Multivariate analysis showed that a high CIRS score (RR=1.52; IC 95% 1.05-2.19) and a decline of creatinine clearance≥ 2 mL/min (4.72; 1.27-17.52) were predictive of mortality. On the opposite, a high MNA-SF score was protective (0.76; 0.62-0.94).

Conclusion: Prognosis of geriatric patients with severe chronic kidney disease is poor. Comprehensive geriatric assessment helps to assess short-term prognosis, in a focus of person-centered care.

Keywords: chronic kidney disease; comprehensive geriatric assessment; elderly; prognosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • France / epidemiology
  • Geriatric Assessment
  • Humans
  • Kidney Function Tests
  • Male
  • Mental Status and Dementia Tests
  • Nutrition Assessment
  • Prognosis
  • Prospective Studies
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / therapy*