ABSTRACT
ANTECEDENTES Y OBJETIVOS: Conocer evolución de pacientes ERC estadios 4 y 5 (ERCA) e influencia de la información (proceso educativo [PE]) que reciben para elección de la modalidad de tratamiento renal sustitutivo (TRS) o tratamiento conservador (TC) en consulta multidisciplinar de ERCA. MATERIAL Y MÉTODOS: Estudio prospectivo, multicéntrico (3 centros españoles). Pacientes incidentes: consulta ERCA desde el 1 de junio del 2014 al 1 de octubre del 015; observación: 12 meses o inicio del TRS o fallecimiento si antes de los 12 meses; finaliza el 1 de octubre del 2016. RESULTADOS: Trescientos treinta y tres pacientes (60% varones), mediana y rango intercuartil: edad 71,5 (17) años (55% ≥ 70 años), FGe CKD-EPI inicio 21 (9) ml/min/1,73 m2, índice de Charlson (ICh) con/sin edad 8 (3)/4 (2). Pacientes diabéticos: 52,4%. Recibieron PE 168 pacientes, FGe al inicio 15 (10) ml/min/1,73 m2. Tratamiento inicial elegido: 26% diálisis peritoneal (DP), 45% hemodiálisis (HD), 26% TC, trasplante renal 3%; 60 pacientes iniciaron TRS: 3,3% trasplante renal, 30% DP, 66% HD. Ingresos: 104 en 73 pacientes, la causa más frecuente fue por enfermedad cardiovascular (42%). Fallecimiento: 23 pacientes (6,8%), de mayor edad (78,4 [6] vs. 67,8 [13,4], p < 0,001), ICh más elevado 9,8 [2,1] vs. 7,4 [2,5], p < 0,001). Todos los fallecidos con PE habían decidido TC; el 61% de los fallecidos tenían al menos un ingreso hospitalario vs. 39%vivos (p < 0,001). Regresión Cox: variables predictivas mortalidad: edad e ICh. CONCLUSIONES:La población de ERCA es añosa, comórbida y con elevado índice de ingresos hospitalarios. La incidencia de DP es mayor a la habitual. El PE ha sido una herramienta de gran utilidad y favorece la elección de DP
BACKGROUND AND OBJECTIVES: Analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. MATERIAL AND METHODS: Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. RESULTS: 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73 m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Fallecimiento: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P < .001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P < .001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P < 0.001). Cox regression: age and Charlson index were the predictive mortality variables. CONCLUSIONS: The population of ACRF patients is elder, comorbid, with high rate hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice
Subject(s)
Humans , Male , Female , Aged , Renal Insufficiency, Chronic/therapy , Renal Replacement Therapy/methods , Prospective Studies , Facilities and Services Utilization , Renal Insufficiency, Chronic/physiopathology , Kidney/physiopathology , Interdisciplinary Communication , Hemodialysis, Home/methods , Hemodialysis, Home/trendsABSTRACT
BACKGROUND AND OBJECTIVES: Analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. MATERIAL AND METHODS: Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. RESULTS: 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Fallecimiento: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P<.001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P<.001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P<0.001). Cox regression: age and Charlson index were the predictive mortality variables. CONCLUSIONS: The population of ACRF patients is elder, comorbid, with high rate hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice.
Subject(s)
Conservative Treatment , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/therapy , Renal Dialysis , Aged , Aged, 80 and over , Decision Making , Female , Humans , Male , Middle Aged , Patient Education as Topic , Prospective Studies , Severity of Illness Index , Time FactorsABSTRACT
Antecedentes: En la actualidad hay una elevada incidencia de pacientes ancianos con enfermedad renal crónica avanzada (ERCA), siendo importante conocer la evolución a largo plazo y qué factores influyen. Objetivos: Analizar la evolución de la ERCA en pacientes ancianos y la influencia del metabolismo óseo-mineral. Métodos: Estudio retrospectivo de 125 pacientes ≥70años con ERC 4-5, que iniciaron seguimiento desde el 1 de enero de 2007 al 31 de diciembre de 2008, observándose la progresión de la ERC (medida con la pendiente de la línea de regresión del filtrado glomerular estimado [FGe] obtenido mediante MDRD-4) durante 5años. Resultados: Progresión grupo completo (mediana y percentiles 25 y 75): -1,15 (-2,80/0,17) ml/min/1,73m2/año, ERC-4: -1,3 (-2,8/0,03) ml/min/1,73m2/año, ERC-5: -1,03 (-3/0,8) ml/min/1,73m2/año; pendiente de línea de regresión positiva en 35 pacientes (28%: ERC no progresa) y negativa 90 pacientes (72%: ERC progresa). Correlación (Spearman) negativa (progresión más lenta): hormona paratiroidea (PTH), albuminuria/Cr, excreción diaria de Na (todos basales). No se correlacionó con FGe, P sérico, excreción urinaria de P, ingesta proteica e ingesta de P (todas basales). Regresión lineal (variable dependiente: pendiente de progresión): albuminuria y PTH (ambos a nivel basal) influyeron de forma independiente en dicha variable. Regresión logística (progresa vs. no progresa): PTH, albuminuria y FGe (todos basales) influyeron de forma significativa. Conclusiones: En nuestro grupo de pacientes de edad avanzada el deterioro de la función renal es muy lento, especialmente en los pacientes en estadio5. La albuminuria y la PTH al inicio del seguimiento son factores pronósticos en la evolución de su función renal (AU)
Background: At present, there is a high incidence of elderly patients with advanced chronic kidney disease (CKD) and it is important to know the long term progression and the factors that influence it. Objectives: To analyse the progression of advanced CKD in elderly patients and the influence of bone-mineral metabolism. Methods: Retrospective study of 125 patients ≥70years of age with CKD stages 4-5 who started follow-up from January 1, 2007 to December 31, 2008, showing the progression of CKD (measured by the slope of the regression line of the estimated glomerular filtration rate [eGFR] by MDRD-4) over 5years. Results: Progression in the entire group (median and 25th and 75th percentiles): -1.15 (-2.8/0.17) ml/min/1.73m2/year, CKD-4: -1.3 (-2.8/0.03) ml/min/1.73m2/year, CKD-5: -1.03 (-3.0/0.8) ml/min/1.73m2/year; the slope of the regression line was positive in 35 patients (28%: CKD does not progress) and negative in 90 patients (72%: CKD progresses). Negative correlation (Spearman) (slower progression): PTH, albumin/Cr ratio and daily Na excretion (all baseline measurements). No correlation with eGFR, serum P, urinary P excretion, protein intake and intake of P (all baseline measurements). In the linear regression analysis (dependent variable: slope of progression): albuminuria and PTH (both at baseline measurements) influenced this variable independently. Logistic regression (progresses vs. does not progress): PTH, albuminuria and eGFR (all at baseline measurements) influenced significantly. Conclusions: In our group of elderly patients, impairment of renal function is slow, particularly in CKD-5 patients. Albuminuria and PTH at baseline levels are prognostic factors in the evolution of renal function (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Parathyroid Hormone/analysis , Renal Insufficiency, Chronic/physiopathology , Albuminuria/diagnosis , Phosphorus/blood , Disease Progression , Risk Factors , Biomarkers/analysis , Retrospective Studies , Glomerular Filtration RateABSTRACT
BACKGROUND: At present, there is a high incidence of elderly patients with advanced chronic kidney disease (CKD) and it is important to know the long term progression and the factors that influence it. OBJECTIVES: To analyse the progression of advanced CKD in elderly patients and the influence of bone-mineral metabolism. METHODS: Retrospective study of 125 patients ≥70years of age with CKD stages 4-5 who started follow-up from January 1, 2007 to December 31, 2008, showing the progression of CKD (measured by the slope of the regression line of the estimated glomerular filtration rate [eGFR] by MDRD-4) over 5years. RESULTS: Progression in the entire group (median and 25th and 75th percentiles): -1.15 (-2.8/0.17) ml/min/1.73m2/year, CKD-4: -1.3 (-2.8/0.03) ml/min/1.73m2/year, CKD-5: -1.03 (-3.0/0.8) ml/min/1.73m2/year; the slope of the regression line was positive in 35 patients (28%: CKD does not progress) and negative in 90 patients (72%: CKD progresses). Negative correlation (Spearman) (slower progression): PTH, albumin/Cr ratio and daily Na excretion (all baseline measurements). No correlation with eGFR, serum P, urinary P excretion, protein intake and intake of P (all baseline measurements). In the linear regression analysis (dependent variable: slope of progression): albuminuria and PTH (both at baseline measurements) influenced this variable independently. Logistic regression (progresses vs. does not progress): PTH, albuminuria and eGFR (all at baseline measurements) influenced significantly. CONCLUSIONS: In our group of elderly patients, impairment of renal function is slow, particularly in CKD-5 patients. Albuminuria and PTH at baseline levels are prognostic factors in the evolution of renal function.
Subject(s)
Kidney Failure, Chronic/blood , Parathyroid Hormone/blood , Phosphorus/blood , Aged , Disease Progression , Female , Humans , Longitudinal Studies , Male , Prognosis , Retrospective StudiesABSTRACT
Introducción: Los pacientes de edad avanzada que llegan a enfermedad renal crónica avanzada (ERCA) se han incrementado en los últimos años. No hay evidencia de la mejor actitud terapéutica en estos pacientes. Objetivos: Observar la evolución de pacientes ancianos en consulta de ERCA (estadios 4 y 5) y comparar la supervivencia de los pacientes con ERC estadio 5 tratados con diálisis o no. Material y métodos: Se incluyó a todos los pacientes con ≥70 años que iniciaron seguimiento en consulta de ERCA desde el 1-1-2007 hasta el 31-12-2008 y se observó su evolución hasta el 31-12-2013. Se recogieron datos demográficos, índice de comorbilidad de Charlson, antecedentes de cardiopatía isquémica (CI) y diabetes mellitus (DM). Resultados: Se estudió a 314 pacientes con ERC estadios 4 y 5 con ≥70 años, 162 de los cuales estaban en el momento del inicio del seguimiento o a lo largo del mismo en estadio 5; 69 de estos pacientes recibieron tratamiento con diálisis. En el grupo estadio 5: mediana de edad de 77 años (74-81); 48% CI; 50% DM; Charlson 7 (6-9). Supervivencia Kaplan-Meier: ≥70 años (93 vs. 69 pacientes con diálisis) log rank: 15 (p<0,001), con ≥75 años (74 vs. 46 pacientes con diálisis; log rank: 8,9; p = 0,003), con ≥80 años (40 vs. 15 pacientes con diálisis) y p=0,2. Los pacientes que recibieron tratamiento con diálisis tenían menor edad e índice de Charlson y el tiempo de seguimiento en consulta era inferior. Conclusiones: En nuestro estudio el tratamiento con diálisis mejora la supervivencia, si bien esta ventaja se pierde en los pacientes con ≥80 años (AU)
Introduction: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. Objectives: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. Material and methods: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. Results: A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. Conclusions: Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Renal Insufficiency, Chronic/epidemiology , Renal Dialysis/statistics & numerical data , Aged/statistics & numerical data , Survival Analysis , Frail Elderly/statistics & numerical dataABSTRACT
INTRODUCTION: The number of elderly patients with advanced chronic kidney disease (ACKD) has increased in recent years, and the best therapeutic approach has not been determined due to a lack of evidence. OBJECTIVES: To observe the progression of elderly patients with ACKD (stages 4 and 5) and to compare the survival of stage 5 CKD patients with and without dialysis treatment. MATERIAL AND METHODS: All patients ≥70 years who began ACKD follow-up from 01/01/2007 to 31/12/2008 were included, and their progression was observed until 31/12/2013. Demographic data, the Charlson comorbidity index, history of ischaemic heart disease (IHD) and diabetes mellitus (DM) were assessed. RESULTS: A total of 314 patients ≥70 years with stages 4 and 5 CKD were studied. Of these patients, 162 patients had stage 5 CKD at the beginning of follow-up or progressed to stage 5 during the study, and 69 of these patients were treated with dialysis. In the stage 5 group: median age was 77 years (74-81); 48% had IHD; 50% had DM, Charlson 7 (6-9). Kaplan-Meier survival analysis: ≥70 years (93 vs. 69 patients with dialysis, log rank: 15 P<.001); patients ≥75 years (74 vs. 46 patients with dialysis, log rank: 8.9 P=.003); patients ≥80 (40 vs. 15 patients with dialysis) and p=0,2. Patients receiving dialysis were younger, with a lower Charlson comorbidity index and shorter follow-up time. CONCLUSIONS: Our study shows that dialysis treatment improves survival, although this benefit is lost in patients ≥80 years.
Subject(s)
Renal Dialysis , Renal Insufficiency, Chronic/mortality , Age Factors , Aged , Aged, 80 and over , Comorbidity , Conservative Treatment , Diabetes Mellitus/epidemiology , Female , Humans , Kaplan-Meier Estimate , Linear Models , Male , Myocardial Ischemia/epidemiology , Proportional Hazards Models , Renal Insufficiency, Chronic/therapy , Retrospective StudiesABSTRACT
En los últimos años se han publicado diversos estudios en pacientes con insuficiencia renal crónica en hemodiálisis en los que se demuestra "paradójicamente" que, al contrario que en la población general, la obesidad, medida a través del índice de masa corporal, se relaciona con mejor supervivencia. En este trabajo hemos estudiado la influencia de la obesidad en la supervivencia a los 5 años en pacientes con insuficiencia renal en Prediálisis. La muestra estaba formada por 160 pacientes, vistos por primera vez en la consulta de Prediálisis desde el 1 de septiembre de 1998 a 31 de octubre de 1999. Se recogieron de la Historia de Enfermería los datos para calcular el IMC (peso (Kg)/ altura2) en la primera (basal) y última (final) visita en Consulta Prediálisis. Consideramos obeso al paciente con IMC=30.De los 157 pacientes que conocimos la evolución a los 5 años: 85 (54%) permanecían vivos: 19 seguían en Prediálisis, 43 en diálisis y 23 con un trasplante funcionante; Los pacientes con un IMC=30 tenían una supervivencia en meses inferior a los no obesos (53=24 vs 61=19 meses p= 0,04), es decir, la obesidad, definida como IMC=30, influye negativamente en la supervivencia a los 5 años en nuestra población de pacientes con insuficiencia renal avanzada atendidos en la Consulta Prediálisis (AU)
In recent years a number of studies have been published on patients with chronic renal insufficiency undergoing haemodialysis in which it is shown "paradoxically" that, contrary to what occurs in the population in general, obesity, measured through the body mass index, is related to better survival. Here we have studied the influence of obesity on survival after 5 years in patients with renal insufficiency in predialysis. The sample was made up of 160 patients, seen for the first time in the predialysis clinic between 1 September 1998 and 31 October 1999. The data required to calculate their BMI (weight (kg)/height2) was taken from the nursing case history on the first (basal) and last (final) predialysis visit. We considered patients with BMI=30 to be obese. Of the 157 patients whose evolution after 5 years is known to us: 85 (54%) were still alive: 19 were still in predialysis, 43 on dialysis and 23 with a functioning transplant. The patients with a BMI=30 had a lower survival in months than the non-obese patients (53±24 compared to 61±19 months p= 0.04), in other words, obesity defined as IMC=30 has a negative effect on survival after 5 years in our population of patients with advanced renal insufficiency treated in the predialysis clinic (AU)
