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Chesnaye, N.C.; Caskey, F.J.; Dekker, F.W.; Rooi, E.N.M. de; Evans, M.; Heimburger, O.; ... ; Kuan, Y. (2023)

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

Article / Letter to editor
Background 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). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR Results 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...Show moreBackground 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). Methods The EQUAL study is a European observational prospective cohort study with an incident eGFR Results 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. Conclusions We identified clinically relevant physiological accelerations in patient trajectories that began similar to 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.Show less
chronic kidney disease
end-of-life
mortality
All authors
Chesnaye, N.C.; Caskey, F.J.; Dekker, F.W.; Rooi, E.N.M. de; Evans, M.; Heimburger, O.; Pippias, M.; Torino, C.; Porto, G.; Szymczak, M.; Drechsler, C.; Wanner, C.; Jager, K.J.; Bahner, U.; Seeger, W.; Cupisti, A.; Sagliocca, A.; Ferraro, A.; Mele, A.; Naticchia, A.; Cosaro, A.; Ranghino, A.; Stucchi, A.; Pignataro, A.; Blasio, A. de; Pani, A.; Tsalouichos, A.; Antonio, B.; Iorio, B.R.D.; Alessandra, B.; Abaterusso, C.; Somma, C.; D'alessandro, C.; Zullo, C.; Pozzi, C.; Bergamo, D.; Ciurlino, D.; Motta, D.; Russo, D.; Favaro, E.; Vigotti, F.; Ansali, F.; Conte, F.; Cianciotta, F.; Giacchino, F.; Cappellaio, F.; Pizzarelli, F.; Greco, G.; Bigatti, G.; Marinangeli, G.; Cabiddu, G.; Fumagalli, G.; Caloro, G.; Piccoli, G.; Capasso, G.; Gambaro, G.; Tognarelli, G.; Bonforte, G.; Conte, G.; Toscano, G.; Rosso, G. del; Capizzi, I.; Baragetti, I.; Oldrizzi, L.; Gesualdo, L.; Biancone, L.; Magnano, M.; Ricardi, M.; Bari, M.D.; Laudato, M.; Sirico, M.L.; Ferraresi, M.; Provenzano, M.; Malaguti, M.; Palmieri, N.; Murrone, P.; Cirillo, P.; Dattolo, P.; Acampora, P.; Nigro, R.; Boero, R.; Scarpioni, R.; Sicoli, R.; Malandra, R.; Savoldi, S.; Bertoli, S.; Borrelli, S.; Maxia, S.; Maffei, S.; Mangano, S.; Cicchetti, T.; Rappa, T.; Palazzo, V.; Simone, W. de; Schrander, A.; Dam, B. van; Siegert, C.; Gaillard, C.; Beerenhout, C.; Verburgh, C.; Janmaat, C.; Hoogeveen, E.; Hoorn, E.; Dekker, F.; Boots, J.; Boom, H.; Eijgenraam, J.W.; Kooman, J.; Rotmans, J.; Jager, K.; Vogt, L.; Raasveld, M.; Vervloet, M.; Buren, M. van; Diepen, M. van; Chesnaye, N.; Leurs, P.; Voskamp, P.; Blankestijn, P.; Esch, S. van; Boorsma, S.; Berger, S.; Konings, C.; Aydin, Z.; Musiala, A.; Szymczak, A.; Olczyk, E.; Augustyniak-Bartosik, H.; Miskowiec-Wisniewska, I.; Manitius, J.; Pondel, J.; Jedrzejak, K.; Nowanska, K.; Nowak, L.; Durlik, M.; Dorota, S.; Nieszporek, T.; Heleniak, Z.; Jonsson, A.; Blom, A.L.; Rogland, B.; Wallquist, C.; Vargas, D.; Dimeny, E.; Sundelin, F.; Uhlin, F.; Welander, G.; Hernandez, I.B.; Groentoft, K.C.; Stendahl, M.; Svensson, M.; Kashioulis, P.; Melander, S.; Almquist, T.; Jensen, U.; Woodman, A.; McKeever, A.; Ullah, A.; McLaren, B.; Harron, C.; Barrett, C.; O'Toole, C.; Summersgill, C.; Geddes, C.; Glowski, D.; McGlynn, D.; Sands, D.; Caskey, F.; Roy, G.; Hirst, G.; King, H.; McNally, H.; Masri-Senghor, H.; Murtagh, H.; Rayner, H.; Turner, J.; Wilcox, J.; Berdeprado, J.; Wong, J.A.T.; Banda, J.; Jones, K.; Haydock, L.; Wilkinson, L.; Carmody, M.; Weetman, M.; Joinson, M.; Dutton, M.; Matthews, M.; Morgan, N.; Bleakley, N.; Cockwell, P.; Roderick, P.; Mason, P.; Kalra, P.; Sajith, R.; Chapman, S.; Navjee, S.; Crosbie, S.; Brown, S.; Tickle, S.; Mathavakkannan, S.; Kuan, Y.
Date
2023-05-16
Journal
Nephrology Dialysis Transplantation
Volume
38
Issue
11
Pages
2494 - 2502
DOI
doi:10.1093/ndt/gfad091
Link
https://academic.oup.com/ndt/article-abstract/38/11/2494/7165764?redirec...