Featured Research

from universities, journals, and other organizations

Certain measures can help predict older dialysis patients' prognoses

Date:
November 21, 2013
Source:
American Society of Nephrology (ASN)
Summary:
Most older adults initiate chronic dialysis in the hospital. Those who have a prolonged hospital stay and receive other forms of life support around the time of dialysis initiation have limited survival and eventually need to undergo more intensive procedures.

Simple measures of the severity of an older kidney failure patient's illness when starting dialysis -- such as whether dialysis was initiated in an inpatient setting, the length of the patient's hospital stay, and the use of other life-sustaining procedures -- can convey meaningful information about the patient's prognosis, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The information can help guide physicians as they determine the best care for patients on dialysis.

Little is known about the circumstances under which older adults with kidney failure initiate dialysis or about how these circumstances might affect patients' outcomes. To investigate, Susan Wong, MD (University of Washington, Seattle) and her colleagues analyzed national registry data pertaining to 416,657 Medicare beneficiaries aged 67 years and older who initiated chronic dialysis between January 1995 and December 2008. The researchers looked at the relationship between health care intensity around the time of dialysis initiation and subsequent aspects of patients' health.

"Our research sought to provide important information on patients' anticipated illness trajectory that could assist providers and patients in formulating treatment decisions and setting realistic expectations for the future," said Dr. Wong.

Among the major findings: • Most patients (64.5%) initiated dialysis in the hospital, including 36.6% who were hospitalized for two or more weeks and 7.4% who underwent one or more intensive procedures, including mechanical ventilation, feeding tube placement, and CPR. Also, the proportion of patients initiating chronic dialysis in the inpatient setting has been rising in recent years. • Compared with patients who initiated dialysis in the outpatient setting, those who received the highest intensity of care at dialysis initiation (those who were hospitalized for two or more weeks and received at least one intensive procedure) had shorter survival times (median 0.7 vs 2.1 years), spent a greater percentage of remaining followup time in the hospital (median 22.9% vs 3.1%), were more likely to undergo subsequent intensive procedures (44.9% vs 26.0%), and were less likely to have discontinued dialysis before death (19.1% vs 26.2%).

The findings indicate that most older adults initiate chronic dialysis in the hospital, and those who have a prolonged hospital stay and receive other forms of life support around the time of dialysis initiation have limited survival and more intensive use of subsequent healthcare.

"Many older patients are unaware of their illness trajectory after starting chronic dialysis, and many nephrologist are not comfortable with discussing prognosis, although patients express wanting this information. We hope that our findings can be used to supplement providers' knowledge and increase their confidence and willingness to discuss prognosis with their patients," said Dr. Wong.

In an accompanying editorial, Amy Williams, MD (Mayo Clinic) stated that the study is "the first to provide insight into the association of site, intensity of care, and length of hospitalization at the initiation of dialysis to the subsequent burden of disease. With these data, translated in the context of patient preferences, we can better design individualized care that will allow patients to meet goals and smooth transitions during health status changes, leading to fewer ICU admissions and ICU deaths, better symptom management, improved quality of life, and decreased cost of end-of-life care."


Story Source:

The above story is based on materials provided by American Society of Nephrology (ASN). Note: Materials may be edited for content and length.


Journal Reference:

  1. A. W. Williams. Older Adults with CKD and Acute Kidney Failure: Do We Know Enough for Critical Shared Decision Making? Journal of the American Society of Nephrology, 2013; DOI: 10.1681/ASN.2013090981

Cite This Page:

American Society of Nephrology (ASN). "Certain measures can help predict older dialysis patients' prognoses." ScienceDaily. ScienceDaily, 21 November 2013. <www.sciencedaily.com/releases/2013/11/131121184204.htm>.
American Society of Nephrology (ASN). (2013, November 21). Certain measures can help predict older dialysis patients' prognoses. ScienceDaily. Retrieved August 23, 2014 from www.sciencedaily.com/releases/2013/11/131121184204.htm
American Society of Nephrology (ASN). "Certain measures can help predict older dialysis patients' prognoses." ScienceDaily. www.sciencedaily.com/releases/2013/11/131121184204.htm (accessed August 23, 2014).

Share This




More Health & Medicine News

Saturday, August 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Drug Used To Treat 'Ebola's Cousin' Shows Promise

Newsy (Aug. 21, 2014) An experimental drug used to treat Marburg virus in rhesus monkeys could give new insight into a similar treatment for Ebola. Video provided by Newsy
Powered by NewsLook.com
Two US Ebola Patients Leave Hospital Free of the Disease

Two US Ebola Patients Leave Hospital Free of the Disease

AFP (Aug. 21, 2014) Two American missionaries who were sickened with Ebola while working in Liberia and were treated with an experimental drug are doing better and have left the hospital, doctors say on August 21, 2014. Duration: 01:05 Video provided by AFP
Powered by NewsLook.com
Cadavers, a Teen, and a Medical School Dream

Cadavers, a Teen, and a Medical School Dream

AP (Aug. 21, 2014) Contains graphic content. He's only 17. But Johntrell Bowles has wanted to be a doctor from a young age, despite the odds against him. He was recently the youngest participant in a cadaver program at the Indiana University NW medical school. (Aug. 21) Video provided by AP
Powered by NewsLook.com
American Ebola Patients Released: What Cured Them?

American Ebola Patients Released: What Cured Them?

Newsy (Aug. 21, 2014) It's unclear whether the American Ebola patients' recoveries can be attributed to an experimental drug or early detection and good medical care. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins