Outcomes of patients in a pre-dialysis clinic and implications for shared decision making.

IF 4.6 2区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Kidney Journal Pub Date : 2025-07-08 eCollection Date: 2025-08-01 DOI:10.1093/ckj/sfaf211

Hannah O'Keeffe, Rosemary Donne, Philip A Kalra, Ibrahim Ali

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引用次数: 0

Abstract

Background: The association of end-stage kidney disease (ESKD) with poor outcomes is well recognized. Education and discussions with patients with advanced chronic kidney disease (CKD) are important to facilitate shared decision making regarding care.

Methods: This study reports longitudinal follow-up of all patients who attended the Advanced Kidney Care Service (AKCS) in a tertiary renal centre in the UK. Patients are routinely referred to AKCS once their estimated glomerular filtration rate (eGFR) drops below 20 mL/min/1.73 m². A total of 1957 patients who first attended between September 2011 and September 2018 were included, with a minimum of 5 years follow-up to 30 September 2023.

Results: During follow-up, 55.7% of the cohort commenced renal replacement therapy (RRT), the initial modality was haemodialysis in 57.2%, peritoneal dialysis in 27.3% and a pre-emptive transplant in 15.5%, of which 42.6% were from live donors. Conservative management was chosen by 17.9% of patients. Of those who had opted for RRT, 26.7% died before reaching it. The 5-year survival was 49.6% from first attendance at AKCS. The 5-year survival rates by age group were: <50 years, 84.2%; 50-64 years, 66.1%; 65-79 years, 40.1%; and ≥80 years, 22.3% (P < .001). The 5-year survival on haemodialysis was 49.6%, peritoneal dialysis 54.7% and 92.3% for pre-emptive transplant 92.3%. For those over 80 years of age a modest survival benefit was seen with RRT, with a median survival of 17.4 months from RRT commencement, compared with 11.8 months once the eGFR declined below 10 mL/min/1.73 m² in the conservative group.

Conclusion: This study highlights the high competing mortality in an advanced CKD cohort. The high rates of pre-emptive transplantation and peritoneal dialysis initiation demonstrate the benefits of a structured AKCS strategy. Older patients with ESKD, particularly those aged over 80 years, have poor outcomes, regardless of whether they choose RRT or conservative management.

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透析前门诊患者的预后及其对共同决策的影响。

背景：终末期肾脏疾病（ESKD）与不良预后的关联已得到充分认识。与晚期慢性肾脏疾病（CKD）患者的教育和讨论对于促进有关护理的共同决策非常重要。方法：本研究报告了在英国三级肾脏中心参加高级肾脏护理服务（AKCS）的所有患者的纵向随访。一旦患者估计肾小球滤过率（eGFR）低于20 mL/min/1.73 m2，就常规转诊AKCS。共纳入了1957名在2011年9月至2018年9月期间首次就诊的患者，随访时间至少为5年，至2023年9月30日。结果：在随访期间，55.7%的队列开始肾脏替代治疗（RRT），初始方式为血液透析（57.2%），腹膜透析（27.3%）和先发制人的移植（15.5%），其中42.6%来自活体供体。17.9%的患者选择保守治疗。在那些选择RRT的人中，26.7%的人在达到RRT之前死亡。首次到AKCS就诊的5年生存率为49.6%。保守组5年生存率分别为：P。结论：本研究强调了晚期CKD队列的高竞争死亡率。先发制人移植和腹膜透析启动的高比率证明了结构化AKCS策略的益处。老年ESKD患者，特别是80岁以上的患者，无论选择RRT还是保守治疗，预后都很差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Kidney Journal Medicine-Transplantation

CiteScore

6.70

自引率

10.90%

发文量

242

审稿时长

8 weeks

期刊介绍： About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.