Internal Medicine Journal最新文献

{"title":"Performance and opportunity: retrospective cohort study of general medicine heart failure management.","authors":"Noor Lammoza, Lung En Teng, Gail Edwards, Maria Hormiz, Matthew Morton, Harry Gibbs, Ingrid Hopper, Ar Kar Aung, Archana Thayaparan","doi":"10.1111/imj.70016","DOIUrl":"https://doi.org/10.1111/imj.70016","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is increasingly prevalent, with growing patient complexity. Understanding the quality of care delivered is key to optimising management.</p><p><strong>Aims: </strong>To characterise HF care by a general medicine service compared to established quality indicators.</p><p><strong>Methods: </strong>A retrospective cohort review was conducted over a 7-month period. Consecutive general medicine patients admitted with a primary diagnosis of HF were included. Main outcomes measures were baseline guideline-directed medical therapy (GDMT) and index admission medication modifications, planned medical follow-up and 30- and 180-day readmission rates. Comparison to National Heart Foundation quality indicators was undertaken.</p><p><strong>Results: </strong>Two hundred and thirteen patients who survived the index admission were included (median age 86 years (interquartile range 82-89), 53.1% female). Comorbidities included hypertension (69.0%), atrial fibrillation (58.7%) and chronic kidney disease (28.2%). Echocardiography was available for 153 patients (72%), with 26.6% who had HF with reduced ejection fraction (HFrEF) and 62.2% who had HF with preserved ejection fraction (HFpEF). GDMT for HFrEF was 73.2% for beta-blockers, 41.5% for renin-angiotensin system inhibitors, 22.0% for mineralocorticoid antagonists and 9.8% for sodium glucose co-transporter-2 inhibitors (SGLT2i). SGLT2i was prescribed in 2.1% of HFpEF patients. Index admission medication modifications occurred for 40 patients, with 37 initiation/dose escalations and 13 cessation/dose de-escalations. Follow-up was planned in 69.0% patients across multiple services. All-cause readmission rates at 30 and 180 days were 19.2% and 45.5% respectively.</p><p><strong>Conclusions: </strong>Our HF cohort is elderly and comorbid with high readmission rates. We found low prescription and modification rates of GDMT and poor continuity of care, highlighting areas to improve care in both inpatient and outpatient settings.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical presentations and outcomes of respiratory tract infections in an Australian cohort of centenarians.","authors":"Louise Mugridge, Lachlan Faktor, Christiaan Yu, Ar Kar Aung","doi":"10.1111/imj.70022","DOIUrl":"https://doi.org/10.1111/imj.70022","url":null,"abstract":"<p><p>Centenarians are a rapidly growing patient population. Little is known about their clinical responses to respiratory tract infections. This study examines a cohort of centenarians admitted to a tertiary centre with multiplex polymerase chain reaction-confirmed respiratory tract infections to characterise clinical characteristics and management outcomes better. Despite multiple comorbidities and frailty, the overall mortality rate and outcomes appeared favourable.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and predictors of transurethral resection of prostate in men with and without type 2 diabetes: the Fremantle Diabetes Study Phase I.","authors":"Timothy M E Davis, Wendy A Davis","doi":"10.1111/imj.70021","DOIUrl":"https://doi.org/10.1111/imj.70021","url":null,"abstract":"<p><strong>Background: </strong>The relationship between type 2 diabetes and the incidence of transurethral resection of the prostate (TURP) remains uncertain.</p><p><strong>Aims: </strong>To utilise data from the Fremantle Diabetes Study Phase I (FDS1) to examine the association between type 2 diabetes and incident TURP and investigate risk factors in men with type 2 diabetes.</p><p><strong>Methods: </strong>First TURP hospitalisations were ascertained for males from the Fremantle Diabetes Study Phase I (n = 581) and age- and postcode-matched men without diabetes (n = 2361) between entry (1993-1996) and end (2017). Incidence rate ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident TURP.</p><p><strong>Results: </strong>There were 86 and 338 TURP hospitalisations in participants with and without type 2 diabetes, respectively, during 42 236 person-years of follow-up. The IRR (95% confidence interval) for diabetes versus no diabetes was 1.23 (0.96, 1.56). A 10-year age increase more than doubled the risk of incident TURP (csHR 2.51 (2.02, 3.12), sdHR 2.59 (2.11, 3.18)), but type 2 diabetes was not a significant predictor in multivariable models. In participants with type 2 diabetes, a 10-year age increase was predictive (csHR 2.94 (1.93, 4.47), sdHR 1.92 (1.51, 2.44)); Anglo-Celt versus other ethnic groups was significant in the Cox (csHR 1.87 (1.17, 3.00)) but not competing risk (sdHR 1.60 (0.99, 2.57)) models.</p><p><strong>Conclusions: </strong>Type 2 diabetes does not increase TURP risk in community-based Australians. There are no diabetes-specific variables associated with incident TURP.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced survival for rural patients with hepatocellular carcinoma within a tertiary hospital network: treatment equality is not enough.","authors":"Andrew Chin, Ali Galalah Mostafa Ismail, Weiyuan Fan, Wendy Cheng, Nick Kontorinis, Justin Chin, Jee Kong, Adam Doyle, Tim Mitchell","doi":"10.1111/imj.70032","DOIUrl":"https://doi.org/10.1111/imj.70032","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality globally, with increasing incidence rates in Australia. As most treatments are performed in metropolitan centres, we hypothesised that rural patients may be adversely affected.</p><p><strong>Aims: </strong>To investigate survival outcomes and treatment access between rural and metropolitan HCC patients within a single tertiary hospital network.</p><p><strong>Methods: </strong>Retrospective cohort study of HCC patients treated at Royal Perth Hospital from May 2012 to May 2023. Analysed variables included clinical and demographic factors, HCC characteristics (including staging), treatment outcomes and adherence to post-intervention surveillance. Overall survival was compared using Kaplan-Meier analysis and multivariable Cox regression to assess potential confounders.</p><p><strong>Results: </strong>Among 400 patients, 305 were from metropolitan (76.2%) and 95 were from rural (23.8%) areas. Baseline characteristics, including demographics, comorbidities, performance status, HCC stage and alpha-fetoprotein levels at diagnosis, were similar between the two groups. Median overall survival was significantly lower for rural patients compared to metropolitan patients (2.53 vs 4.70 years; P = 0.035). Multivariable analysis indicated that rural residence was an independent predictor of poorer survival (adjusted hazard ratio 1.45, P = 0.026). There was no difference in time to treatment or treatment allocation between groups. Surveillance adherence post-curative intervention was lower in rural patients (63% vs 96%, P < 0.001).</p><p><strong>Conclusions: </strong>This study highlights a significant survival disadvantage for rural HCC patients, emphasising geographical disparities in healthcare outcomes. While our patients had equal access to treatment, disparities may emerge from challenges in post-treatment care and surveillance adherence. Strategies targeting rural healthcare delivery and patient follow-up are necessary to mitigate these disparities.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute coronary syndrome in patients with autosomal dominant polycystic kidney disease: a systematic review and meta-analysis","authors":"Ashraf Ahmed,&nbsp;Sandeep Nayak,&nbsp;Mayssaa Hoteit,&nbsp;Daniyal Ameen,&nbsp;David Bauer,&nbsp;Salem Elshenawy,&nbsp;Anton Stolear,&nbsp;Rasha Kaddoura,&nbsp;Gregory Buller","doi":"10.1111/imj.16659","DOIUrl":"10.1111/imj.16659","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autosomal dominant polycystic kidney disease (ADPKD) is associated with various cardiovascular abnormalities, including spontaneous coronary artery dissection and atrial fibrillation. However, limited data exist to describe the association between ADPKD and acute coronary syndrome or heart failure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This systematic review and meta-analysis evaluated the occurrence of cardiovascular events among patients with ADPKD compared to those without ADPKD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A comprehensive literature search was conducted using Embase, PubMed and Scopus databases. Of 416 initially identified articles, 18 of them were reviewed in detail, and three cohort studies, comprising a total of 7888 patients with ADPKD, were included in the final analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In comparison with patients without ADPKD, the pooled data revealed that ADPKD patients had a significantly higher odds of any adverse cardiovascular events (odds ratio (OR) 1.36; 95% confidence interval (CI): 1.24–1.28), including myocardial infarction (OR 1.86; 95% CI: 1.05–3.32) and congestive heart failure (OR 1.36; 95% CI: 1.22–1.51). However, there was no significant difference in mortality (OR 1.37; 95% CI: 0.77–2.44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with ADPKD are at a significantly increased risk for major adverse cardiovascular events, such as myocardial infarction and congestive heart failure. Despite the elevated risk of these cardiovascular complications, no significant difference in overall mortality was observed. Further studies are needed to assess ADPKD's cardiovascular risk and possible preventive strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"493-502"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stomal calprotectin as a biomarker for assessing Crohn disease activity in patients with stomas","authors":"Kavindra Abeyratne,&nbsp;Martin Harb,&nbsp;Karen Bensted,&nbsp;Simon Ghaly,&nbsp;Susan J. Connor,&nbsp;Jane M. Andrews,&nbsp;Kate D. Lynch","doi":"10.1111/imj.16648","DOIUrl":"10.1111/imj.16648","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Faecal calprotectin is a reliable biomarker for lower gastrointestinal inflammation. However, there are limited data on the utility of calprotectin from stoma effluent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>The aim of this study was to determine the performance of stomal calprotectin in identifying Crohn disease activity in those with a stoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with Crohn disease and an ileostomy or colostomy were identified from three sites in Australia using a clinical management software. Disease activity was classified based on the presence of inflammation on imaging and/or endoscopy within 3 months of the sample. The primary outcome was the median stomal calprotectin in people with active versus inactive Crohn disease. Other clinical indices, such as C-reactive protein and Harvey Bradshaw Index, were evaluated as a surrogate biomarker for disease activity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty stomal calprotectin results were identified for 23 patients with paired investigations. Of 30 cases, six had active disease. The median stomal calprotectin in active versus inactive disease were 17 μg/g (interquartile range (IQR) 5–211) and 61 μg/g (IQR 19–105, <i>P</i> = 0.38) respectively. Accordingly, stomal calprotectin demonstrated poor sensitivity for active disease (33% at cut-off of 50 μg/g). C-reactive protein was higher for active disease (25, IQR 5–199) compared with inactive disease (5, IQR 2–17, <i>P</i> = 0.06), but there was no difference in the Harvey Bradshaw Index (9 (IQR 7–11) vs 5 (3–7), <i>P</i> = 0.10).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stomal calprotectin did not reliably distinguish between active and inactive Crohn disease. C-reactive protein is a more reliable biomarker for disease activity in the setting of ileostomy/colostomy. Further prospective studies are needed to identify more robust biomarkers for detecting inflammation in stoma patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"461-466"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/imj.16648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, efficacy and post-endoscopic retrograde cholangiopancreatography survival in nonagenarians: a retrospective cohort study","authors":"Amirah Etchegaray,&nbsp;Sanjivan Mudaliar,&nbsp;Kimberley Ryan,&nbsp;Karen Hay,&nbsp;Jason Hwang,&nbsp;Benedict Devereaux,&nbsp;Mark Appleyard,&nbsp;Florian Grimpen","doi":"10.1111/imj.16652","DOIUrl":"10.1111/imj.16652","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Increasing numbers of older patients with pancreatobiliary disease are undergoing endoscopic retrograde cholangiopancreatography (ERCP). Older patients may be at higher risk of ERCP-related adverse events due to their age and comorbidities; however, data are sparse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to evaluate long-term mortality, procedural outcomes and safety of ERCP in nonagenarians.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively evaluated consecutive patients aged ≥90 years who underwent ERCP at a tertiary hospital over 12 years. The primary outcome was survival. Secondary outcomes included procedural success and adverse events. Logistic regression was used to analyse procedural outcomes, and factors predictive of survival were identified using a Cox proportional hazard model visualised by Kaplan–Meier plot.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 159 consecutive ERCPs were performed in 115 nonagenarian patients. The mean age of the cohort was 92.3 (standard deviation ± 2.1) years. Choledocholithiasis (78.6%) was the most common indication, followed by malignant biliary obstruction (MBO, 18.9%) and bile leak (2.5%). Survival following ERCP for MBO at 30 days, 3 months and 1 year was 78%, 52% and 9%, respectively, compared to 98%, 94% and 89% for choledocholithiasis (<i>P</i> &lt; 0.001). Procedural success was achieved in 91% of ERCPs (benign or malignant). ERCPs performed for MBO were more likely to fail (<i>P</i> &lt; 0.001). Adverse events occurred in 5% of procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Therapeutic ERCP in select nonagenarians is a clinically relevant intervention for both malignant and benign pathology. Age does not constitute a barrier to the performance of ERCP in appropriately selected patients. Nonagenarians may be counselled for a success and adverse event rate equivocal to younger populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":"55 3","pages":"435-443"},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling the gaps to empower regional centres to manage myelodysplastic syndrome and acute myeloid leukaemia leading to wider cancer healthcare delivery and access to clinical trials.","authors":"Michael Ashby, Shaun Fleming, Andrew Spencer, Anne Woollett, Tricia Wright","doi":"10.1111/imj.70011","DOIUrl":"https://doi.org/10.1111/imj.70011","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with haematological malignancies in rural and regional Australia is different to that in metropolitan centres due to many factors. Lower-intensity and easier-to-access treatments that are now available for acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) have improved the deliverability of treatment options for these disorders. Despite the challenges, urgent work is required to allow the care and outcomes of these patients to mirror those living in metropolitan centres.</p><p><strong>Aims: </strong>To highlight the challenges in management of AML and MDS in regional Victoria.</p><p><strong>Methods: </strong>Four clinical cases describing the difficulties faced in the management of AML/MDS patients in regional Victoria.</p><p><strong>Results: </strong>We describe limitations in inpatient services, supportive care, blood product access and both specialised diagnostics and specialist workforce. Access to clinical trials is limited but vital to allow the availability of all therapeutic options.</p><p><strong>Conclusions: </strong>Limitations in management of AML/MDS patients exist in regional centres. We utilised focused clinical fellows in a partnership between Latrobe Regional Health and Alfred Health in Victoria to improve treatment options for these patients. Moreover, we demonstrate future areas of focus, which will further enable rural and regional healthcare providers to bridge the gap in the care of patients with haematological malignancies.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventive medication deprescribing in advanced cancer patients approaching end of life.","authors":"Jane McKenzie, Catherine Dunn, Grace Gard, Brian Le, Peter Gibbs","doi":"10.1111/imj.70013","DOIUrl":"https://doi.org/10.1111/imj.70013","url":null,"abstract":"<p><p>Previous reports indicated many patients with advanced cancer and limited life expectancy have ongoing preventive medication prescription (PMP) of uncertain benefit and increased risk. Our review of palliative care oncology admissions found high rates of PMP (69%) at time of first palliative care admission, despite high rates of inpatient deprescription (88%) and death at a median of 16 days (interquartile range 10-45) following admission. Rates of PMPs did not vary by time from last systemic treatment (P = 0.29) or by prior palliative care involvement (P = 0.82). Physicians and the wider multidisciplinary care team may be missing deprescription opportunities for terminally ill patients.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incorporating the Clinical Frailty Scale into routine outpatient nephrology practice: a 3-year follow-up of outcomes and associations.","authors":"Nicholas Pizzino, Matthew Pugliese, Michelle Soye, Aron Chakera, Anuttara Panchali W Kumarasinghe","doi":"10.1111/imj.70009","DOIUrl":"https://doi.org/10.1111/imj.70009","url":null,"abstract":"<p><strong>Background: </strong>There remains a lack of evidence based guidelines regarding the benefit of applying scoring systems in the outpatient nephrology setting. As such, we set out to investigate and follow-up the utility of the Clinical Frailty Scale (CFS) for the ongoing management of patients with end stage kidney disease.</p><p><strong>Aims: </strong>To explore the association between frailty, as measured by a Clinical Frailty Score (CFS) 5-8, and long-term outcomes in a cohort of patients with chronic kidney disease (CKD).</p><p><strong>Methods: </strong>This was a 3-year follow-up analysis of a prospective cohort study. This study included participants of age >50 years and with CKD with an estimated glomerular filtration rate <30 mL/min/1.73 m². The primary outcome included actual end-stage kidney disease (ESKD) management at 3 years (transplantation, haemodialysis, peritoneal dialysis or supportive care). The secondary outcomes include all-cause mortality, hospitalisation rates, and ESKD- and dialysis-related complications.</p><p><strong>Results: </strong>Seventy-nine of 81 patients from the initial study were included; two were lost to follow-up. After 3 years, 18 patients remained on conservative management, 20 on hospital haemodialysis and 13 on peritoneal dialysis. Non-frail patients (CFS 1-4) were twice as likely to have ESKD treatment changes by 3 years. This may carry clinical importance despite not achieving statistical significance (44% (n = 22) vs 22% (n = 4), P = 0.11). Hospitalisation rates were similar between groups (77.8% (n = 14) frail vs 82.0% (n = 41) non-frail; P = 0.74). Mortality was higher in patients living with frailty at baseline (56% (n = 10) vs 8% (n = 4); P ≤ 0.001).</p><p><strong>Conclusions: </strong>Of older adults screened for frailty, those not identified to be frail (CFS 1-4) were twice as likely to have changes in ESKD management as frail patients (CFS 5-8). Three-year mortality was seven times higher (56%) in patients identified as frail at baseline. There were no statistically significant differences in hospitalisation rates or dialysis-related or ESKD-related complications.</p>","PeriodicalId":13625,"journal":{"name":"Internal Medicine Journal","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}