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DOI: 10.1055/a-1746-0465
Prognosefaktoren bei älteren Dialysepatienten beachten
Management von multimorbiden Patienten mit terminaler Niereninsuffizienz![](https://www.thieme-connect.de/media/dialyseakt/202204/lookinside/thumbnails/10-1055-a-1746-0465-1.jpg)
ZUSAMMENFASSUNG
Der Anteil betagter und hochbetagter Patienten mit terminaler Niereninsuffizienz hat aufgrund der demografischen Entwicklung und der besseren medizinischen Versorgung deutlich zugenommen. Ob jedoch die Einleitung der Dialyse mit einem Überlebensvorteil und/oder einer Verbesserung der Lebensqualität einhergehen, ist umstritten. Dies betrifft insbes. multimorbide und gebrechliche („frail”) Patienten. Zur optimalen Patienten- und Angehörigenberatung gehören deshalb Kenntnisse zu prognostisch relevanten Faktoren, um im Sinne einer partizipativen Entscheidungsfindung („shared decision making“) das Vorgehen festzulegen – sowohl im Hinblick auf die Dialysebehandlung als auch auf die Formen des konservativen Krankheitsmanagements. Die aktuell verfügbaren Prognosefaktoren entstammen zumeist retrospektiven Registerstudien und sind somit einer ausgeprägten Verzerrung („bias“) ausgesetzt. Neben dem erforderlichen nephrologischen Fachwissen ist eine altersmedizinische Expertise hilfreich, um eine optimale Versorgung der Patienten zu gewährleisten.
Publication History
Article published online:
18 May 2022
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Literatur
- 1 Singh P, Germain MJ, Cohen L. et al The elderly patient on dialysis: geriatric considerations. Nephrol Dial Transplant 2014; 29: 990-996 DOI: 10.1093/ndt/gft246.
- 2 Collins AJ, Kasiske B, Herzog C. et al Excerpts from the United States Renal Data System 2006 Annual Data Report. Am J Kidney Dis 2007; 49: A6-A7 S1-296 DOI: 10.1053/j.ajkd.2006.11.019.
- 3 Kurella M, Covinsky KE, Collins AJ. et al Octogenarians and nonagenarians starting sialysis in the United States. Ann Intern Med 2007; 146: 177-183 DOI: 10.7326/0003-4819-146-3-200702060-00006.
- 4 Foote C, Morton RL, Jardine M. et al Considerations of nephrologists when suggesting dialysis in elderly patients with renal failure (CONSIDER): a discrete choice experiment. Nephrol Dial Transplant 2014; 29: 2302-2309 DOI: 10.1093/ndt/gfu257.
- 5 Morton RL, Snelling P, Webster AC. et al Factors influencing patient choice of dialysis versus conservative care to treat end-stage kidney disease. CMAJ 2012; 184: E277-E283 DOI: 10.1503/cmaj.111355.
- 6 Lobbedez T, Verger C, Ryckelynck JP. et al Is assisted peritoneal dialysis associated with technique survival when competing events are considered?. Clin J Am Soc Nephrol 2012; 07: 612-618 DOI: 10.2215/CJN.10161011.
- 7 Kurella Tamura M, Covinsky KE, Chertow GM. et al Functional Status of Elderly Adults before and after Initiation of Dialysis. N Engl J Med 2009; 361: 1539-1547 DOI: 10.1056/NEJMoa0904655.
- 8 Seckinger J, Dschietzig W, Leimenstoll G. et al Morbidity, mortality and quality of life in the ageing haemodialysis population: results from the ELDERLY study. Clin Kidney J 2016; 09: 839-848 DOI: 10.1093/ckj/sfw087.
- 9 Foote C, Kotwal S, Gallagher M. et al Survival outcomes of supportive care versus dialysis therapies for elderly patients with end-stage kidney disease: a systematic review and meta-analysis. Nephrology (Carlton) 2016; 21: 241-253 DOI: 10.1111/nep.12586.
- 10 Verberne WR, Geers ABMT, Jellema WT. et al Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis. Clin J Am Soc Nephrol 2016; 11: 633-640 DOI: 10.2215/CJN.07510715.
- 11 Schell JO, Green JA, Tulsky JA. et al Communication skills training for dialysis decision-making and end-of-life care in nephrology. Clin J Am Soc Nephrol 2013; 08: 675-680 DOI: 10.2215/CJN.05220512.
- 12 Tonkin-Crine S, Okamoto I, Leydon GM. et al Understanding by older patients of dialysis and conservative management for chronic kidney failure. Am J Kidney Dis 2015; 65: 443-450 DOI: 10.1053/j.ajkd.2014.08.011.
- 13 Schell JO, Johnson DS. Challenges with providing hospice care for patients undergoing long-term dialysis. Clin J Am Soc Nephrol 2021; 16: 473-475 DOI: 10.2215/CJN.10710720.
- 14 Wachterman MW, Hailpern SM, Keating NL. et al Association between hospice length of stay, health care utilization, and medicare costs at the end of life among patients who received maintenance hemodialysis. JAMA Intern Med 2018; 178: 792-799 DOI: 10.1001/jamainternmed.2018.0256.
- 15 Anderson RT, Cleek H, Pajouhi AS. et al Prediction of risk of death for patients starting dialysis: a systematic review and meta-analysis. Clin J Am Soc Nephrol 2019; 14: 1213-1227 DOI: 10.2215/CJN.00050119.
- 16 Thorsteinsdottir B, Hickson LJ, Giblon R. et al Validation of prognostic indices for short term mortality in an incident dialysis population of older adults > 75. PLoS One 2021; 16: e0244081 DOI: 10.1371/journal.pone.0244081.
- 17 Moss AH, Ganjoo J, Sharma S. et al Utility of the „surprise“ question to identify dialysis patients with high mortality. Clin J Am Soc Nephrol 2008; 03: 1379-1384 DOI: 10.2215/CJN.00940208.
- 18 Farrington K, Covic A, Nistor I. et al Clinical practice guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR < 45 mL/min/1.73 m2): a summary document from the European Renal Best Practice Group. Nephrol Dial Transplant 2017; 32: 9-16 DOI: 10.1093/ndt/gfw411.
- 19 Bansal N, Katz R, de Boer IH. et al Development and validation of a model to predict 5-year risk of death without ESRD among older adults with CKD. Clin J Am Soc Nephrol 2015; 10: 363-371 DOI: 10.2215/CJN.04650514.
- 20 Couchoud CG, Beuscart J-BR, Aldigier J-C. et al Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int 2015; 88: 1178-1186 DOI: 10.1038/ki.2015.245.
- 21 Tangri N, Stevens LA, Griffith J. et al A predictive model for progression of chronic kidney disease to kidney failure. JAMA 2011; 305: 1553-1559 DOI: 10.1001/jama.2011.451.
- 22 Tangri N, Grams ME, Levey AS. et al Multinational assessment of accuracy of equations for predicting risk of kidney failure: a meta-analysis. JAMA 2016; 315: 164-174 DOI: 10.1001/jama.2015.18202.
- 23 Rob PM. Nephrologie im Spannungsfeld von Palliativ- und Intensivmedizin. Nieren – und Hochdruckkrankheiten 2021; 50: 228-236 DOI: 10.5414/NHX02188.
- 24 Gemeinsamer Bundesausschuss. Beschluss des Gemeinsamen Bundesausschusses über die Veröffentlichung des Jahresberichts 2019 zur Qualität in der Dialyse (20.11.2020). Im Internet. https://www.g-ba.de Stand: 04.01.2022
- 25 Saran R, Robinson B, Abbott KC. et al US Renal Data System 2019 Annual Data Report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2020; 75: A6-A7 DOI: 10.1053/j.ajkd.2019.09.003.
- 26 Brown EA, Finkelstein FO, Iyasere OU. et al Peritoneal or hemodialysis for the frail elderly patient, the choice of 2 evils?. Kidney Int 2017; 91: 294-303 DOI: 10.1016/j.kint.2016.08.026.
- 27 Lee MB, Bargman JM. Survival by dialysis modality – Who cares?. Clin J Am Soc Nephrol 2016; 11: 1083-1087 DOI: 10.2215/CJN.13261215.
- 28 Korevaar JC, Feith GW, Dekker FW. et al Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int 2003; 64: 2222-2228 DOI: 10.1046/j.1523-1755.2003.00321.x.
- 29 Manns B, Hemmelgarn B, Lillie E. et al Setting research priorities for patients on or nearing dialysis. Clin J Am Soc Nephrol 2014; 09: 1813-1821 DOI: 10.2215/CJN.01610214.
- 30 Weisbord SD, Fried LF, Arnold RM. et al Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 2005; 16: 2487-2494 DOI: 10.1681/ASN.2005020157.
- 31 Taylor G, Gravel D, Johnston L. et al Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control 2004; 32: 155-160 DOI: 10.1016/j.ajic.2003.05.007.
- 32 Fysaraki M, Samonis G, Valachis A. et al Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci 2013; 10: 1632-1638 DOI: 10.7150/ijms.6710.
- 33 Drew DA, Lok CE, Cohen JT. et al Vascular access choice in incident hemodialysis patients: a decision analysis. J Am Soc Nephrol 2015; 26: 183-191 DOI: 10.1681/ASN.2013111236.
- 34 Joly D, Anglicheau D, Alberti C. et al Octogenarians reaching end-stage renal disease: cohort study of decision-making and clinical outcomes. J Am Soc Nephrol 2003; 14: 1012-1021 DOI: 10.1097/01.ASN.0000054493.04151.80.
- 35 Pottel H, Hoste L, Dubourg L. et al An estimated glomerular filtration rate equation for the full age spectrum. Nephrol Dial Transplant 2016; 31: 798-806 DOI: 10.1093/ndt/gfv454.
- 36 Levey AS, Stevens LA, Schmid CH. et al A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150: 604-612 DOI: 10.7326/0003-4819-150-9-200905050-00006.
- 37 Levey AS, Coresh J, Greene T. et al Expressing the modification of diet in renal disease study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007; 53: 766-772 DOI: 10.1373/clinchem.2006.077180.
- 38 Schaeffner ES, Ebert N, Delanaye P. et al Two novel equations to estimate kidney function in persons aged 70 years or older. Ann Intern Med 2012; 157: 471-481 DOI: 10.7326/0003-4819-157-7-201210020-00003.
- 39 Song Y-H, Cai G-Y, Xiao Y-F. et al Risk factors for mortality in elderly haemodialysis patients: a systematic review and meta-analysis. BMC Nephrol 2020; 21: 377 DOI: 10.1186/s12882-020-02026-x.
- 40 Ifudu O, Mayers J, Matthew J. et al Dismal rehabilitation in geriatric inner-city hemodialysis patients. JAMA 1994; 271: 29-33
- 41 Blagg CR, Fitts SS. Dialysis, old age, and rehabilitation. JAMA 1994; 271: 67-68
- 42 Alfaadhel TA, Soroka SD, Kiberd BA. et al Frailty and mortality in dialysis: evaluation of a clinical frailty scale. Clin J Am Soc Nephrol 2015; 10: 832-840 DOI: 10.2215/CJN.07760814.
- 43 McAdams-DeMarco MA, Suresh S, Law A. et al Frailty and falls among adult patients undergoing chronic hemodialysis: a prospective cohort study. BMC Nephrol 2013; 14: 224 DOI: 10.1186/1471-2369-14-224.
- 44 Johansen KL, Chertow GM, Jin C. et al Significance of frailty among dialysis patients. J Am Soc Nephrol 2007; 18: 2960-2967 DOI: 10.1681/ASN.2007020221.
- 45 Sy J, Johansen KL. The impact of frailty on outcomes in dialysis. Curr Opin Nephrol Hypertens 2017; 26: 537-542 DOI: 10.1097/MNH.0000000000000364.
- 46 Bohm C, Storsley L, Tangri N. The assessment of frailty in older people with chronic kidney disease. Curr Opin Nephrol Hypertens 2015; 24: 498-504 DOI: 10.1097/MNH.0000000000000163.
- 47 Fried LP, Tangen CM, Walston J. et al Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146-M156 DOI: 10.1093/gerona/56.3.m146.
- 48 Fugate Woods N, LaCroix AZ, Gray SL. et al Frailty: emergence and consequences in women aged 65 and older in the Women’s Health Initiative observational study. J Am Geriatr Soc 2005; 53: 1321-1330 DOI: 10.1111/j.1532-5415.2005.53405.x.
- 49 Guralnik JM, Simonsick EM, Ferrucci L. et al A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49: M85-M94 DOI: 10.1093/geronj/49.2.M85.
- 50 Mitnitski AB, Graham JE, Mogilner AJ. et al Frailty, fitness and late-life mortality in relation to chronological and biological age. BMC Geriatr 2002; 02: 1 DOI: 10.1186/1471-2318-2-1.
- 51 Rockwood K, Song X, MacKnight C. et al A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489-495 DOI: 10.1503/cmaj.050051.
- 52 Komaba H, Zhao J, Yamamoto S. et al Secondary hyperparathyroidism, weight loss, and longer term mortality in haemodialysis patients: results from the DOPPS. J Cachexia Sarcopenia Muscle 2021; 12: 855-865 DOI: 10.1002/jcsm.12722.
- 53 Usvyat LA, Barth C, Bayh I. et al Interdialytic weight gain, systolic blood pressure, serum albumin, and C-reactive protein levels change in chronic dialysis patients prior to death. Kidney Int 2013; 84: 149-157 DOI: 10.1038/ki.2013.73.
- 54 Gromadziński L, Januszko-Giergielewicz B, Czarnacka K. et al NT-proBNP in the prognosis of death or need for renal replacement therapy in patients with stage 3–5 chronic kidney disease. Cardiorenal Med 2019; 09: 125-134 DOI: 10.1159/000496238.
- 55 Artunc F, Nowak A, Müller C. et al Mortality prediction using modern peptide biomarkers in hemodialysis patients--a comparative analysis. Kidney Blood Press Res 2014; 39: 563-572 DOI: 10.1159/000368468.
- 56 Artunc F, Haag S, Friedrich B. et al Performance of a novel high sensitivity cardiac troponin I assay in asymptomatic hemodialysis patients – evidence for sex-specific differences. Clin Chem Lab Med 2019; 57: 1261-1270 DOI: 10.1515/cclm-2018-1176.
- 57 Untersteller K, Girerd N, Duarte K. et al NT-proBNP and echocardiographic parameters for prediction of cardiovascular outcomes in patients with CKD stages G2-G4. Clin J Am Soc Nephrol 2016; 11: 1978-1988 DOI: 10.2215/CJN.01660216.
- 58 Hickson LJ, Rule AD, Butler KR. et al Troponin T as a predictor of end-stage renal disease and all-cause death among African-Americans and whites from hypertensive families. Mayo Clin Proc 2015; 90: 1482-1491 DOI: 10.1016/j.mayocp.2015.08.016.
- 59 Chadban SJ, Ahn C, Axelrod DA. et al KDIGO Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation. Transplantation 2020; 104: S11-S103 DOI: 10.1097/TP.0000000000003136.
- 60 Al-Shraideh Y, Farooq U, Farney AC. et al Influence of recipient age on deceased donor kidney transplant outcomes in the expanded criteria donor era. Clin Transplant 2014; 28: 1372-1382 DOI: 10.1111/ctr.12463.
- 61 Humar A, Denny R, Matas AJ. et al Graft and quality of life outcomes in older recipients of a kidney transplant. Exp Clin Transplant 2003; 01: 69-72
- 62 Pérez-Sáez MJ, Arcos E, Comas J. et al Survival benefit from kidney transplantation using kidneys from deceased donors aged ≥ 75 years: a time-dependent analysis. Am J Transplant 2016; 16: 2724-2733 DOI: 10.1111/ajt.13800.
- 63 Lloveras J, Arcos E, Comas J. et al A paired survival analysis comparing hemodialysis and kidney transplantation from deceased elderly donors older than 65 years. Transplantation 2015; 99: 991-996 DOI: 10.1097/TP.0000000000000474.