Abstract
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 CKD.
METHODS
The EQUAL study is a European observational prospective cohort study with an incident eGFR<20 ml/min per 1.73 m2 and ≥ 65 years of age. The evolution of each clinical indicator was explored using generalized additive models during the 4 years preceding death.
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 1 hospitalization per person year, increasing exponentially at 6 months preceding death.
CONCLUSIONS
We identified clinically relevant physiological accelerations in patient trajectories that began approximately 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.
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 CKD.
METHODS
The EQUAL study is a European observational prospective cohort study with an incident eGFR<20 ml/min per 1.73 m2 and ≥ 65 years of age. The evolution of each clinical indicator was explored using generalized additive models during the 4 years preceding death.
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 1 hospitalization per person year, increasing exponentially at 6 months preceding death.
CONCLUSIONS
We identified clinically relevant physiological accelerations in patient trajectories that began approximately 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.
| Original language | English |
|---|---|
| Pages (from-to) | 2494-2502 |
| Number of pages | 9 |
| Journal | Nephrology Dialysis Transplantation |
| Volume | 38 |
| Issue number | 11 |
| Early online date | 16 May 2023 |
| DOIs | |
| Publication status | Published - 1 Nov 2023 |