Scripties UMCG - Rijksuniversiteit Groningen
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Toekomstig screeningsinstrument predialyse patiënten die wetenschappelijk onderbouwde keuze omtrent de vraag: wel/niet starten met nierfunctievervangende therapie mogelijk maakt. :Een prospectief observationeel onderzoek.

(2018) Spiekman, A.C.

Background: The prevalence of end stage renal disease increases, partially because of
senescence. Many of these elderly patients are frail and have multiple comorbidities and some
have low performance scores and/or cognitive dysfunction. In this group, renal replacement
therapy (RRT) may possibly not increase survival and attribute to quality of life. This study
investigates whether a screening tool may help in the decision-making process pro or against
Methods: In this prospective observational study 90 elderly pre-dialysis patients were
screened with the Charlson co-morbidity Index (CCI), Davies comorbidity score, Groningen
Frailty Indicator (GFI), Karnofsky score and the mini-mental state examination (MMSE) in
combination with the clock drawing test to determine eligibility for RRT. Age and serumalbumin
levels of the patients, as well as a surprise question (“Would you be surprised if this
patient died within the next year?”) answered by the treating nephrologist were taken into
account to determine the advisable treatment option.
Results: According to currently suggested decision protocol, conservative treatment was
preferable in 31 (34.4%) patients. This is an increase of 19 (21.1%) patients compared to the
standard treatment decision making process, which is based on the opinion of the physician
and wishes of the patient (NcNemar: p < 0.001).
Conclusions: After a complete screening, significantly more patients would be advised not to
start with RRT. The 77 patients from this study that started RRT will be followed for 3-5
years to determine whether this screening method correctly predicts eligibility for RRT, based
on outcome.

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