In:
Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
Abstract:
The “Surprise Question” (SQ) (“would you be surprised if this patient died in 6 months/one year?”) has proven to be an interesting prognostication tool in a range of settings. However, its reliability in non-dialysis-dependent CKD is still unclear. Our aim was to study the applicability of the SQ to an outpatient CKD-EPI stages 4 to 5 and correlate it with mortality. Method Observational, prospective and single center study. Baseline comorbid conditions, cause of CKD, degree of autonomy, literacy, social support and baseline laboratory values (i.e., serum creatinine/ estimated glomerular filtration rate, serum albumin and hemoglobin) were collected. Results A total of 269 patients completed the study, mean age 65 years old; 256 patients (85.3%) had hypertension and 124 (41.3%) had diabetes. The main causes of renal disease were diabetic kidney disease (n = 53; 17.7%), hypertension (n = 15; 5%) and IgA nephropathy (n = 11; 3.7%). The etiology of kidney disease was undetermined for 24 patients (8.0%). Average CKD-EPI was15.5±7.4 mL/min/1.73 m2. A total of 188 patients (63%) were independent for daily living activities and 68 (23%) were professionally active and 45 (48%) were accompanied by family members or caregivers in outpatient consultation to discuss and define the care of plan regarding end stage renal disease. Mean follow up time of the study was 365±254 days, and 27 (9%) patients died during this time period. Using the SQ, providers responded Yes and No for 162 (54%) and 92 (31%) patients, respectively. There were no differences in CKD-EPI stage, arterial hypertension, cerebrovascular disease and dyslipidemia. The No group was older (73±16 vs. 63±16, p & lt;0.001) and had more diabetes (n = 46, 55%, p = 0.015). About 8 (30%) and 18 (67%) of Yes and No patients died, respectively (P & lt;0.001). In the Cox-proportional hazard model adjusted to diabetes, the risk of all-cause mortality was significantly increased by around 5.700 times in patients with a No answer by the providers to the SQ (95%CI, 2.340-13.900; p & lt;0.001) and around 1.045 times with increasing age (95%IC, 1.012-1.080; p = 0.007). The model of the SQ to have predictive capacity for occurrence of death had an area under the ROC curve of 0.684 (95%CI, 0.580-0.790; p = 0.002). Conclusion SQ proved to be a support tool in order to identify patients at high risk of death, who might not have a full benefit of starting dialysis. The choice around kidney replacement therapy is a shared decision-making process, in which competing risks and benefits must be considered. It is essential and urgent to identify means of support for patients, caregivers and health providers to provide and discuss personalized prognostic information.
Type of Medium:
Online Resource
ISSN:
0931-0509
,
1460-2385
DOI:
10.1093/ndt/gfad063c_3546
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2023
detail.hit.zdb_id:
1465709-0
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