P1486CHRONIC DIALYSIS IN ELDERLY PATIENTS: FUNCTIONAL PERFORMANCE STATUS AND TREATMENT OUTCOMES - A SINGLE-CENTER STUDY
Authors: Kurylovich Krystsina , Komissarov Kirill 
Published: June 2020

Abstract

Background and Aims
The presence of multiple comorbid conditions and different geriatric impairments in elderly patients leads to a certain specificity in the management of this cohort of patients. The aim was to assess changes in functional performance status and treatment outcomes in elderly patients on chronic dialysis.

Method
A single-center longitudinal prospective study was conducted, which included 48 patients aged 65 years and older who underwent dialysis (hemodialysis and continuous ambulatory peritoneal dialysis) for more than 3 months. Participants’ functional performance status was measured by the Frailty Scale of Rockwood (FSR) at baseline and after a year of treatment. Functional performance status decline was defined as deterioration by 1 or more positions on the FSR, stable was defined as no difference between baseline and follow-up, and improvement was defined as a gain of 1 or more positions. At baseline, all participants were assessed by the Charlson Comorbidity Index (CCI) and standard lab tests were carried out. All data are presented as median and quartiles (25%; 75%).

Results
The median of age was 69 (67; 74) and 39.6% were women. The main causes of end-stage renal disease were hypertension (33.3%) and diabetes (31.3%). There were 83.3% hemodialysis patients and 31.3% received dialysis up to 1 year.
At baseline 16.7% of patients were frail, 54.2% - pre-frail and 29.1% were fit.
Among frail patients at the 1-year follow-up, 62.5% died, 12.5% had received a kidney transplant (KT), 25% showed a further functional performance status decline.
Among pre-frail patients, almost half (46.2%) experienced functional decline and 15.4% died; the functional status remained unchanged in 30.8% of patients and 3.8% was transplanted; 1 patient (3.8%) had an improvement in functional performance status.
Among fit patients, over half (57.2%) showed stable functional status, a functional decline was observed in 21.4% of patients (all of them became frail), 7.1% died and 14.3% had received a KT.
All patients, who had stable functional performance status after a year of treatment, had target values of kt/v, albumin, and phosphorus at baseline. All deceased patients (20.8%) had CCI ≥ 6, 60% of them had high serum phosphorus level. Most functional performance status decline among participants was associated with a loss of mobility, which was most often caused by the progression of chronic heart failure (both independently and after heart attack) or chronic arterial failure (diabetic, due to obliterating atherosclerosis of the lower extremities), including the development of critical limb ischemia, especially in patients on hemodialysis.
The distribution of patients according to the FSR in the initial assessment and re-assessment are presented in the table below.

Conclusion
Functional decline is highly prevalent in elderly patients on chronic dialysis, the risk is higher among frail and pre-frail patients. In most cases, functional performance status decline is associated with a loss of mobility due to the progression of chronic heart or arterial failure. Death probability is higher among frail patients and those with high serum phosphorus level (because of inadequate dialysis due to the initially severe condition of these patients) and high CCI. Achievement in the complex of the target values of kt/v, serum albumin, and phosphorus levels can help to maintain the functional status stable.