Spiekman, A.C. (2018) Toekomstig screeningsinstrument predialyse patiënten die wetenschappelijk onderbouwde keuze omtrent de vraag: wel/niet starten met nierfunctievervangende therapie mogelijk maakt. :Een prospectief observationeel onderzoek. thesis, Medicine.
Full text available on request.Abstract
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 RRT. 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.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Naam facultair begeleider: and Kleij, dr. F.G.H. van der internist-nefroloog. and Zorgorganisatie: Treant Zorggroep and Locatie: Scheper Ziekenhuis te Emmen and Afdeling: Interne Geneeskunde, Dialysecentrum |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2413 |
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