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End stage renal disease: a new trajectory of functional decline in the last year of life

End stage renal disease: a new trajectory of functional decline in the last year of life
End stage renal disease: a new trajectory of functional decline in the last year of life
Objectives: To determine the functional trajectory in the last year of life in end-stage renal disease managed without dialysis.

Design: Longitudinal cohort study of functional status over time and toward death.

Setting: Three renal units in the United Kingdom.

Participants: Patients with Stage 5 chronic kidney disease managed conservatively (without dialysis).

Measurements: The main outcome measure was functional status, measured using the Karnofsky Performance Scale.

Results: Seventy-five participants (mean age 80.7, 62% response rate) recruited and followed up monthly for up to 2 years (median 8-month follow-up, range 1–23 months). Forty-nine (66%) died during follow-up. Those who died had similar distribution of age, ethnicity, primary renal pathology, and comorbidity as those still alive at study end. Analysis according to time before death revealed that functional status remained stable during the last year of life but declined steeply in the last month of life.

Conclusion: This distinctive renal trajectory, reported here for the first time, contrasts with that previously described in other conditions. This has important clinical implications—the steep functional decline indicates that healthcare services need to be rapidly responsive to changing needs in this population as function declines in the last months and weeks of life.
functional trajectories, stage 5 chronic kidney disease, end-stage kidney disease, palliative care, end-of-life care
0002-8614
304-308
Murtagh, Fliss E.M.
70c29ac0-d67c-4f1b-ac20-20ba9159dd24
Addington-Hall, Julia M.
87560cc4-7562-4f9b-b908-81f3b603fdd8
Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3
Murtagh, Fliss E.M.
70c29ac0-d67c-4f1b-ac20-20ba9159dd24
Addington-Hall, Julia M.
87560cc4-7562-4f9b-b908-81f3b603fdd8
Higginson, Irene J.
8bff8e06-57f3-491b-ab81-2ecf983f52f3

Murtagh, Fliss E.M., Addington-Hall, Julia M. and Higginson, Irene J. (2011) End stage renal disease: a new trajectory of functional decline in the last year of life. Journal of the American Geriatrics Society, 59 (2), 304-308. (doi:10.1111/j.1532-5415.2010.03248.x). (PMID:21275929)

Record type: Article

Abstract

Objectives: To determine the functional trajectory in the last year of life in end-stage renal disease managed without dialysis.

Design: Longitudinal cohort study of functional status over time and toward death.

Setting: Three renal units in the United Kingdom.

Participants: Patients with Stage 5 chronic kidney disease managed conservatively (without dialysis).

Measurements: The main outcome measure was functional status, measured using the Karnofsky Performance Scale.

Results: Seventy-five participants (mean age 80.7, 62% response rate) recruited and followed up monthly for up to 2 years (median 8-month follow-up, range 1–23 months). Forty-nine (66%) died during follow-up. Those who died had similar distribution of age, ethnicity, primary renal pathology, and comorbidity as those still alive at study end. Analysis according to time before death revealed that functional status remained stable during the last year of life but declined steeply in the last month of life.

Conclusion: This distinctive renal trajectory, reported here for the first time, contrasts with that previously described in other conditions. This has important clinical implications—the steep functional decline indicates that healthcare services need to be rapidly responsive to changing needs in this population as function declines in the last months and weeks of life.

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More information

Published date: February 2011
Keywords: functional trajectories, stage 5 chronic kidney disease, end-stage kidney disease, palliative care, end-of-life care

Identifiers

Local EPrints ID: 193059
URI: http://eprints.soton.ac.uk/id/eprint/193059
ISSN: 0002-8614
PURE UUID: ddfa1217-d01d-449d-96eb-8a4476e4f397

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Date deposited: 12 Jul 2011 08:26
Last modified: 14 Mar 2024 03:53

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Contributors

Author: Fliss E.M. Murtagh
Author: Irene J. Higginson

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