The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case–Control Study in Analogous Basal Conditions
Abstract
:1. Introduction
2. Materials and Methods
- -
- Age over 75 years;
- -
- eGFR < 12 mL/min/1.73m2;
- -
- 6 months of CCM or HD;
- -
- Availability of a 12-item Short-Form Health Survey at the end of the observational period.
- Type of intervention
- Demographic data as the gender and age.
- The Charlson Comorbidity Index (CCI) adjusted by the patient’s age (+3 in patients between 70 and 79 years old, +4 in patients over 80 years old) was detected at the beginning of HD or CM. Specifically, CCI evaluates the following conditions: diabetes, congestive heart failure, peripheral vascular disease, chronic pulmonary disease, liver disease, hemiplegia, renal disease, hematological or metastatic cancer, and acquired immunodeficiency syndrome.
- Blood examinations: creatinine, urea, sodium, potassium, calcium, phosphorus, parathyroid hormone (PTH), Vitamin D 25-OH, bicarbonate, albumin, cholesterol, and triglycerides. In all patients, venous blood samples were collected between 7 and 8 am at the end of the observational period. In HD patients, samples were collected in the long interval before the HD session.
- Urine output in 24 h.
- The median Visual Analog Scale (VAS) was calculated for pain assessment for each patient according to the scoring reported in the clinical notes in the observational period. To avoid differences in the number of observations between the case and control groups, we considered all outpatient visits in CCM patients and the first evaluation of the month in HD patients.
- Severe complications such as sepsis, pneumonia, myocardial infarction, and cerebrovascular events that required hospitalization were detected during the observational period.
2.1. Outcomes
2.2. Sample Size
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
- In general, would you say your health is:
- □1 Excellent □2 Very good □3 Good □4 Fair □5 Poor
- 2.
- Moderate activities such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.
- □YES limited a lot □YES limited a little □NO, not limited at all
- 3.
- Climbing several flights of stairs.
- □YES limited a lot □YES limited a little □NO, not limited at all
- 4.
- Accomplished less than you would like. □YES □NO
- 5.
- Were limited in the kind of work or other activities. □YES □NO
- 6.
- Accomplished less than you would like. □YES □NO
- 7.
- Did work or activities less carefully than usual. □YES □NO
- 8.
- During the past 4 weeks, how much did pain interfere with your normal work (including work outside the home and housework)?
- □1 Not at all □2 A little bit □3 Moderately □4 Quite a bit □5 Extremely
- 9.
- Have you felt calm & peaceful? □All of the time □Most the bit of time □A good of the time □Some of the time □A little of the time □None of the time.
- 10.
- Did you have a lot of energy? □All of the time □Most the bit of time □A good of the time □Some of the time □A little of the time □None of the time.
- 11.
- Have you felt downhearted and Blue? □All of the time □Most the bit of time □A good of the time □Some of the time □A little of the time □None of the time.
- 12.
- During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc.)?
- □All of the time □Most of the time □Some of the time □A little of the time □None of the time
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Related to Lack of HD Complications | Related to CCM |
---|---|
Avoiding intradialytic hypotension | Slow CKD progression |
Avoiding intradialytic cramps | Adequate control of urea retention |
Limiting hospital facility access | Adequate control of anemia |
Avoiding vascular access thrombosis | Adequate control of calcium–phosphate metabolism |
Avoiding vascular access infection | Adequate control of metabolic acidosis |
Reducing hospitalization rate | Positive impact of blood pressure control |
Entire Population | HD | CCM | p-Value | |
---|---|---|---|---|
Age (years) * | 81.5 (±4.5) | 80.6 (±4.7) | 82.5 (±4.3) | 0.15 |
Female (%) | 40 | 24 | 56 | 0.021 |
CCI 9 10 11 12 13 14 | 14 28 12 18 12 6 | 12 28 24 20 12 4 | 16 28 20 16 12 8 | 0.98 |
eGFR * (mL/min) | 8.22 (±2.1) | 7.95 (±1.7) | 8.45 (±2.4) | 0.37 |
Urea * (mmol/L) | 28.5 (±9.5) | 30.9 (±9.5) | 26.1 (±9) | 0.07 |
Hemoglobin * (g/dL) | 10.7 (±1.6) | 10.6 (±1.3) | 11 (±1.6) | 0.002 |
BMI * (Kg2/m2) | 24.4 (± 3.6) | 24.7 (±4.06) | 24.1 (±3) | 0.51 |
Albumin * (g/L) | 3.49 (±0.5) | 3.4 (±0.54) | 3.6 (±0.54) | 0.14 |
Sodium * (mmol/L) | 138 (±4.6) | 137.4 (±5.6) | 139.8 (±2.9) | 0.064 |
Potassium * (mmol/L) | 4.2 (±0.79) | 4.2 (± 1.08) | 4.3 (±0.5) | 0.73 |
Calcium * (mmol/L) | 2.23(±0.18) | 2.21 (±0.23) | 2.25 (±0.13) | 0.45 |
Phosphate ^ (mmol/L) | 1.56 [1.3–1.8] | 1.6 [1.4–1.8] | 1.48 [1.2–1.7] | 0.28 |
Entire Population | HD | CCM | p-Value | |
---|---|---|---|---|
Urine output * (cc/d) | 1.34 (±0.50) | 1.09 (±0.49) | 1.6 (±0.37) | <0.001 |
BMI * (Kg/m2) | 24.3 (±3.2) | 24.5 (±3.7) | 24.2 (±2.9) | 0.84 |
Urea * (mmol/L) | 24.6 (±7.7) | 27 (±8.2) | 21.9 (±6.1) | 0,01 |
Albumin *(g/L) | 3.7 (±0.5) | 3.7 (±0–4) | 3.6 (±0.6) | 0.54 |
Hemoglobin (g/dL) | 10.9(±1.4) | 10.8(±1.5) | 11 (±1.2) | 0.61 |
Sodium *(mmol/L) | 137.7 (±3.5) | 136.8 (±3.5) | 138.6 (±3.4) | 0.08 |
Potassium (mmol/L) | 4.5 (±0.8) | 4.7 (±0.8) | 4.4 (±0.7) | 0.01 |
Calcium * (mmol/L) | 2.3 (±0.29) | 2.2 (±0.19) | 2.24 (±0.4) | 0.28 |
Phosphate ^ (mmol/L) | 1.37 [1.3–1.7] | 1.6 [1.3–1.8] | 1.3 [1.1–1.55] | 0.03 |
PTH ^ (ng/L) | 286 [172–370] | 274 [167.5–399] | 288 [178–348] | 0.82 |
Bicarbonate * (mmol/L) | 23.6 (±3.2) | 25.9 (±0.8) | 23.5 (±3.2) | 0.31 |
VAS ^ score | 4 [2–6] | 6 [2–6] | 4 [2–6] | 0.09 |
Physical Composite Score | Mental Composite Score | |||||
---|---|---|---|---|---|---|
B | p | 95% CI | B | p | 95% CI | |
Age (^) | 0.003 | 0.72 | −0.14 0.02 | 0.001 | 0.98 | −0.1 0.017 |
CCM | 0.24 | 0.001 | 0.1 0.38 | 0.15 | 0.048 | 0.001–0.3 |
Female | 0.052 | 0.51 | −0.1 0.21 | −0.01 | 0.91 | −0.02 0.13 |
Protein intake | −0.004 | 0.008 | −0.007 −0.00 | −0.002 | 0.26 | −0.005 0.001 |
Urine output | 0.25 | 0.001 | 0.1 0.4 | 0.18 | 0.02 | 0.028 0.33 |
BMI | 0.01 | 0.43 | −0.02 0.04 | 0.004 | 0.77 | −0.23 0.3 |
Hemoglobin | −0.008 | 0.78 | −0.06 0.05 | −0.31 | 0.26 | −0.09 0.024 |
Albumin | −0.06 | 0.47 | −0.21 0.1 | 0.003 | 0.96 | −0.15 0.16 |
Urea | −0.009 | 0.09 | −0.02 0.001 | −0.006 | 0.26 | −0.02 0.004 |
Sodium | 0.009 | 0.4 | −0.01 0.03 | 0.013 | 0.24 | −0.01 0.035 |
Potassium | 0.02 | 0.67 | −0.08 0.12 | 0.004 | 0.93 | −0.97 0.105 |
Calcium | 0.18 | 0.16 | −0.07 0.45 | 0.024 | 0.86 | −0.24 0.29 |
Phosphate (^) | −0.14 | 0.43 | −0.49 0.22 | −0.31 | 0.083 | −0.65 0.41 |
PTH (^) | −0.08 | 0.24 | −0.22 0.06 | −0.27 | 0.7 | −0.17 0.114 |
Bicarbonate | 0.008 | 0.66 | −0.3 0.04 | 0.01 | 0.58 | −0.25 0.044 |
Hospitalization | −0.18 | 0.024 | −0.33 −0.25 | −0.1 | 0.21 | −0.26 0.06 |
VAS score (^) | −0.26 | <0.001 | −0.4 −0.14 | −0.14 | 0.048 | −0.28 −0.001 |
Physical Composite Score | Metal Composite Score | |||||
---|---|---|---|---|---|---|
B | p | 95% CI | B | p | 95% CI | |
CCM | 0.19 | 0.003 | 0.07 0.32 | 0.16 | 0.03 | 0.16 0.3 |
VAS score ^ | −0.24 | <0.001 | −0.36 −0.12 | −0.157 | 0.024 | −0.28 −0.02 |
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Martino, F.K.; Campo, D.; Stefanelli, L.F.; Zattarin, A.; Piccolo, D.; Cacciapuoti, M.; Bogo, M.; Del Prete, D.; Nalesso, F.; Calò, L.A. The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case–Control Study in Analogous Basal Conditions. Nutrients 2024, 16, 3037. https://doi.org/10.3390/nu16173037
Martino FK, Campo D, Stefanelli LF, Zattarin A, Piccolo D, Cacciapuoti M, Bogo M, Del Prete D, Nalesso F, Calò LA. The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case–Control Study in Analogous Basal Conditions. Nutrients. 2024; 16(17):3037. https://doi.org/10.3390/nu16173037
Chicago/Turabian StyleMartino, Francesca K., Daniela Campo, Lucia Federica Stefanelli, Alessandra Zattarin, Daria Piccolo, Martina Cacciapuoti, Marco Bogo, Dorella Del Prete, Federico Nalesso, and Lorenzo A. Calò. 2024. "The Quality of Life in Elderly Patients in Comprehensive Conservative Management or Hemodialysis: A Case–Control Study in Analogous Basal Conditions" Nutrients 16, no. 17: 3037. https://doi.org/10.3390/nu16173037