Survival and quality of life in elderly patients in conservative management.
INTRODUCTION
Conservative Management (CM) has become a therapeutic option in Advanced Chronic Kidney Disease in the elderly. However, there is a lack of evidence about prognosis of these patients in terms of survival and health related quality of life (HRQoL).


OBJECTIVE
Establish predictive variables associated with mortality and analyse HRQoL in CM patients.


PATIENTS AND METHODS
Prospective cohort study. An assessment of renal function parameters and a comprehensive geriatric assessment were made, including: analysis of comorbidity, functional, cognitive, fragility, nutritional, social and HRQoL status.


RESULTS
82 patients with a mean age of 84 years and significant pluripathology were studied: 56% had history of vascular event and Charlson >8. The mortality rate was 23/1,000 patients per month, with a homogeneous mortality rate after 6 months. Survival differed significantly depending on whether they presented with a previous vascular event (36.7 vs. 14.8; p=0.028), Charlson score ≥10 (42 vs. 17; p=0.002), functional status (48.4 vs. 19; p=0.002) and fragility (27 vs. 10; p=0.05). Mortality predictors included eGFR and proteinuria, the presence of previous vascular events, Charlson comorbidity score, malnutrition-inflammation parameters (albumin and MNA score), degree of dependency, physical HRQoL and increase of PTH level. The presence of previous vascular event, comorbidity, decreased albumin and elevated PTH were independent predictors of mortality. HRQoL remained stable over time and no significant worsening occurred during treatment.


CONCLUSIONS
Having knowledge of the factors associated with mortality and HRQoL assessment can be a useful tool to helping decision making during CM. Previous vascular events, comorbidity, decreased albumin and increased PTH were independent predictors of mortality.
['Rubio Rubio|María Victoria|MV|', 'Lou Arnal|Luis Miguel|LM|', 'Gimeno Orna|José Antonio|JA|', 'Munguía Navarro|Paula|P|', 'Gutiérrez-Dalmau|Alex|A|', 'Lambán Ibor|Elena|E|', 'Paúl Ramos|Javier|J|', 'Pernaute Lavilla|Raquel|R|', 'Campos Gutiérrez|Belén|B|', 'San Juan Hernández-Franch|Alberto|A|']
D000369:Aged, 80 and over D015897:Comorbidity D000072700:Conservative Treatment D005260:Female D015577:Geriatric Assessment D006801:Humans D007249:Inflammation D008297:Male D044342:Malnutrition D010281:Parathyroid Hormone D011379:Prognosis D011446:Prospective Studies D011788:Quality of Life D051436:Renal Insufficiency, Chronic D012709:Serum Albumin D015996:Survival Rate
Survival Elderly Conservative management Advanced chronic kidney disease Ancianos Enfermedad renal crónica avanzada Manejo conservador Supervivencia