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Psychological, Social, and Somatic Prognostic Indicators in Old Patients Undergoing Long-term Dialysis

Psychological, Social, and Somatic Prognostic Indicators in Old Patients Undergoing Long-term... Abstract • We prospectively studied the influence of 29 demographic, social, psychological, and somatic factors on survival of 78 patients over age 70 years receiving long-term dialysis. Three years after the prospective evaluation, 54% of the patients had died. Only four factors, all psychosocial, were prognostically important. The patients who survived rated higher on the Karnofsky scale (85 vs 78 points), gained less weight between dialyses (1.5 vs 1.9 kg), more often underwent home dialysis (44% vs 21%), and less often wished for transplantation (28% vs 57%). In stepwise and multiple regression analysis, home dialysis and Karnofsky scale resulted in best fit. No somatic variable predicted outcome. Thirty-one patients were reinterviewed three years later. At that time, more patients were depressed and had a lower income, fewer wanted a transplant, and five had lost their living companion. There was a decrease in the number of patients who cooked their own meals, spent time outdoors, went to church, or had hobbies. Activity on the Karnofsky scale decreased from 87 to 84 points. The home dialysis patients' perceived health decreased from 3.9 to 3.4 points. Our study shows that psychosocial, but not somatic variables, are prognostically important in survival of older patients undergoing dialysis, and there is a measurable decline in these variables during a three-year follow-up period. (Arch Intern Med 1987;147:1921-1924) References 1. Kjellstrand CM, Koppy K, Umen A, et al: Hemodialysis of the elderly , in Oreopoulos DG (ed): Proceedings of the International Symposium of Geriatric Nephrology, Toronto, 1985 . Hingham, Mass, Martinus Nijhoff Publishers, 1986. 2. Kjellstrand CM, Logan G: Racial, sexual, and age discrimination in chronic dialysis. Nephron 1987;45:257-263.Crossref 3. Eggers PW, Connerton R, McMullan M: The Medicare experience with end-stage renal disease: Trends in incidence prevalence and survival. Health Care Finance Rev 1984;5:69-87. 4. Weller JM, Wu S-CH, Ferguson CW, et al: End-stage renal disease in Michigan: Incidence, underlying causes, prevalence, and modalities of treatment. Am J Nephrol 1985;5:84-95.Crossref 5. Westlie L, Umen A, Nestrud S, et al: Mortality, morbidity, and life satisfaction in the very old dialysis patient. Trans Am Soc Artif Intern Organs 1984;30;21-30. 6. Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer , in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents . New York, Columbia University Press, 1949, pp 191-205. 7. Gutman RA, Stead WW, Robinson RR: Physical activity and employment status of patients on maintenance dialysis. N Engl J Med 1981;304:309.Crossref 8. Neu S, Kjellstrand CM: Stopping long-term dialysis: An empirical study of withdrawal of life-supporting treatment. N Engl J Med 1986;314: 14-20.Crossref 9. Port FK, Ferguson CW, Hawthorne VM: Stopping long-term dialysis. N Engl J Med 1986;314:1450. 10. Schriel J, Silims J, Hauser J, et al: Canadian Renal Failure Registry, 1984 Report . Ottawa, Kidney Foundation of Canada, 1985. 11. Kjellstrand CM: Demand for and changing patient population, mortality, and death patterns in chronic dialysis , in Gurland H (ed): Uremic Therapy . New York, Springer-Verlag NY Inc, 1986. 12. Kjellstrand CM, Rosa AA, Shideman JR, et al: Optimal dialysis frequency and duration: The 'unphysiology hypothesis.' Kidney Int 1978;13: S120-S124. 13. Shideman JR, Buselmeier TJ, Kjellstrand CM: Hemodialysis in diabetics: Complications in insulin-dependent patients accepted for renal transplantation. Arch Intern Med 1976;136:1126-1130.Crossref 14. Friend R, Singletary Y, Mendell NR, et al: Group participation and survival among patients with end-stage renal disease. Am J Public Health 1986;76:670-672.Crossref 15. Burton HJ, Kline SA, Lindsay RM, et al: The relationship of depression to survival in chronic renal failure. Psychosom Med 1986;48:261-269.Crossref 16. Greene MC, Zabetakis PM, Gleim GW, et al: Effect of exercise on lipid metabolism and dietary intake in hemodialysis patients. Proc Dial Transplant Forum 1979;9:80-85. 17. Goldberg AP, Hagberg JM, Delmez JA, et al: Metabolic effects of exercise training in hemodialysis patients. Kidney Int 1980;18:754-761.Crossref 18. Shalom R, Blumenthal J, Williams RS, et al: Feasibility and benefits of exercise training in patients on maintenance dialysis. Kidney Int 1984;25: 958-963.Crossref 19. Schleifer SJ, Keller SE, Camerino M, et al: Suppression of lymphocyte stimulation following bereavement. JAMA 1983;250:374-377.Crossref 20. Locke SE, Kraus L, Lesserman J, et al: Life change stress, psychiatric symptoms, and natural killer cell activity. Psychosom Med 1984;46: 441-453.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Psychological, Social, and Somatic Prognostic Indicators in Old Patients Undergoing Long-term Dialysis

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References (25)

Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1987.00370110049007
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Abstract

Abstract • We prospectively studied the influence of 29 demographic, social, psychological, and somatic factors on survival of 78 patients over age 70 years receiving long-term dialysis. Three years after the prospective evaluation, 54% of the patients had died. Only four factors, all psychosocial, were prognostically important. The patients who survived rated higher on the Karnofsky scale (85 vs 78 points), gained less weight between dialyses (1.5 vs 1.9 kg), more often underwent home dialysis (44% vs 21%), and less often wished for transplantation (28% vs 57%). In stepwise and multiple regression analysis, home dialysis and Karnofsky scale resulted in best fit. No somatic variable predicted outcome. Thirty-one patients were reinterviewed three years later. At that time, more patients were depressed and had a lower income, fewer wanted a transplant, and five had lost their living companion. There was a decrease in the number of patients who cooked their own meals, spent time outdoors, went to church, or had hobbies. Activity on the Karnofsky scale decreased from 87 to 84 points. The home dialysis patients' perceived health decreased from 3.9 to 3.4 points. Our study shows that psychosocial, but not somatic variables, are prognostically important in survival of older patients undergoing dialysis, and there is a measurable decline in these variables during a three-year follow-up period. (Arch Intern Med 1987;147:1921-1924) References 1. Kjellstrand CM, Koppy K, Umen A, et al: Hemodialysis of the elderly , in Oreopoulos DG (ed): Proceedings of the International Symposium of Geriatric Nephrology, Toronto, 1985 . Hingham, Mass, Martinus Nijhoff Publishers, 1986. 2. Kjellstrand CM, Logan G: Racial, sexual, and age discrimination in chronic dialysis. Nephron 1987;45:257-263.Crossref 3. Eggers PW, Connerton R, McMullan M: The Medicare experience with end-stage renal disease: Trends in incidence prevalence and survival. Health Care Finance Rev 1984;5:69-87. 4. Weller JM, Wu S-CH, Ferguson CW, et al: End-stage renal disease in Michigan: Incidence, underlying causes, prevalence, and modalities of treatment. Am J Nephrol 1985;5:84-95.Crossref 5. Westlie L, Umen A, Nestrud S, et al: Mortality, morbidity, and life satisfaction in the very old dialysis patient. Trans Am Soc Artif Intern Organs 1984;30;21-30. 6. Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer , in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents . New York, Columbia University Press, 1949, pp 191-205. 7. Gutman RA, Stead WW, Robinson RR: Physical activity and employment status of patients on maintenance dialysis. N Engl J Med 1981;304:309.Crossref 8. Neu S, Kjellstrand CM: Stopping long-term dialysis: An empirical study of withdrawal of life-supporting treatment. N Engl J Med 1986;314: 14-20.Crossref 9. Port FK, Ferguson CW, Hawthorne VM: Stopping long-term dialysis. N Engl J Med 1986;314:1450. 10. Schriel J, Silims J, Hauser J, et al: Canadian Renal Failure Registry, 1984 Report . Ottawa, Kidney Foundation of Canada, 1985. 11. Kjellstrand CM: Demand for and changing patient population, mortality, and death patterns in chronic dialysis , in Gurland H (ed): Uremic Therapy . New York, Springer-Verlag NY Inc, 1986. 12. Kjellstrand CM, Rosa AA, Shideman JR, et al: Optimal dialysis frequency and duration: The 'unphysiology hypothesis.' Kidney Int 1978;13: S120-S124. 13. Shideman JR, Buselmeier TJ, Kjellstrand CM: Hemodialysis in diabetics: Complications in insulin-dependent patients accepted for renal transplantation. Arch Intern Med 1976;136:1126-1130.Crossref 14. Friend R, Singletary Y, Mendell NR, et al: Group participation and survival among patients with end-stage renal disease. Am J Public Health 1986;76:670-672.Crossref 15. Burton HJ, Kline SA, Lindsay RM, et al: The relationship of depression to survival in chronic renal failure. Psychosom Med 1986;48:261-269.Crossref 16. Greene MC, Zabetakis PM, Gleim GW, et al: Effect of exercise on lipid metabolism and dietary intake in hemodialysis patients. Proc Dial Transplant Forum 1979;9:80-85. 17. Goldberg AP, Hagberg JM, Delmez JA, et al: Metabolic effects of exercise training in hemodialysis patients. Kidney Int 1980;18:754-761.Crossref 18. Shalom R, Blumenthal J, Williams RS, et al: Feasibility and benefits of exercise training in patients on maintenance dialysis. Kidney Int 1984;25: 958-963.Crossref 19. Schleifer SJ, Keller SE, Camerino M, et al: Suppression of lymphocyte stimulation following bereavement. JAMA 1983;250:374-377.Crossref 20. Locke SE, Kraus L, Lesserman J, et al: Life change stress, psychiatric symptoms, and natural killer cell activity. Psychosom Med 1984;46: 441-453.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Nov 1, 1987

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