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Table 2 Patients with high CGA ratings by geriatrician and patients listed on transplant waitlist both have lower degrees of frailty compared to patients with low CGA ratings and those not listed, respectively. P-values, calculated through independent samples t-tests and Chi-squared or Fischer’s Exact tests, show the similarities and differences in parameters between the cohorts stratified by the geriatrician’s recommendation for transplant (CGA rating) and MDM decision

From: Comprehensive geriatric assessment predicts listing for kidney transplant in patients with end-stage renal disease: a retrospective cohort study

Assessed during CGA

All

CGA rating

P-value†

MDM decision

P-value*

N = 230

(100.0%)

High

N = 135

(58.7%)

Low

N = 95 (41.3%)

Listed active

N = 74

(32.2%)

Deferred or not a candidate

N = 156

(67.8%)

Number of CGA visits– mean ± SD

1.22 ± 0.5

1.24 ± 0.6

1.18 ± 0.5

0.375

1.36 ± 0.7

1.15 ± 0.5

0.005

Still driving– no. (%)

128 (55.7)

92 (68.1)

36 (37.9)

< 0.001

51 (68.9)

77 (49.4)

0.005

Two or more falls in last year– no. (%)

37 (16.1)

9 (6.7)

28 (29.5)

< 0.001

3 (4.1)

34 (21.8)

< 0.001

Difficulty with balance– no. (%)

85 (37.0)

29 (21.5)

56 (58.9)

< 0.001

19 (25.7)

66 (42.3)

0.015

Hospital admission in last year– no. (%)

115 (50.0)

54 (40.0)

61 (64.2)

< 0.001

27 (36.5)

88 (56.4)

0.005

Low physical activity– no. (%)

100 (43.5)

30 (22.2)

70 (73.7)

< 0.001

14 (18.9)

86 (55.8)

< 0.001

Surgical risk– no. (%)

   

< 0.001

  

< 0.001

Average

51 (22.2)

50 (37.0)

1 (1.1)

 

27 (36.5)

24 (15.4)

 

Above average

116 (50.4)

85 (63.0)

31 (32.6)

 

47 (63.5)

69 (44.2)

 

Significantly increased

56 (24.3)

0 (0.0)

56 (58.9)

 

0 (0.0)

56 (35.9)

 

High

7 (3.0)

0 (0.0)

7 (7.4)

 

0 (0.0)

7 (4.5)

 

Social Support

   

< 0.001

  

0.005

Adequate

212 (92.2)

132 (97.8)

80 (84.2)

 

73 (98.6)

139 (89.1)

 

Inadequate

17 (7.4)

2 (1.5)

15 (15.8)

 

0 (0.0)

17 (10.9)

 

Unknown

1 (0.4)

0 (0.0)

1 (0.7)

 

1 (1.4)

0 (0.0)

 

Control of Comorbidities‡

   

< 0.001

  

< 0.001

None or well controlled

5 (2.2)

4 (3.0)

1 (1.1)

 

3 (4.1)

2 (1.3)

 

Generally well controlled

166 (72.2)

125 (92.6)

41 (43.2)

 

70 (94.6)

96 (61.5)

 

Poorly controlled

49 (21.3)

4 (3.0)

45 (47.4)

 

1 (1.4)

48 (30.8)

 

Unable to be determined

10 (4.3)

2 (1.5)

8 (8.4)

 

0 (0.0)

10 (6.4)

 

ADLsa, assistance

0.2 ± 0.7

0.5 ± 0.0

1.0 ± 0.2

< 0.001

0.0 ± 0.3

0.3 ± 0.8

< 0.001

iADLsb– mean ± SD

       

Combined

1.9 ± 2.3

1.0 ± 1.7

3.9 ± 2.5

< 0.001

0.9 ± 1.5

2.8 ± 2.7

< 0.001

Dependency

0.6 ± 0.5

0.1 ± 0.4

0.6 ± 1.3

0.001

0.2 ± 0.5

0.4 ± 1.1

< 0.001

Assistance

0.3 ± 0.9

0.9 ± 1.6

3.3 ± 2.4

< 0.001

0.8 ± 1.4

2.4 ± 2.4

< 0.001

VES-13c– mean ± SD

2.5 ± 2.6

1.1 ± 1.7

4.5 ± 2.3

< 0.001

1.0 ± 1.6

3.2 ± 2.7

< 0.001

Medications– mean ± SD

10.2 ± 4.7

9.4 ± 4.5

11.4 ± 4.8

0.003

10.1 ± 4.7

10.2 ± 4.7

0.661

History of Tobacco use– no. (%)

91 (39.6)

47 (34.8)

44 (46.3)

0.079

19 (25.7)

72 (46.2)

0.003

ETOH use– no. (%)

24 (10.4)

18 (13.3)

6 (6.3)

0.229

6 (8.1)

15 (9.6)

0.711

Health care power of attorney– no. (%)

69 (30.0)

41 (30.4)

29 (21.5)

0.885

24 (32.4)

45 (28.8)

0.536

Living will– no. (%)

15 (6.5)

13 (9.6)

2 (2.1)

0.028

7 (9.5)

8 (5.1)

0.259

Use of healthcare facilities in last year– no. (%)

       

ER visit

87 (37.8)

38 (28.1)

49 (51.6)

< 0.001

22 (29.7)

65 (41.7)

0.081

Long term care facility

1 (0.4)

0 (0.0)

1 (1.1)

0.413

0 (0.0)

1 (0.6)

1.000

Subacute rehab

20 (8.7)

4 (3.0)

16 (16.8)

< 0.001

4 (5.4)

16 (10.3)

0.223

Acute rehab

1 (0.4)

1 (0.7)

0 (0.0)

1.00

1 (1.4)

0 (0.0)

0.322

Months on dialysis§– mean ± SD

40.5 ± 42.2

39.1 ± 43.6

42.4 ± 40.4

0.607

44.8 ± 48.6

38.5 ± 38.8

0.351

Not on dialysis– no. (%)

36 (15.7)

26 (19.3)

8 (8.4)

0.023

15 (20.3)

19 (12.2)

1.000

MoCAd– mean ± SD

23.9 ± 4.0

24.9 ± 3.5

22.5 ± 4.2

< 0.001

25.5 ± 3.2

23.1 ± 4.1

0.061

Mini coge– mean ± SD

3.6 ± 1.3

3.8 ± 1.3

3.2 ± 1.2

0.074

4.0 ± 1.3

3.4 ± 1.3

0.765

SPPBf– mean ± SD

       

Balance

2.8 ± 1.4

3.5 ± 0.9

1.9 ± 1.4

< 0.001

3.3 ± 1.1

2.6 ± 1.4

0.003

Gait

3.2 ± 1.2

3.9 ± 0.4

2.3 ± 1.5

< 0.001

3.8 ± 0.5

3.0 ± 1.4

< 0.001

Chair stands

1.5 ± 1.3

2.0 ± 1.3

0.7 ± 1.0

< 0.001

2.1 ± 1.4

1.2 ± 1.2

0.119

Total

7.5 ± 3.3

9.3 ± 1.9

4.9 ± 3.1

< 0.001

9.2 ± 2.2

6.7 ± 3.4

< 0.001

Physical Frailty Phenotypeg– mean ± SD

1.6 ± 1.3

0.8 ± 0.7

2.7 ± 1.2

< 0.001

0.9 ± 0.9

1.9 ± 1.4

< 0.001

PHQ-2h– mean ± SD

0.3 ± 0.9

0.2 ± 0.7

0.5 ± 1.2

0.012

0.2 ± 0.5

0.4 ± 1.1

0.012

CGA rating of “Excellent” or “Good”

135 (58.7)

--

--

--

70 (94.6)

65 (41.7)

< 0.001

  1. †P-values calculated between the “Excellent”/”Good” and “Borderline”/”Fair”/”Poor” groups
  2. *P-values calculated between the “Listed active” and “Deferred or not a candidate” groups
  3. §Months on dialysis calculated as difference between initial date of starting dialysis in EMR and latest CGA visit
  4. ‡Control of comorbidities of patients was determined by geriatrician during the CGA.
  5. aActivities of daily living (ADLs), including dressing, bathing, feeding, toileting, transferring, and continence. No patients had dependency in ADLs.
  6. bInstrumental activities of daily living (iADLs), including driving, medications, cooking, cleaning, finances, telephone use, shopping, and laundry, were summated to produce a combined and separated score for assistance and dependence
  7. cVulnerable Elders Survey (VES-13) score ranges from 0–10. A score of 2 or less is considered normal. 6 or higher indicates high risk for postoperative complications
  8. dMontreal Cognitive Assessment (MoCA) score ranges from 0–30. A score of 25 or lower is considered abnormal
  9. eThe Mini-Cog© score ranges from 0–5. A score of 1 or 2 is indicative of possible dementia or cognitive impairment
  10. fThe short physical performance battery (SPPB) test is a lower extremity physical function test scored from 0–12 (4 maximum points from Balance, Chair Stands, and Gait). A score of 7–9 suggests mild impairment while 0–6 suggests severe impairment
  11. gPhysical Frailty Phenotype (PFP) test is scored as 0 = Not frail, 1–2 = Pre-frail, 3–5 = Frail
  12. hPatient Health Questionnaire-2 (PHQ-2) of 3 or higher is cutoff for possible Major Depressive Disorder
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BMC Geriatrics

ISSN: 1471-2318

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