Phenotypes of Symptom, Function, and Medication Burden in Older Adults with Nondialysis Advanced Kidney Disease.

Abstract

Older adults with advanced chronic kidney disease (CKD, stages 4 and 5) have significant symptoms, polypharmacy, and functional difficulties and prior studies evaluated these burdens separately. Identifying subgroups with similar patterns of burdens could help clinicians optimize care for these individuals. We conducted a secondary analysis of 377 older participants (≥ 70 years old) with stage 4 and 5 CKD at high risk of hospitalization enrolled in a national Veterans Affairs (VA) prospective cohort study. Adults on dialysis or with prior kidney transplant were excluded. We used latent class analysis (LCA) to identify participants with similar patterns across symptoms, medication burden, and function. Sixteen variables were included: symptoms (anxiety, depression, appetite, pain, shortness of breath, fatigue, dizziness, leg weakness, constipation, stiffness using the Symptom Burden Score), polypharmacy (≥ 10 medications and potentially inappropriate medications), and function (activities of daily living (ADL), physical and cognitive instrumental activities of daily living (IADLs), falls in the last year). We also compared 12 month hospitalization and mortality between the three classes. Three classes of participants with similar functional impairment, medication burden, and symptom phenotypes were identified. The largest participant class (N=208) primarily had difficulties with physical IADLs and polypharmacy. The second participant class (N=99) had shortness of breath, constipation, and dizziness. The third participant class (N=70) had complex needs with daily pain, psychological symptoms (anxiety and depression), functional limitations (ADLs and physical and cognitive IADLs), and polypharmacy. The three classes had significantly different levels of comorbidities, financial stress, and social support. There were no significant differences in mortality and hospitalization among the three classes. There are distinct classes of older adults with advanced CKD who have physical and psychological symptoms, functional impairment, and medication burden. Tailoring care for this population should include a multidisciplinary team to address these overlapping symptoms, medication, and functional needs.