275Chronic Kidney Disease in Relation to Cumulative Disease Burden in a Geriatric Medicine Outpatient Population

Abstract

Background: Patients attending geriatric medicine clinics often have multiple comorbidities with coexistent medical functional and psychosocial needs. Chronic kidney disease (CKD) is associated with increased levels of frailty and disability. Our aims are to characterize the cohort of patients referred for assessment, and to compare the level of concomitant disease burden between the CKD and non-CKD groups as represented by abnormal blood tests, polypharmacy and number of comorbidities Methods: We performed a retrospective review of new patients attending the clinic in 2017. Demographic data, comorbidities, medications, and blood results were collected from clinic letters and the laboratory system. The Cumulative Illness Scale (CIRS-G) was calculated as a marker of overall health status, with higher scores indicating greater disease burden. Patients with missing data were excluded from analysis. Patients were divided into two groups (CKD and non-CKD) based on diagnoses listed in their clinic letter, irrespective of eGFR. We used SAS software to perform T-test analysis of inter-group variances. Results: Of 147 patients seen in 2017, 112 were included in data analysis. 12 patients (7 male) were diagnosed with CKD (average eGFR 39 ml/min/1.73 m2, range 10-77) and 100 patients (42 male) were classified as non-CKD (average eGFR 63 ml/min/1.73 m2, range 28-90). The CKD patients were significantly older (84 vs 78, p = 0.03), had lower hemoglobin levels (11 g/dL vs 14 g/dL, p = 0.049) and serum iron levels (12.1umol/L vs 13.1umol/L p = 0.048) than the non-CKD patients. Overall disease burden as measured by the CIRS-G correlated strongly with CKD status (10.3 vs 5.9, p < 0.001). Conclusion: In our small population, patients with CKD had higher overall disease burden levels than non-CKD patients. Higher CIRS-G scores correlate strongly with CKD status as well as predicting future hospitalization and mortality. These results may be useful in identifying frailty, measuring comorbidity, and usefully incorporating this into clinical decision making.