The US dialysis population is growing faster than the number of new nephrologists. At the same time, our population is aging, and there is a shortage of geriatricians. Beyond efforts to expand the nephrology and geriatrics workforces, it is also extremely important to pursue interdisciplinary collaboration. How can we ensure that older adults receiving dialysis receive quality care for their geriatric conditions? How can geriatricians be great partners in managing older adults with chronic kidney disease? Communication between nephrologists and geriatricians will add value for patient care and generate ideas for research.
As the liaison between the American Society of Nephrology (ASN) and the American Geriatric Society (AGS), I attended the AGS annual meeting in May 2017. The meeting focused on current issues in aging and was geared toward all health care professionals who care for older adults, including nephrologists. The value of individualized care for older adults on the basis of life expectancy prediction was the focus of a compelling talk by Sei Lee of the University of California, San Francisco Department of Medicine, Division of Geriatrics. Patients predicted to have limited life expectancy are not likely to benefit from preventive interventions, such as colon cancer screening, Lee noted. This theme overlapped with my own presentation showing that the cost-effectiveness of arteriovenous fistula is reduced in older adults with limited life expectancy.
Beyond life expectancy, another key theme at the meeting was co-management. A poster from Laura Fernandez and Julie Paik at the Boston Veterans Affairs Medical Center highlighted a Geriatric-Nephrology Collaborative Clinic, in which a geriatrician performed comprehensive geriatric assessments in older veterans with chronic kidney disease. The geriatrician then identified geriatric syndromes and provided treatment recommendations to the nephrology team. Although functional impairment was the most common geriatric syndrome, the most common treatment recommendations were medication changes followed by referrals to nonphysician services, such as rehabilitation or audiology.
Laura Plantinga and her colleagues at Emory University presented a study about the association of serious fall injuries in dialysis patients who received a kidney transplant. They found that patients who experienced a serious fall injury were nearly 80% less likely to be waitlisted. Among the waitlisted patients, those who had a serious fall injury were 53% less likely to subsequently receive a transplant. Prior studies show that falls increase mortality risk in dialysis patients, so these findings bring attention to yet another complication of injurious falls in this population.
Another highlight from the AGS annual meeting is its annual morning meeting for medical subspecialists. As ASN liaison, I highlighted the ASN’s Supportive Care online community and the Coalition for the Supportive Care of Kidney Patients Luncheon held at Kidney Week 2016. I also described current National Institute on Aging–funded research involving frailty, disability, and shared decision-making in older adults with ESRD. From other subspecialists’ presentations, I learned about integrated working groups, such as the Cancer and Aging Research Group that pursues research collaborations across multiple institutions. This model of collaboration among various specialists at multiple institutions is an intriguing example for growing the field of geriatric nephrology.
Want to learn more and/or get involved in geriatric nephrology? Through the ASN’s website, you can access the Online Curriculum on Geriatric Nephrology and the Supportive Care online community. At ASN Kidney Week 2017, you may network with members of the Supportive Care online community who will be present for a Supportive Care Meetup at the ASN Communities Lounge. Last, consider attending the next AGS annual meeting May 3 to 5, 2018, in Orlando, FL.