Supplementary Material for: Domains for a Comprehensive Geriatric Assessment of Older Adults with Chronic Kidney Disease: Results from the CRIC Study

Introduction: A comprehensive geriatric assessment (CGA) tailored to the chronic kidney disease (CKD) population would yield a more targeted approach to assessment and care. We aimed to identify domains of a CKD-specific CGA (CKD-CGA), characterize patterns of these domains, and evaluate their predictive utility on adverse health outcomes.
Methods: We used data from 864 participants in the Chronic Renal Insufficiency Cohort aged ≥55 years and not on dialysis. Constituents of the CKD-CGA were selected a priori. Latent class analysis informed the selection of domains and identified classes of participants based on their domain patterns. Predictive utility of class membership on mortality, dialysis initiation, and hospitalization was examined. Model discrimination was assessed with C-statistic.
Results: The CKD-CGA included 16 domains: cardiovascular disease, diabetes, five frailty phenotype components, depressive symptoms, cognition, five kidney disease quality of life components, health literacy, and medication use. A two-class latent class model fit the data best, with 34.7% and 65.3% in the high- and low-burden of geriatric conditions classes, respectively. Relative to the low-burden class, participants in the high-burden class were at increased risk of mortality (aHR=2.09; 95% CI: 1.56, 2.78), dialysis initiation (aHR=1.63; 95% CI: 1.06, 2.52), and hospitalization (aOR=2.00; 95% CI: 1.38, 2.88). Model discrimination was the strongest for dialysis initiation (C-statistics=0.86), and moderate for mortality and hospitalization (C-statistics=0.70 and 0.66, respectively).
Conclusion: With further validation in an external cohort, the CKD-CGA has the potential to be used in nephrology practices for assessing and managing geriatric conditions in older adults with CKD.

引言：针对慢性肾脏病（CKD）人群定制的全面老年评估（CGA）可提供更具针对性的评估与照护方案。本研究旨在明确针对慢性肾脏病的全面老年评估（CKD-CGA）的维度，刻画这些维度的分布模式，并评估其对不良健康结局的预测效能。
方法：本研究使用慢性肾功能不全队列（Chronic Renal Insufficiency Cohort）中864名年龄≥55岁且未接受透析的参与者数据。CKD-CGA的构成项已提前通过先验确定。潜在类别分析用于指导维度筛选，并基于参与者的维度模式划分类别。本研究考察了类别归属对死亡、透析启动与住院的预测效能，并使用C统计量评估模型区分度。
结果：CKD-CGA共包含16个维度：心血管疾病、糖尿病、5项衰弱表型组分、抑郁症状、认知功能、5项肾脏病患者生活质量组分、健康素养以及用药情况。两类别潜在类别模型对数据的拟合效果最优，其中34.7%的参与者归为老年疾病负担较高组，65.3%归为负担较低组。与低负担组相比，高负担组参与者的死亡风险（校正后风险比aHR=2.09；95%置信区间CI：1.56, 2.78）、透析启动风险（aHR=1.63；95%CI：1.06, 2.52）以及住院风险（校正后优势比aOR=2.00；95%CI：1.38, 2.88）均显著升高。模型对透析启动的区分度最强（C统计量=0.86），对死亡与住院的区分度为中等水平（C统计量分别为0.70与0.66）。
结论：若能在外部队列中进一步验证，CKD-CGA有望应用于肾脏病临床实践，用于评估与管理老年慢性肾脏病患者的老年健康问题。