About the polder initiative

The POLDER initiative develops a care pathway for older patients with End Stage Renal Disease (ESRD). By assessing a geriatric assessment, patients and health care providers take into account all aging aspects in the treatment plan.  How frail is a person, and how does he function physically and cognitively?  

Understanding the effects of  chronic kidney failure on aging. And improving healthcare accordingly. 

Our aim

To prepare implementation of a national registry for chronic care in older patients with ESRD, to study determinants of adverse outcomes, implement interventions and improve outcomes for these patients.

We believe that the implementation of a geriatric assessment and a national registry in pre-dialysis care for older patients with ESRD will:

1) provide insights in determinants of adverse outcomes.
2) inform and benefit decision making trajectories for treatment modality, and
3) will improve outcomes for these patients. 

nationwide cooperation

POLDER is an acronym for Pathway for Older Patients Reaching End Stage Renal Disease. 

Multiple Dutch hospitals and academic centers cooperate to develop and improve healthcare for the older renal patient.

In a pilot project we study the feasibility of implementation of a geriatric assessment in routine pre-dialysis care. The POLDER study involves capturing the clinical and geriatric data in a national database and collecting biomaterial for future research.

Continuation.. 

The follow-up project DIALOGICA is initiated to further implementation of geriatric assessment. The aim of this prospective study is to compare HRQoL, clinical outcomes, and costs between conservative care and dialysis in older patients.

scientific publications

1. Perspectives and experiences of patients and healthcare professionals with geriatric assessment in chronic kidney disease: a qualitative study BMC Nephrol (2021)22:9

2. Design of a consensus-based geriatric assessment tailored for older chronic kidney disease patients: results of a pragmatic approach Eur Geriatr Med (2021)12:931-942

3. Impact of the COVID-19 pandemic on symptoms of anxiety and depression and health-related quality of life in older patients with chronic kidney disease. BMC Geriatrics (2021):650

4. Feasibility of nephrology-tailored geriatric assessment: POLDER study. - in process

Related projects: 

1. DIALysis or not: Outcomes in odler kidney patients with GerIatriC Assessment (DIALOGICA): rationale and design. BMC Nephrol (2021)23:22:39

2. Survival of patients who opt for dialysis versus conservative care: a systematic review and meta-analysis. NDT (2022)37:1529-1544

3. Health-related quality of life and symptoms of conservative care versus dialysis in patients with end-stage kidney disease: a systematic review. NDT (2021) 36:1418-1433

4. Changing the choice form didalysis to conservative care or vice versa in older patients with advanced CKD. NDT(2021)36:1958-1961

5. Prevalence of apathy and associations with physical and cognitive impairment and mortality in older CKD patients: prospective cohort study. - in process

TESTset

We use a consensus based testset, maximum duration 1 hour. This set will be evaluated at the end of the pilot study.

Functional: Katz ADL-6, Lawton iADL, Hand grip strenght

Cognition: MOCA, 6-CIT, Letter Digit Substitution Test

Mood: Geriatric Depression Scale, Optimism check

Proms: SF-12 (QOL), Dialysis Symptom Index (DSI)

Nutrition: PG-SGA

Other: Charlson comorbidity index, Clinical judgement, Surprise question, Clinical Frailty scale, Caretaker questionnaire, Questionnaire on choice of treatment.