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.
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.
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.
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.
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
4. Feasibility of nephrology-tailored geriatric assessment: POLDER study. - in process
1. DIALysis or not: Outcomes in odler kidney patients with GerIatriC Assessment (DIALOGICA): rationale and design. BMC Nephrol (2021)23:22:39
5. Prevalence of apathy and associations with physical and cognitive impairment and mortality in older CKD patients: prospective cohort study. - in process
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
Proms: SF-12 (QOL), Dialysis Symptom Index (DSI)
Other: Charlson comorbidity index, Clinical judgement, Surprise question, Clinical Frailty scale, Caretaker questionnaire, Questionnaire on choice of treatment.
Improving healthcare for older renal patients
polder in a nutshell
- The POLDER intiative is a cooperation between multiple peripheral and academic hospitals. By implementing the same care pathway - a geriatric assessment in pre dialysis care- we can learn from each other.
- Sharing knowledge and outcomes to improve healthcare is an important aspect of this care pathway. Both patients and health care providers (such as the nephrologist, geriatrician, renal nurse, dietician, and the social worker) should discuss the outcomes and implications of the geriatric assessment.
- If necessary, additional care can be provided, like dietary prescriptions, physiotherapy or other care.
- The POLDER project provides additional education for health care providers working in renal care.
- Clinical and geriatric data will be gathered in a nationwide database in order to investigate the effects of kidney failure on the aging process.