{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T09:08:17Z","timestamp":1780304897147,"version":"3.54.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004856","name":"Department of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004856","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To address the changing demographic and increasing frailty and comorbidity of people referred to renal services, we initiated novel, routine, embedded, consultant-led, focused geriatric assessment of a selected group of patients in our Renal Low Clearance Clinic, seeking effects on treatment decision-making, patient outcomes and undertaking a health economic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 133 patients fulfilling study-developed referral criteria received focused geriatric assessment. Short-term results (treatment decisions) of all 133 patients, plus long-term (survival) data for the first 77 patients for whom we have 3 years\u2019 follow-up are presented. Health economic analysis compared the cost of employing the Geriatrician versus avoiding unnecessary\/futile dialysis access (arteriovenous fistula) creation based on historic rates in our own unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Starting in 2018, 77 patients were reviewed before suspension enforced by the COVID-19 pandemic in March 2020, and a further 56 since resumption between July 2021 and January 2023 [mean age 78 (range 62\u201392) years; 70% male]. Following focused geriatric assessment, the number of patients undecided about treatment changed from 43 to 3; those choosing dialysis reduced from 80 to 44 and those choosing conservative management (CM) increased from 10 to 74. The number of advance care plans made increased from 0 to 77, and recorded resuscitation decisions from 6 to 42. Thirty-six months after focused geriatric assessment, the survival rate in the group choosing dialysis was 50% and in the CM group was 33%; most deaths were unrelated to renal failure and there was a trend towards clinical frailty scores impacting outcome more than treatment choice. Health economic analysis demonstrated that the costs of providing this review were more than offset by reductions in unnecessary\/futile fistula formation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Routine, protocol-supported focused geriatric assessment in a tertiary referral renal service appears cost-effective and is associated with improved dialysis decision-making, advance care-planning and resuscitation decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag132","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T11:38:16Z","timestamp":1779190696000},"source":"Crossref","is-referenced-by-count":0,"title":["The utility and cost of embedding geriatric expertise in a tertiary referral renal clinic"],"prefix":"10.1093","volume":"19","author":[{"given":"Virginia","family":"Aylett","sequence":"first","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust Department of Healthcare for the Elderly, , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel D","family":"Relton","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, School of Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Rogers","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, School of Medicine, University of Leeds , Leeds ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Howdon","sequence":"additional","affiliation":[{"name":"Leeds Institute of Health Sciences, School of Medicine, University of Leeds , Leeds 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