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Functional status of elderly adults before and after initiation of dialysis.
N Engl J Med 2009; 361(16):1539-47NEJM

Abstract

BACKGROUND

It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD).

METHODS

Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty).

RESULTS

The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis.

CONCLUSIONS

Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA. mktamura@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

19828531

Citation

Kurella Tamura, Manjula, et al. "Functional Status of Elderly Adults Before and After Initiation of Dialysis." The New England Journal of Medicine, vol. 361, no. 16, 2009, pp. 1539-47.
Kurella Tamura M, Covinsky KE, Chertow GM, et al. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539-47.
Kurella Tamura, M., Covinsky, K. E., Chertow, G. M., Yaffe, K., Landefeld, C. S., & McCulloch, C. E. (2009). Functional status of elderly adults before and after initiation of dialysis. The New England Journal of Medicine, 361(16), pp. 1539-47. doi:10.1056/NEJMoa0904655.
Kurella Tamura M, et al. Functional Status of Elderly Adults Before and After Initiation of Dialysis. N Engl J Med. 2009 Oct 15;361(16):1539-47. PubMed PMID: 19828531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional status of elderly adults before and after initiation of dialysis. AU - Kurella Tamura,Manjula, AU - Covinsky,Kenneth E, AU - Chertow,Glenn M, AU - Yaffe,Kristine, AU - Landefeld,C Seth, AU - McCulloch,Charles E, PY - 2009/10/16/entrez PY - 2009/10/16/pubmed PY - 2009/10/27/medline SP - 1539 EP - 47 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 361 IS - 16 N2 - BACKGROUND: It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). METHODS: Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). RESULTS: The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. CONCLUSIONS: Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/19828531/full_citation L2 - http://www.nejm.org/doi/full/10.1056/NEJMoa0904655?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -