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Functional status of elderly adults before and after initiation of dialysis.

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.

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    Source

    The New England journal of medicine 361:16 2009 Oct 15 pg 1539-47

    MeSH

    Activities of Daily Living
    Age Factors
    Aged
    Aged, 80 and over
    Female
    Humans
    Kidney Failure, Chronic
    Male
    Nursing Homes
    Renal Dialysis
    Treatment Outcome

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    19828531

    Citation

    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/abs/10.1056/NEJMoa0904655?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed ER -