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Decline in the Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study.
J Ren Nutr. 2019 11; 29(6):504-510.JR

Abstract

OBJECTIVES

Patients with end-stage renal disease (ESRD) treated with hemodialysis suffer a high burden of poor functional status. Poor functional status is known as a strong, consistent predictor of mortality. However, little is known about the trajectory of functional status and its association with clinical outcomes in the ESRD population. We examined the association between a change in the functional status over time and all-cause mortality among patients on hemodialysis.

DESIGN AND METHODS

This was a prospective cohort study of 817 patients with ESRD on hemodialysis with repeat measures of functional status, who enrolled in the Japan Dialysis Outcomes and Practice Patterns Study phase V. The functional status was assessed based on the Katz Index and Lawton-Brody instrumental activities of daily living scale, and the assessments were conducted twice over a median of 361 (range: 339-378) days between 2012 and 2013. We classified patients into 2 groups based on having or not having at least a 1-point decline in the functional status score. To evaluate the association between the decline in the functional status and all-cause mortality with adjustment for potential confounders, a Cox regression analysis was conducted.

RESULTS

Over the study period, 19.9% of the patients showed a decline in the functional status score. During the follow-up period, 44 (5.4%) patients died. Using the Cox regression analysis and adjusting for potential confounders, it was determined that the decline in functional status score was significantly associated with higher mortality (incidence rate: 2.2 vs. 7.0 per 100 person-years; adjusted hazard ratio: 2.68; 95% confidence interval: 1.31-5.50).

CONCLUSIONS

The present study provides evidence that ESRD patients on hemodialysis demonstrating a decline in the functional status are at elevated risk of mortality. Our findings strengthen the evidence underpinning the importance of interventions to maintain the functional status in this vulnerable population.

Authors+Show Affiliations

Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. Electronic address: ryota122560@gmail.com.Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.Department of Medicine, Division of Nephrology, University of California Davis, Sacramento, California.Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30591357

Citation

Matsuzawa, Ryota, et al. "Decline in the Functional Status and Mortality in Patients On Hemodialysis: Results From the Japan Dialysis Outcome and Practice Patterns Study." Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, vol. 29, no. 6, 2019, pp. 504-510.
Matsuzawa R, Kamitani T, Roshanravan B, et al. Decline in the Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study. J Ren Nutr. 2019;29(6):504-510.
Matsuzawa, R., Kamitani, T., Roshanravan, B., Fukuma, S., Joki, N., & Fukagawa, M. (2019). Decline in the Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study. Journal of Renal Nutrition : the Official Journal of the Council On Renal Nutrition of the National Kidney Foundation, 29(6), 504-510. https://doi.org/10.1053/j.jrn.2018.10.012
Matsuzawa R, et al. Decline in the Functional Status and Mortality in Patients On Hemodialysis: Results From the Japan Dialysis Outcome and Practice Patterns Study. J Ren Nutr. 2019;29(6):504-510. PubMed PMID: 30591357.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decline in the Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study. AU - Matsuzawa,Ryota, AU - Kamitani,Tsukasa, AU - Roshanravan,Baback, AU - Fukuma,Shingo, AU - Joki,Nobuhiko, AU - Fukagawa,Masafumi, Y1 - 2018/12/24/ PY - 2018/07/07/received PY - 2018/10/10/revised PY - 2018/10/26/accepted PY - 2018/12/29/pubmed PY - 2020/8/15/medline PY - 2018/12/29/entrez SP - 504 EP - 510 JF - Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation JO - J Ren Nutr VL - 29 IS - 6 N2 - OBJECTIVES: Patients with end-stage renal disease (ESRD) treated with hemodialysis suffer a high burden of poor functional status. Poor functional status is known as a strong, consistent predictor of mortality. However, little is known about the trajectory of functional status and its association with clinical outcomes in the ESRD population. We examined the association between a change in the functional status over time and all-cause mortality among patients on hemodialysis. DESIGN AND METHODS: This was a prospective cohort study of 817 patients with ESRD on hemodialysis with repeat measures of functional status, who enrolled in the Japan Dialysis Outcomes and Practice Patterns Study phase V. The functional status was assessed based on the Katz Index and Lawton-Brody instrumental activities of daily living scale, and the assessments were conducted twice over a median of 361 (range: 339-378) days between 2012 and 2013. We classified patients into 2 groups based on having or not having at least a 1-point decline in the functional status score. To evaluate the association between the decline in the functional status and all-cause mortality with adjustment for potential confounders, a Cox regression analysis was conducted. RESULTS: Over the study period, 19.9% of the patients showed a decline in the functional status score. During the follow-up period, 44 (5.4%) patients died. Using the Cox regression analysis and adjusting for potential confounders, it was determined that the decline in functional status score was significantly associated with higher mortality (incidence rate: 2.2 vs. 7.0 per 100 person-years; adjusted hazard ratio: 2.68; 95% confidence interval: 1.31-5.50). CONCLUSIONS: The present study provides evidence that ESRD patients on hemodialysis demonstrating a decline in the functional status are at elevated risk of mortality. Our findings strengthen the evidence underpinning the importance of interventions to maintain the functional status in this vulnerable population. SN - 1532-8503 UR - https://www.unboundmedicine.com/medline/citation/30591357/Decline_in_the_Functional_Status_and_Mortality_in_Patients_on_Hemodialysis:_Results_from_the_Japan_Dialysis_Outcome_and_Practice_Patterns_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1051-2276(18)30252-8 DB - PRIME DP - Unbound Medicine ER -