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The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
Perit Dial Int. 2019 Mar-Apr; 39(2):103-111.PD

Abstract

BACKGROUND

Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis.

METHODS

A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix.

RESULTS

Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis.

CONCLUSION

Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis.

Authors+Show Affiliations

Dalhousie University/Nova Scotia Health Authority, Halifax, NS, Canada.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.Division of Nephrology, University Health Network, Toronto, ON, Canada.Yale University, New Haven, CT, USA.Kidney and Metabolic Research Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.Khon Kaen University, Khon Kaen, Thailand.Arbor Research Collaborative for Health, Ann Arbor, MI, USA.Baxter Healthcare Corporation, Deerfield, IL, USA.St. Michael's Hospital, Toronto, ON, Canada perlj@smh.ca.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30739094

Citation

Tennankore, Karthik, et al. "The Association of Functional Status With Mortality and Dialysis Modality Change: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS)." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 39, no. 2, 2019, pp. 103-111.
Tennankore K, Zhao J, Karaboyas A, et al. The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int. 2019;39(2):103-111.
Tennankore, K., Zhao, J., Karaboyas, A., Bieber, B. A., Robinson, B. M., Morgenstern, H., Jassal, S. V., Finkelstein, F. O., Kanjanabuch, T., Cheawchanwattana, A., Pisoni, R. L., Sloand, J. A., & Perl, J. (2019). The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 39(2), 103-111. https://doi.org/10.3747/pdi.2018.00094
Tennankore K, et al. The Association of Functional Status With Mortality and Dialysis Modality Change: Results From the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int. 2019 Mar-Apr;39(2):103-111. PubMed PMID: 30739094.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Association of Functional Status with Mortality and Dialysis Modality Change: Results from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). AU - Tennankore,Karthik, AU - Zhao,Junhui, AU - Karaboyas,Angelo, AU - Bieber,Brian A, AU - Robinson,Bruce M, AU - Morgenstern,Hal, AU - Jassal,S Vanita, AU - Finkelstein,Fredric O, AU - Kanjanabuch,Talerngsak, AU - Cheawchanwattana,Areewan, AU - Pisoni,Ronald L, AU - Sloand,James A, AU - Perl,Jeffrey, AU - ,, Y1 - 2019/02/09/ PY - 2018/05/14/received PY - 2018/11/14/accepted PY - 2019/2/11/pubmed PY - 2020/1/3/medline PY - 2019/2/11/entrez KW - Daily activities KW - functional impairment KW - hemodialysis KW - survival SP - 103 EP - 111 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 39 IS - 2 N2 - BACKGROUND: Little is known about the prevalence of functional impairment in peritoneal dialysis (PD) patients, its variation by country, and its association with mortality or transfer to hemodialysis. METHODS: A prospective cohort study was conducted in PD patients from 7 countries in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) (2014 - 2017). Functional status (FS) was assessed by combining self-reports of 8 instrumental and 5 basic activities of daily living, using the Lawton-Brody and the Katz questionnaires. Summary FS scores, ranging from 1.25 (most dependent) to 13 (independent), were based on the patient's ability to perform each activity with or without assistance. Logistic regression was used to estimate the odds ratio (OR; 95% confidence interval [CI]) of a FS score < 11 comparing each country with the United States (US). Cox regression was used to estimate the hazard ratio (HR; 95% CI) for the effect of a low FS score on mortality and transfer to hemodialysis, adjusting for case mix. RESULTS: Of 2,593 patients with complete data on FS, 48% were fully independent (FS = 13), 32% had a FS score 11 to < 13, 14% had a FS score 8 to < 11, and 6% had a FS score < 8. Relative to the US, low FS scores (< 11; more dependent) were more frequent in Thailand (OR = 10.48, 5.90 - 18.60) and the United Kingdom (UK) (OR = 3.29, 1.77 - 6.08), but similar in other PDOPPS countries. The FS score was inversely and monotonically associated with mortality but not with transfer to hemodialysis; the HR, comparing a FS score < 8 vs 13, was 4.01 (2.44 - 6.61) for mortality and 0.91 (0.58 - 1.43) for transfer to hemodialysis. CONCLUSION: Regional differences in FS scores observed across PDOPPS countries may have been partly due to differences in regional patient selection for PD. Functional impairment was associated with mortality but not with permanent transfer to hemodialysis. SN - 1718-4304 UR - https://www.unboundmedicine.com/medline/citation/30739094/The_Association_of_Functional_Status_with_Mortality_and_Dialysis_Modality_Change:_Results_from_the_Peritoneal_Dialysis_Outcomes_and_Practice_Patterns_Study__PDOPPS__ L2 - https://journals.sagepub.com/doi/10.3747/pdi.2018.00094?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -