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Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden.
Clin J Am Soc Nephrol. 2019 07 05; 14(7):1039-1047.CJ

Abstract

BACKGROUND AND OBJECTIVES

Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden.

DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS

This study included participants aged ≥65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors.

RESULTS

Of the 196 included participants functional data were available for 187 participants. Mean age was 75±7 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death.

CONCLUSIONS

In patients aged ≥65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden.

Authors+Show Affiliations

Dianet Dialysis Center, Utrecht, The Netherlands; n.a.goto@umcutrecht.nl. Department of Geriatrics.Dianet Dialysis Center, Utrecht, The Netherlands. Department of Nephrology and Hypertension, and.Dianet Dialysis Center, Utrecht, The Netherlands. Department of Internal Medicine and.Department of Geriatrics.Department of Geriatrics, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.Department of Internal Medicine, Tergooi Hospital, Hilversum, The Netherlands.Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands.Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, The Netherlands.Department of Internal Medicine, Antonius Hospital, Nieuwegein, The Netherlands.Department of Internal Medicine, St. Franciscus Hospital, Rotterdam, The Netherlands.Department of Internal Medicine, Bernhoven Hospital, Uden, The Netherlands.Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; and.Department of Internal Medicine, Gelderse Vallei Hospital, Ede, The Netherlands.Department of Nephrology and Hypertension, and.Department of Nephrology and Hypertension, and.Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands.

Pub Type(s)

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

Language

eng

PubMed ID

31248948

Citation

Goto, Namiko A., et al. "Association of Initiation of Maintenance Dialysis With Functional Status and Caregiver Burden." Clinical Journal of the American Society of Nephrology : CJASN, vol. 14, no. 7, 2019, pp. 1039-1047.
Goto NA, van Loon IN, Boereboom FTJ, et al. Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. Clin J Am Soc Nephrol. 2019;14(7):1039-1047.
Goto, N. A., van Loon, I. N., Boereboom, F. T. J., Emmelot-Vonk, M. H., Willems, H. C., Bots, M. L., Gamadia, L. E., van Bommel, E. F. H., Van de Ven, P. J. G., Douma, C. E., Vincent, H. H., Schrama, Y. C., Lips, J., Hoogeveen, E. K., Siezenga, M. A., Abrahams, A. C., Verhaar, M. C., & Hamaker, M. E. (2019). Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. Clinical Journal of the American Society of Nephrology : CJASN, 14(7), 1039-1047. https://doi.org/10.2215/CJN.13131118
Goto NA, et al. Association of Initiation of Maintenance Dialysis With Functional Status and Caregiver Burden. Clin J Am Soc Nephrol. 2019 07 5;14(7):1039-1047. PubMed PMID: 31248948.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden. AU - Goto,Namiko A, AU - van Loon,Ismay N, AU - Boereboom,Franciscus T J, AU - Emmelot-Vonk,Marielle H, AU - Willems,Hanna C, AU - Bots,Michiel L, AU - Gamadia,Laila E, AU - van Bommel,Eric F H, AU - Van de Ven,Peter J G, AU - Douma,Caroline E, AU - Vincent,Hieronymus H, AU - Schrama,Yvonne C, AU - Lips,Joy, AU - Hoogeveen,Ellen K, AU - Siezenga,Machiel A, AU - Abrahams,Alferso C, AU - Verhaar,Marianne C, AU - Hamaker,Marije E, Y1 - 2019/06/27/ PY - 2018/11/06/received PY - 2019/04/12/accepted PY - 2019/6/30/pubmed PY - 2020/9/29/medline PY - 2019/6/29/entrez KW - Activities of Daily Living KW - Aged KW - Caregivers KW - Follow-Up Studies KW - Frailty KW - Functional decline KW - Geriatric Assessment KW - Kidney Failure, Chronic KW - Life KW - Logistic Models KW - Prevalence KW - dialysis KW - elderly KW - geriatric nephrology KW - renal dialysis KW - risk factors SP - 1039 EP - 1047 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 14 IS - 7 N2 - BACKGROUND AND OBJECTIVES: Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: This study included participants aged ≥65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. RESULTS: Of the 196 included participants functional data were available for 187 participants. Mean age was 75±7 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. CONCLUSIONS: In patients aged ≥65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/31248948/Association_of_Initiation_of_Maintenance_Dialysis_with_Functional_Status_and_Caregiver_Burden_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=31248948 DB - PRIME DP - Unbound Medicine ER -