Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

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• 作者：S. Vanita Jassal ; MSc ; MB ; BChir ; MD¹ ; Angelo Karaboyas ; MS² ; Leah A. Comment ; MPH ; MS² ; ³ ; Brian A. Bieber ; MPH ; MS² ; Hal Morgenstern ; PhD⁴ ; ⁵ ; ⁶ ; Ananda Sen ; PhD³ ; Brenda W. Gillespie ; PhD² ; ³ ; Patricia De Sequera ; MD⁷ ; Mark R. Marshall ; MD⁸ ; ⁹ ; ¹⁰ ; Shunichi Fukuhara ; MD ; MS ; DMS¹¹ ; ¹² ; Bruce M. Robinson ; MD ; MS² ; ³ ; Ronald L. Pisoni ; PhD ; MS² ; Francesca Tentori ; MD ; MS² ; ¹³ ; ^{francesca.tentori@arborresearch.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Chronic kidney disease (CKD) ; functional dependence ; activity of daily living (ADL) ; functional status ; dialysis ; hospitalization ; independence ; morbidity ; mortality ; physical activity ; quality of life (QoL) ; end-stage renal disease (ESRD) ; Dialysis Outcomes and Practice Patterns Study (DOPPS)
• 刊名：American Journal of Kidney Diseases
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：67
• 期：2
• 页码：283-292
• 全文大小：451 K

文摘

Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients.

Study Design

Prospective cohort study.

Setting & Participants

7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status.

Predictor

Patients’ ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]).

Outcome

Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months.

Results

The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status < 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status < 8.

Limitations

Possible nonresponse bias and residual confounding.

Conclusions

We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality.