Abstract: FR-PO537
Decline in Functional Status and Mortality in Patients on Hemodialysis: Results from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS)
Session Information
- Physical Activity, Body Composition, Metabolism: Clinical
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Health Maintenance, Nutrition, and Metabolism
- 1302 Health Maintenance, Nutrition, and Metabolism: Clinical
Authors
- Matsuzawa, Ryota, Kitasato University Hospital, Sagamihara, Japan
- Kamitani, Tsukasa, Kyoto university, Kyoto, Japan
- Roshanravan, Baback, University of Washington - Kidney Research Institute, Seattle, Washington, United States
- Fukuma, Shingo, Kyoto University, Kyoto, Japan
- Joki, Nobuhiko, TOHO University Ohashi Medical Center, Tokyo, Japan
- Fukagawa, Masafumi, Tokai University School of Medicine, Isehara, KANAGAWA, Japan
Group or Team Name
- J-CLIP
Background
Poor functional status — the limitation in activities of daily living (ADL) — is strongly associated with adverse clinical outcomes among end-stage renal disease (ESRD) patients treated with hemodialysis (HD). Little is known in regard to the association of change in functional status and adverse clinical outcomes in this population. The current investigation tests the association of decline in functional status with all-cause mortality among HD patients using data from the Japan Dialysis Outcome and Practice Patterns Study (J-DOPPS).
Methods
We studied 817 ESRD patients on HD with repeat measures of functional status enrolled in the J-DOPPS. Information on age, sex, body mass index, smoke, dialysis vintage, comorbidities and laboratory data was collected. The assessments of functional status were conducted twice over a one-year baseline period (2012-2013), and functional status score was calculated based on Katz index and Lawton-Brody instrumental ADL scale. We classified patients into 2 groups based on having or not at least 1 point declined in functional status score during the baseline period. A Cox regression analysis was conducted to evaluate the association between the decline in functional status and the all-cause mortality during the follow-up period (2013-2015) with adjustment for potential confounders.
Results
Over this period, 163 (20.0%) patients showed decline in functional status score, and 44 (5.4%) patients died. Using Cox regression analysis adjusting for potential confounders including baseline functional status, the declined in functional status score was significantly associated with higher mortality (adjusted hazard ratio, 2.68; 95% confidence interval, 1.31-5.50).
Conclusion
Decline in functional status was strongly associated with mortality among patients treated with HD. These findings underscore the importance of interventions directed at preventing deterioration in functional status over time among HD patients.
Association between decline in functional status score and all-cause mortality
| All-cause mortality | |||
| N | Incidence rate (per 100 person years) | Adjusted HR (95%CI) | |
| Functional status score | |||
| not declined | 654 | 2.2 | Reference |
| declined | 163 | 7.0 | 2.68 (1.31 – 5.50) |
HR: hazard ratio; CI: confidence interval.
Funding
- NIDDK Support – Kyowa Hakko Kirin