Top

BMC Nephrology

Published in:

Open Access 01-12-2018 | Research article

Functional status, pre-dialysis health and clinical outcomes among elderly dialysis patients

Authors: Silvi Shah, Anthony C. Leonard, Charuhas V. Thakar

Published in: BMC Nephrology | Issue 1/2018

Abstract

Background

Elderly patients comprise the fastest growing population initiating dialysis in United States. The impact of poor functional status and pre-dialysis health status on clinical outcomes in elderly dialysis patients is not well studied.

Methods

We studied a retrospective cohort of 49,645 incident end stage renal disease patients that initiated dialysis between January 1, 2008 and December 31, 2008 from the United States Renal Data System with linked Medicare data covering at least 2 years prior to dialysis initiation. Using logistic regression models adjusted for pre-dialysis health status and other cofounders, we examined the impact of poor functional status as defined from form 2728 on 1-year all-cause mortality as primary outcome, type of dialysis modality (hemodialysis vs. peritoneal dialysis), and type of initial vascular access (arteriovenous access vs. central venous catheter) among hemodialysis patients as secondary outcomes.

Results

Mean age was 72 ± 11 years. At dialysis initiation, 18.7% reported poor functional status, 88.9% had at least 1 pre-dialysis hospitalization, and 27.8% did not receive pre-dialysis nephrology care. In adjusted analyses, 1-year mortality was higher in patients with poor functional status (OR, 1.48; 95% CI, 1.40–1.57). Adjusted odds of being initiated on hemodialysis than peritoneal dialysis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.16–1.66) were higher in patients with poor functional status. Poor functional status decreased the adjusted odds of starting hemodialysis with arteriovenous access as compared to central venous catheter (OR, 0.79; 95% CI, 0.72–0.86).

Conclusion

Poor functional status in elderly patients with end stage renal disease is associated with higher odds of initiating hemodialysis; increases the risk of central venous catheter use, and is an independent predictor of 1-year mortality.

Available only for authorised users

U.S. Renal Data System. Researcher’s guide to the USRDS database, vol. 2015. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2015.

Noordzij M, Jager KJ. Increased mortality early after dialysis initiation: a universal phenomenon. Kidney Int. 2014;85(1):12–4.CrossRefPubMed

Soucie JM, McClellan WM. Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am Soc Nephrol. 1996;7(10):2169–75.PubMed

Thamer M, Kaufman JS, Zhang Y, Zhang Q, Cotter DJ, Bang H. Predicting early death among elderly Dialysis patients: development and validation of a risk score to assist shared decision making for Dialysis initiation. Am J Kidney Dis. 2015;66(6):1024–32.CrossRefPubMedPubMedCentral

Bao Y, Dalrymple L, Chertow GM, Kaysen GA, Johansen KL. Frailty, dialysis initiation, and mortality in end-stage renal disease. Arch Intern Med. 2012;172(14):1071–7.CrossRefPubMedPubMedCentral

Kurella Tamura M, Covinsky KE, Chertow GM, Yaffe K, Landefeld CS, McCulloch CE. Functional status of elderly adults before and after initiation of dialysis. N Engl J Med. 2009;361(16):1539–47.CrossRefPubMed

Leidy NK. Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework. Nurs Res. 1994;43(4):196–202.CrossRefPubMed

Ritchie JP, Alderson H, Green D, Chiu D, Sinha S, Middleton R, O'Donoghue D, Kalra PA. Functional status and mortality in chronic kidney disease: results from a prospective observational study. Nephron Clin Pract. 2014;128(1–2):22–8.CrossRefPubMed

Fraser SD, Roderick PJ, May CR, McIntyre N, McIntyre C, Fluck RJ, Shardlow A, Taal MW. The burden of comorbidity in people with chronic kidney disease stage 3: a cohort study. BMC Nephrol. 2015;16:193.CrossRefPubMedPubMedCentral

10.

United States Renal Data System. USRDS annual data report: epidemiology of kidney disease in the United States. Bethesda, MD: National Institutes of Health National Institute of Diabetes and Digestive and Kidney Disease; 2016.

11.

Daratha KB, Short RA, Corbett CF, Ring ME, Alicic R, Choka R, Tuttle KR. Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol. 2012;7(3):409–16.CrossRefPubMed

12.

Crews DC, Scialla JJ, Liu J, Guo H, Bandeen-Roche K, Ephraim PL, Jaar BG, Sozio SM, Miskulin DC, Tangri N, et al. Predialysis health, dialysis timing, and outcomes among older United States adults. J Am Soc Nephrol. 2014;25(2):370–9.CrossRefPubMed

13.

Kausz AT, Obrador GT, Arora P, Ruthazer R, Levey AS, Pereira BJ. Late initiation of dialysis among women and ethnic minorities in the United States. J Am Soc Nephrol. 2000;11(12):2351–7.PubMed

14.

Cook WL, Jassal SV. Functional dependencies among the elderly on hemodialysis. Kidney Int. 2008;73(11):1289–95.CrossRefPubMed

15.

Yazawa M, Kido R, Ohira S, Hasegawa T, Hanafusa N, Iseki K, Tsubakihara Y, Shibagaki Y. Early mortality was highly and strongly associated with functional status in incident Japanese hemodialysis patients: a cohort study of the large National Dialysis Registry. PLoS One. 2016;11(6):e0156951.CrossRefPubMedPubMedCentral

16.

Foote C, Ninomiya T, Gallagher M, Perkovic V, Cass A, McDonald SP, Jardine M. Survival of elderly dialysis patients is predicted by both patient and practice characteristics. Nephrol Dial Transplant. 2012;27(9):3581–7.CrossRefPubMed

17.

Baek SH, Ahn S, Lee SW, Park YS, Kim S, Na KY, Chae DW, Kim S, Chin HJ. Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis. PLoS One. 2015;10(6):e0128715.CrossRefPubMedPubMedCentral

18.

Schwenger V, Morath C, Hofmann A, Hoffmann O, Zeier M, Ritz E. Late referral--a major cause of poor outcome in the very elderly dialysis patient. Nephrol Dial Transplant. 2006;21(4):962–7.CrossRefPubMed

19.

Pugh J, Aggett J, Goodland A, Prichard A, Thomas N, Donovan K, Roberts G. Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education. Clin Kidney J. 2016;9(2):324–9.CrossRefPubMedPubMedCentral

20.

Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F, Phibbs C, Courtney D, Lyles KW, May C, et al. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002;346(12):905–12.CrossRefPubMed

21.

Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005;67(6):2462–9.CrossRefPubMed

22.

Ocak G, Halbesma N, le Cessie S, Hoogeveen EK, van Dijk S, Kooman J, Dekker FW, Krediet RT, Boeschoten EW, Verduijn M. Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients. Nephrol Dial Transplant. 2011;26(8):2611–7.CrossRefPubMed

23.

Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis. 2003;42(5):1013–9.CrossRefPubMed

24.

Lamping DL, Constantinovici N, Roderick P, Normand C, Henderson L, Harris S, Brown E, Gruen R, Victor C. Clinical outcomes, quality of life, and costs in the North Thames Dialysis study of elderly people on dialysis: a prospective cohort study. Lancet (London, England). 2000;356(9241):1543–50.CrossRef

25.

Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, Da Silva-Gane M, Beckett N, Hickson M. Broadening options for long-term Dialysis in the elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients. Nephrol Dial Transplant. 2010;25(11):3755–63.CrossRefPubMedPubMedCentral

26.

Berger JR, Hedayati SS. Renal replacement therapy in the elderly population. Clin J Am Soc Nephrol. 2012;7(6):1039–46.CrossRefPubMedPubMedCentral

Title: Functional status, pre-dialysis health and clinical outcomes among elderly dialysis patients
Authors: Silvi Shah
Anthony C. Leonard
Charuhas V. Thakar
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2018
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-018-0898-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Functional status, pre-dialysis health and clinical outcomes among elderly dialysis patients

Abstract

Background

Methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

End-stage renal disease treated in Provence-Alpes Côte d’Azur: 12-years follow-up and forecast to the year 2030

Fructose increases risk for kidney stones: potential role in metabolic syndrome and heat stress

Incidence, aetiology and outcomes of obstetric-related acute kidney injury in Malawi: a prospective observational study

The lived experiences of patients undergoing hemodialysis with the concept of care: a phenomenological study

Transport of neutral IgG2 versus anionic IgG4 in PD: implications on the electrokinetic model

Body weight definitions for evaluating a urinary diagnosis of acute kidney injury in patients with sepsis

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page