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Multicenter Study
. 2019 Jul 5;14(7):1039-1047.
doi: 10.2215/CJN.13131118. Epub 2019 Jun 27.

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Namiko A Goto  1   2 , Ismay N van Loon  1   3 , Franciscus T J Boereboom  1   4 , Marielle H Emmelot-Vonk  2 , Hanna C Willems  5 , Michiel L Bots  6 , Laila E Gamadia  7 , Eric F H van Bommel  8 , Peter J G Van de Ven  9 , Caroline E Douma  10 , Hieronymus H Vincent  11 , Yvonne C Schrama  12 , Joy Lips  13 , Ellen K Hoogeveen  14 , Machiel A Siezenga  15 , Alferso C Abrahams  3 , Marianne C Verhaar  3 , Marije E Hamaker  16
Affiliations
Multicenter Study

Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Namiko A Goto et al. Clin J Am Soc Nephrol. .

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.

Keywords: Activities of Daily Living; Aged; Caregivers; Follow-Up Studies; Frailty; Functional decline; Geriatric Assessment; Kidney Failure, Chronic; Life; Logistic Models; Prevalence; dialysis; elderly; geriatric nephrology; renal dialysis; risk factors.

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Figures

None
Graphical abstract
Figure 1.
Figure 1.
Change in functional status over 6 months from dialysis initiation as defined by changes in ADL, IADL, or both (functional status). Outcome in functional status is defined as the difference in number of dependencies (ADL and IADL combined) between baseline and follow-up. All outcomes were categorized in improvement (score ≥+1), stable (score of 0), decline (score ≤−1), and death.
Figure 2.
Figure 2.
Change in functional status over 6 months from dialysis initiation according to baseline age and functional dependence.
See this image and copyright information in PMC

Comment in

  • Functioning on Dialysis: An Oxymoron?
    Abel DL. Abel DL. Clin J Am Soc Nephrol. 2019 Jul 5;14(7):963-964. doi: 10.2215/CJN.05870519. Epub 2019 Jun 27. Clin J Am Soc Nephrol. 2019. PMID: 31248949 Free PMC article. No abstract available.

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