File
Watanabe T1,2, Kutsuna T1,3, Harada M1,2, Suzuki Y1, Yamamoto S1, Matsunaga Y1, Isobe Y1, Imamura K1, Matsuzawa R4, Kamiya K1, Yoshida A2, Matsunaga A1
1Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan, 2Sagami Circulatory Organ Clinic, Sagamihara, Japan, 3Tokyo University of Technology, Ota, Japan, 4Kitasato University Hospital, Sagamihara, Japan
Background: In Japan, more than half of the patients undergoing maintenance haemodialysis (HD) reportedly have the ability to perform basic activities of daily living (ADL) and instrumental ADL tasks without assistance. However, most patients undergoing HD perceive difficulties in performing ADLs related to mobility. Difficulties in ADL are an early predictor of loss of independence and mortality in older community-dwelling people. However, very few studies have examined the association between ADL difficulties and mortality risk in patients undergoing HD.
Purpose: This study aimed to prospectively assess the association between ADL difficulties and mortality in patients undergoing HD.
Methods: A total of 300 outpatients (178 men, 122 women; mean age, 64.1±10.9 years) undergoing maintenance HD therapy 3 times a week at a HD centre were recruited in this study. Patients were excluded in case of hospitalization ≤ 3 months prior to study enrolment, presence of uncontrolled cardiac arrhythmias, severe disdialysis syndrome, critical limb ischemia, need for walking assistance, and presence of any other conditions that limited walking (e.g., dementia, low vision or blindness, paralysis due to stroke, and leg amputation). Clinical characteristics, including age, sex, body mass index, primary cause of end-stage renal disease, time of HD, comorbid conditions, and haemoglobin and serum albumin levels were documented at baseline. ADL difficulties were assessed with the questionnaire on perceived mobility difficulty for patients undergoing HD (Kutsuna et al., 2011; Watanabe et al., 2018). This questionnaire comprises 12 items divided into the following 3 categories obtained by factor analysis: “basic ADL”, “ambulation”, and “walking up or down stairs”. Patients were asked to rate perceived difficulty in performing these items on a scale of 1 to 5 (1, not possible; 2, severe difficulty; 3, moderate difficulty; 4, mild difficulty; and 5, ease). The ADL difficulty score ranged from 12 to 60 points, with lower scores indicating greater ADL difficulties. Baseline patient characteristics and ADL difficulty were compared between survivors and non-survivors using unpaired t-test or chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to determine the area under the curve and cut-off values of ADL difficulty scores for predicting all-cause mortality. Cut-off values were determined according to the maximum Youden index. Patients were categorized into two ADL difficulty groups by cut-off values, and differences in the survival curves between the groups were tested using a log-rank test.
Results: During the follow-up period (median, 50 months), 71 patients died. The areas under the ROC curves of ADL difficulty scores for predicting all-cause mortality was 0.69. Cut-off value of ADL difficulty for predicting all-cause mortality was 43 points. The survival rates were 87.7% in the group of ≤43 points of ADL difficulty score and 62.8% in the group of >43 points (log rank test, P 0.01).
Conclusion(s): This study showed that ADL difficulties were strongly associated with survival in patients undergoing HD. In addition, the cut-off value of 43 points for ADL difficulty score predicted all-cause mortality in clinically-stable patients undergoing HD.
Implications: This study provides useful data for planning physical therapy regimens for patients undergoing HD.
Keywords: Activities of daily living (ADL) difficulty, Haemodialysis, Mortality
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Numbers 23500614 and 26350631.
Purpose: This study aimed to prospectively assess the association between ADL difficulties and mortality in patients undergoing HD.
Methods: A total of 300 outpatients (178 men, 122 women; mean age, 64.1±10.9 years) undergoing maintenance HD therapy 3 times a week at a HD centre were recruited in this study. Patients were excluded in case of hospitalization ≤ 3 months prior to study enrolment, presence of uncontrolled cardiac arrhythmias, severe disdialysis syndrome, critical limb ischemia, need for walking assistance, and presence of any other conditions that limited walking (e.g., dementia, low vision or blindness, paralysis due to stroke, and leg amputation). Clinical characteristics, including age, sex, body mass index, primary cause of end-stage renal disease, time of HD, comorbid conditions, and haemoglobin and serum albumin levels were documented at baseline. ADL difficulties were assessed with the questionnaire on perceived mobility difficulty for patients undergoing HD (Kutsuna et al., 2011; Watanabe et al., 2018). This questionnaire comprises 12 items divided into the following 3 categories obtained by factor analysis: “basic ADL”, “ambulation”, and “walking up or down stairs”. Patients were asked to rate perceived difficulty in performing these items on a scale of 1 to 5 (1, not possible; 2, severe difficulty; 3, moderate difficulty; 4, mild difficulty; and 5, ease). The ADL difficulty score ranged from 12 to 60 points, with lower scores indicating greater ADL difficulties. Baseline patient characteristics and ADL difficulty were compared between survivors and non-survivors using unpaired t-test or chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to determine the area under the curve and cut-off values of ADL difficulty scores for predicting all-cause mortality. Cut-off values were determined according to the maximum Youden index. Patients were categorized into two ADL difficulty groups by cut-off values, and differences in the survival curves between the groups were tested using a log-rank test.
Results: During the follow-up period (median, 50 months), 71 patients died. The areas under the ROC curves of ADL difficulty scores for predicting all-cause mortality was 0.69. Cut-off value of ADL difficulty for predicting all-cause mortality was 43 points. The survival rates were 87.7% in the group of ≤43 points of ADL difficulty score and 62.8% in the group of >43 points (log rank test, P 0.01).
Conclusion(s): This study showed that ADL difficulties were strongly associated with survival in patients undergoing HD. In addition, the cut-off value of 43 points for ADL difficulty score predicted all-cause mortality in clinically-stable patients undergoing HD.
Implications: This study provides useful data for planning physical therapy regimens for patients undergoing HD.
Keywords: Activities of daily living (ADL) difficulty, Haemodialysis, Mortality
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Numbers 23500614 and 26350631.
Topic: Professional practice: other
Ethics approval required: Yes
Institution: Kitasato University
Ethics committee: Ethics Committee of Kitasato University School of Allied Health Sciences
Ethics number: 2015-033
All authors, affiliations and abstracts have been published as submitted.
