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Functional status commonly declines within 6 months of starting dialysis
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Forty percent of older patients with ESKD experienced functional decline within 6 months after initiating dialysis, according to a recently published study. Researchers also observed an increase in caregiver burden concurrent with the initiation.
“Elderly patients are a very heterogeneous group with a high prevalence of comorbidity and geriatric problems,” Namiko A. Goto, MD, PhD-student and resident in geriatric medicine at Dianet Dialysis Center and University Medical Center Utrecht in the Netherlands, and colleagues wrote. “One of these problems is functional dependence. This can be defined as the loss of the ability to carry out activities essential to independent living. Therefore, it is important to understand the impact the initiation of dialysis has on the course of functional status. Moreover, it is important to try to predict in which patients functional status will improve after initiating dialysis (assumed through improvement in uremic complaints) and in which it will decline (due to burden of dialysis therapy).”
To assess the effects of dialysis initiation on functional status and caregiver burden, researchers conducted a prospective multicenter cohort study of 187 adults aged 65 years or older who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study (mean age, 75 years; 33% women; 77% on hemodialysis; 23% on PD). At the time of dialysis initiation, all participants underwent a geriatric assessment and a frailty screening.
Researchers assessed functional status at baseline and again at 6 months.
Functional status was scored based on the ability to carry out activities necessary to independent living, related both to self-care (eg, bathing, dressing and continence) and to community living (eg, shopping, housecleaning and telephone use).
Caregiver burden, also measured at baseline and 6 months, was determined through completion of questionnaires.
Researchers found that, at baseline, 21% of participants were independent in functional status, 52% were mildly/moderately dependent and 27% were severely dependent.
Severely dependent participants had more symptoms of depression, more impaired mobility and more frailty.
At 6 months, researchers found that 8% of the study population had died.
Of those living, 40% experienced decline in functional status, 34% were stable and 18% had improved.
Finally, researchers observed that the frequency of high caregiver burden increased from 23% at baseline to 38% at 6 months after dialysis initiation.
"It is important that healthcare providers inform elderly patients about the risk of functional decline when starting dialysis," Goto told Healio/Nephrology. "This, in combination with knowledge about frailty and the individual’s health-related goals (such as remaining independent or engaging in social activities), may help in the discussion about whether to start dialysis. Further research should focus on improving the identification of patients at risk for functional decline and interventions that could maintain functional status. Furthermore, additional knowledge on caregiver experience (eg, modifiable risk factors for burden) would be helpful to reduce and prevent caregiver burden."
In an accompanying patient-voice editorial, entitled “Functioning on Dialysis: An Oxymoron?”, Daniel L. Abel wrote, “Kidney disease may jeopardize our functional status and place burden on our caregivers, but it does not take away our birthday or make us less entitled to choices about our care. Old or young, frail or strong, the physical ramifications of our lives on dialysis can be devastating and life-changing in ways that are unique and individual. We depend on our medical team to recognize and respect these differences and, when we aren’t wearing our agony on our sleeve, insight and kindness go a long way.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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