Common tool may not predict physical function decline in older patients on dialysis
Annual change in the short-form health survey physical component score may not be the most accurate means of monitoring physical function change among older patients on hemodialysis, according to this study.
Despite prior investigations that have shown the short-form health survey-12 physical component score (SF-12 PCS) to be reliable in identifying mortality risk among this patient population, Rasheeda K. Hall, MD, MBA, MHSc, of Duke University Medical Center, and colleagues argued that it remains unknown “whether SF-12 PCS change is a clinically useful means of monitoring functional status change.”
They added that it is also unclear as to whether SF-12 PCS change is associated with modifiable or “immutable” risk factors that are associated with survival in patients with end-stage kidney disease, providing examples of hypoalbuminemia and hemodialysis access type for the former and age, race or time on dialysis for the latter.
“Toward an ultimate goal of improving both practical application of the SF-12 PCS and identifying potentially modifiable risk factors for declining functional status in older adults receiving dialysis, we sought to describe the extent of functional decline or improvement over a year, as measured using SF-12 PCS change; identify associated risk factors; and describe the extent that SF-12 PCS change is associated with subsequent mortality in a survivor cohort of older adults receiving hemodialysis,” Hall and colleagues wrote.
For the study, the researchers included 1,371 patients who were 65 years or older and who had received hemodialysis for 6 months or more. Researchers determined annual SF-12 PCS change, considering physical functioning, bodily pain, role limitations due to impaired physical health and general health, as well as mortality (801 died, with the researchers noting survivors had fewer central venous catheters and hospitalizations and higher mean baseline SF-12 PCSs).
They found that although average SF-12 PCS change in 1 year was “minimal” (0.9), 39.3% and 32.2% of the cohort had clinically relevant SF-12 PCS decline and improvement, respectively. Further findings suggested albumin level and access type were not statistically associated with SF-12 PCS change and that SF-12 PCS change was not associated with mortality (adjusted HR = 0.98).
According to the researchers, this study indicates that the SF-12 PCS might not be the best tool to capture the “wide range” of patients who could be at high risk for functional decline, writing that “SF-12 PCS change is less informative in an older segment of the dialysis population, particularly if patients have already adapted to low physical function or activity.”
They recommend using objective physical performance measures (such as timed up-and- go, gait speed and chair stand tests) to obtain more accurate measures of functional decline as these methods “can identify subtle changes in physical function before identified by self-report.”
“Further research is needed to identify the best tool(s) and appropriate frequency for assessing functional status changes in older adults receiving dialysis,” the researchers concluded. – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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Hall RK, et al. Kidney Med. 2020;doi:10.1016/j.xkme.2019.08.001.
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