Poor functional kidney status among elderly patients with end-stage renal disease was associated with higher odds of central venous catheter use and initiating hemodialysis and was an independent predictor of 1-year mortality, according to research from the University of Cincinnati.
“What this points out is we have to take into account patients’ functional status and pre-dialysis health while initiating elderly patients on dialysis,” Silvi Shah, MD, lead author of the study from the University of Cincinnati, said in a press release from the university. “The information from the present study can influence a health care provider’s decision to initiate dialysis, help counsel patients and families and can facilitate an integrated approach in shared decision-making.”
Researchers conducted a retrospective cohort study of 49,645 patients with end-stage renal disease (ESRD) who initiated dialysis between Jan. 1, 2008 and Dec. 31, 2008. Data for the study was taken from the United States Renal Data System with linked Medicare data that covered at least 2 years prior to initiation of dialysis, according to the study.
Investigators found that at dialysis initiation, 18.7% of patients reported poor functional status, which was defined as inability to ambulate, inability to transfer or requiring assistance with daily activities; 88.9% had at least one pre-dialysis hospitalization; and 27.8% did not receive pre-dialysis nephrology care. Patients with poor functional status had an odds ratio of 1.48 for 1-year mortality. These patients also had an adjusted odds ratio of 1.39 for initiation on hemodialysis vs. peritoneal dialysis and had an odds ratio of 0.79 for central venous catheter use vs. arteriovenous access.
“An average patient who initiates dialysis in the United States is over 65 years of age and has either diabetes or hypertension as a major cause of their kidney disease, along with other comorbid conditions,” Charuhas Thakar, MD, co-author of the study from the University of Cincinnati, said in the release. “The study finds that one out of two patients with poor functional status who initiate dialysis may not make it to the end of their first year. This is a relevant prognostic indicator, given that dialysis patients experience a reduced quality of life and may help in informed choices.”
Shah reports she is supported by a Junior Pilot Faculty Award from University of Cincinnati’s Department of Internal Medicine. Please see the study for all other authors’ relevant financial disclosures.