Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)
| Autor: | Brian Bieber, Mark R. Marshall, Brenda W. Gillespie, Bruce M. Robinson, Francesca Tentori, Ronald L. Pisoni, Leah Andrews Comment, Angelo Karaboyas, Patricia de Sequera, Hal Morgenstern, S. Vanita Jassal, Shunichi Fukuhara, Ananda Sen |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Activities of daily living Internationality medicine.medical_treatment 030232 urology & nephrology independence physical activity Chronic kidney disease (CKD) morbidity 030204 cardiovascular system & hematology functional dependence functional status Article Cachexia Cohort Studies 03 medical and health sciences 0302 clinical medicine quality of life (QoL) Renal Dialysis Internal medicine Activities of Daily Living medicine Humans Non-response bias Prospective Studies Mortality Intensive care medicine Prospective cohort study Dialysis Aged Aged 80 and over business.industry Proportional hazards model Confounding Middle Aged medicine.disease Dialysis Outcomes and Practice Patterns Study (DOPPS) Treatment Outcome Nephrology end-stage renal disease (ESRD) activity of daily living (ADL) dialysis Female Hemodialysis business hospitalization Follow-Up Studies |
| Zdroj: | Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid |
| Popis: | Patients receiving long-term dialysis have among the highest mortality and hospitalization rates. In the nonrenal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of kidney function has been observed in several studies, suggesting that functional dependence may contribute to both morbidity and mortality in dialysis patients.Prospective cohort study.7,226 hemodialysis patients from 12 countries in the DOPPS (Dialysis Outcomes and Practice Patterns Study) phase 4 (2009-2011) with self-reported data for functional status.Patients' ability to perform 13 basic and instrumental activities of daily living was summarized to create an overall functional status score (range, 1.25 [most dependent] to 13 [functionally independent]).Cox regression was used to estimate the association between functional status and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months.The proportion of patients who could perform each activity of daily living task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (functional status = 13), and 14% of patients had high functional dependence (functional status 8). Functionally independent patients were younger and had many indicators of better health status, including higher quality of life. Compared with functionally independent patients, the adjusted HR for mortality was 2.37 (95% CI, 1.92-2.94) for patients with functional status 8.Possible nonresponse bias and residual confounding.We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia, and multimorbidity, functional dependence was a strong consistent predictor of mortality. |
| Databáze: | OpenAIRE |
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