Researchers examine impact of poor functional kidney status

May 14, 2018, University of Cincinnati Academic Health Center
Picture of Charuhas Thakar, M.D., professor and director of the Kidney CARE program and Silvi Shah M.D., assistant professor in the Division of Nephrology, both at the University of Cincinnati College of Medicine. Credit: Colleen Kelley

A study by researchers at the University of Cincinnati (UC) finds poor functional kidney status in elderly patients with end stage renal disease (ESRD) is associated with a higher incidence of initiating hemodialysis, increased the risk of central venous catheter use and is an independent predictor of one-year mortality. The study was published in the April 27, 2018 edition of BMC Nephrology.

The article, "Functional Status, Pre-Dialysis Health and Clinical Outcomes Among Elderly Dialysis Patients," describes research conducted by Silvi Shah, MD, assistant professor, and Charuhas Thakar, MD, professor and director of the Division of Nephrology, Kidney CARE (Clinical Advancement, Research and Education) Program in the UC College of Medicine, and Anthony Leonard, Ph.D., research associate professor in the Department of Family and Community Medicine.

Researchers studied nearly 50,000 adult ESRD patients who started hemodialysis or between Jan. 1 and Dec. 31, 2008 using data from the United States Renal Data System (USRDS), with linked Medicare data covering at least two years prior to dialysis initiation. A major predictor was poor functional status defined by any of the three co-morbid conditions as specified in Department of Health and Human Services Centers for Medicare and Medicaid Services form 2728—(1) inability to ambulate, (2) inability to transfer or (3) need of assistance with daily activities. Shah says they discovered that who have poor functional status have an increased one-year mortality by 48 percent.

Elderly chronic kidney disease patients, meaning those over the age of 60, represent the fastest growing segment of the ESRD patients in the United States. The annual mortality in ESRD patients is roughly 20 percent, and is higher in the first few months after starting on dialysis. Shah says even though early mortality is a significant problem among elderly ESRD patients, it remains underrecognized.

"What this points out is we have to take into account patients' functional status and pre-dialysis health while initiating elderly patients on dialysis," says Shah, the principal investigator of the study. "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."

Shah says one of the unique aspects of the study was linking the USRDS database to Medicare claims to determine the pre-dialysis health of incident ESRD patients.

"In the present study, we examined the impact of poor functional status on key clinical outcomes in elderly patients who get initiated on dialysis, after taking into account their pre-dialysis health including pre-dialysis acute hospitalizations, pre-dialysis nephrology care, history of nursing home stays, laboratory data and comorbidities," says Shah.

A secondary outcome examined in the study was the presence of vascular access for dialysis initiation. Shah says it is well known that arteriovenous access is preferred to a central venous catheter. Patients with poor functional status had 21 percent lower odds of initiating hemodialysis with arteriovenous access. Additionally, elderly patients with poor functional status had 39 percent higher odds of being started on hemodialysis as compared to peritoneal dialysis.

"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," says Thakar. "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 very relevant prognostic indicator, given that patients experience a reduced quality of life, and may help in informed choices.

"On the other hand, it provides hope that aggressive efforts to improve functional status in potentially reversible situations may allow better outcomes in these ."

Explore further: Researchers examine racial and gender disparities in dialysis patients

Related Stories

Researchers examine racial and gender disparities in dialysis patients

November 3, 2017
University of Cincinnati (UC) researchers are examining racial and gender disparities in dialysis patients as well as the impact of poor functional status and pre-dialysis hospitalizations on elderly dialysis patients. Silvi ...

Increase in employment among patients starting dialysis

January 19, 2018
(HealthDay)—The probability of employment has increased in recent years among patients initiating dialysis but is still low, according to a study published online Jan. 18 in the Clinical Journal of the American Society ...

Dialysis of little benefit to elderly end-stage renal disease patients

March 21, 2016
(HealthDay)—Dialysis does not significantly improve survival for elderly patients with end-stage renal disease (ESRD), according to research published online March 17 in the Clinical Journal of the American Society of Nephrology.

High burden, high cost and low awareness of kidney disease in the United States

October 30, 2017
According to an annual data report from the United State Renal Data System, the overall burden of kidney disease remains high in U.S. with the rates of kidney failure requiring dialysis or kidney transplantation ranking among ...

Post-RFA mortality up for ESRD patients who receive dialysis

March 20, 2017
(HealthDay)—For patients with end-stage renal disease (ESRD), receipt of hemodialysis (HD) is associated with increased mortality after radiofrequency ablation (RFA) for hepatocellular carcinoma, according to a study published ...

Telemedicine program provides life-saving kidney care to patients in rural areas

November 17, 2016
Although dialysis rates are similar in urban and rural areas, most remote rural counties in the United States lack in-county dialysis facilities. Of all the community hospitals in the country, only 38% are designated as rural ...

Recommended for you

Lung-on-a-chip simulates pulmonary fibrosis

May 25, 2018
Developing new medicines to treat pulmonary fibrosis, one of the most common and serious forms of lung disease, is not easy.

Reconstructing Zika's spread

May 24, 2018
The urgent threat from Zika virus, which dominated news headlines in the spring and summer of 2016, has passed for now. But research into how Zika and other mosquito-borne infections spread and cause epidemics is still very ...

Tick bite protection: New CDC study adds to the promise of permethrin-treated clothing

May 24, 2018
The case for permethrin-treated clothing to prevent tick bites keeps getting stronger.

Molecular network boosts drug resistance and virulence in hospital-acquired bacterium

May 24, 2018
In response to antibiotics, a gene regulation network found in the bacterium Acinetobacter baumannii acts to boost both virulence and antibiotic resistance. Edward Geisinger of Tufts University School of Medicine and colleagues ...

Past use of disinfectants and PPE for Ebola could inform future outbreaks

May 24, 2018
Data from the 2014 Ebola virus outbreak at two Sierra Leone facilities reveal daily usage rates for disinfectant and personal protective equipment, informing future outbreaks, according to a study published May 24, 2018 in ...

Early lactate measurements appear to improve results for septic patients

May 24, 2018
On October 1, 2015, the United States Centers for Medicare and Medicaid Services (CMS) issued a bundle of recommendations defining optimal treatment of patients suffering from sepsis, a life-threatening response to infection ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.