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Kidney Week

Abstract: FR-PO914

Impact of Poor Functional Status on Outcomes among Elderly Dialysis Patients

Session Information

  • Geriatric Nephrology
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Geriatric Nephrology

  • 901 Geriatric Nephrology

Authors

  • Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background

One-in-four incident end stage renal disease (ESRD) patients are > 75 years of age; and in prevalent trends for ESRD, the highest growth has occurred in those above 75 years. Hospitalizations and comorbidities are common in pre-ESRD patients, and along with age, can contribute to poor functional status at dialysis initiation.

Methods

We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United States Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Poor functional status was defined by any of the three comorbidities listed in form 2728 – inability to ambulate, inability to transfer or need of assistance with daily activities. Using case-mix logistic regression adjusted models (16 variables including pre-ESRD hospitalizations), we examined the impact of poor functional status on type of dialysis modality (hemodialysis [HD] vs. peritoneal dialysis [PD]) and one-year all cause mortality. In a separate model among HD patients, we studied the effect of functional status on type of vascular access (arteriovenous [AV] access vs. catheter).

Results

Of the study cohort, 55% were male. Mean age was 72 ±11 years. At dialysis initiation, 26% were octogenarian, 20% reported poor functional status and 10% had reported nursing home stay. Patients with poor functional status were 10 times more likely have a nursing home stay than those without poor functional status. Only 4% of patients initiated PD. Of those who started HD, 82% initiated with a catheter. Overall, one-year mortality was 31%; it was 48% in patients with poor functional status and 57% in octogenarians with poor functional status. In adjusted analyses, patients with poor functional status were more likely to be started on HD (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.18-1.69); and among those on HD, the odds for starting HD with AV access were lower (OR, 0.78; CI, 0.72-0.85). One-year adjusted mortality was higher in patients with poor functional status (OR, 1.5; CI, 1.42-1.59).

Conclusion

Poor functional status is associated with higher odds of initiating HD than PD; increases the risk of catheter use in those with HD, and is an independent predictor of one-year mortality. Patients with poor functional status, independent of age, should be counseled for shared decision-making and assessed for conservative treatment options.