ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: SA-PO723

Functional Decline and Associated Risk Factors in a Survivor Cohort of Older Dialysis Patients

Session Information

  • Geriatric Nephrology
    October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Hall, Rasheeda K., Duke University, Durham, North Carolina, United States
  • Luciano, Alison, Duke University, Durham, North Carolina, United States
  • Pendergast, Jane F., Duke University, Durham, North Carolina, United States
  • Colon-emeric, Cathleen, Duke University, Durham, North Carolina, United States
Background

At least 50% of older adults undergo functional decline or die within the first 6 months of dialysis. Little is known about functional decline in older adults who survive the first 6 months of dialysis. We sought to identify risk factors for functional decline, as measured by Short Form-12 physical component score (SF-12 PCS) change, in a survivor cohort of older dialysis patients.

Methods

We conducted a retrospective study of 3,284 adults aged ≥ 65 years with ≥ 6 months of hemodialysis and complete SF-12s in 2012 and 2013. We calculated PCS change as second minus first PCS for individuals with PCSs ≥ 300 days apart. Using a multivariable linear regression, we modeled PCS change and adjusted for baseline age, gender, race, Medicaid status, access type, Kt/V, albumin, hemoglobin, time on dialysis, Charlson index, hospitalization rate, and days between PCSs. In post hoc analysis, we compared individuals in categories: clinically relevant (CR) PCS decline or increase (PCS change > 3) and no CR change.

Results

Of 3,284, 801 (24.4%) died and an additional 1,112 (33.9%) did not have 2 PCSs ≥ 300 days apart. Our analytic cohort included the remaining 1,371 (41.7%) who had 2 PCSs ≥ 300 days apart (mean 399 ± 74 days), mean time on dialysis 6.1 ± 3.1 years, and mean PCS change -0.9 ± 9.6. Cohort members with time on dialysis < 5 years had significant but modestly smaller decline in PCS compared to those with ≥ 5 years (p=0.03) (Table), but the regression did not reveal any significant associations between patient characteristics and PCS change. The proportion with CR PCS decline, increase, or no CR change were 39.3% (n=539), 32.2% (n=442), and 28.4% (n=390), respectively. Mean hospitalization rate was highest among those with CR PCS decline (2.0 ± 3.7) compared to those with CR increase (1.7± 3.5) or no CR change (1.4 ± 2.6) (p<0.05).

Conclusion

In this survivor cohort, nearly 25% died and 40% of those who did not die had CR PCS decline within 2 years. Although age, race, time on dialysis, and access type were not associated with SF-12 PCS change, one potential risk factor for CR PCS decline is recurrent hospitalizations.

Mean Time on Dialysis and Relation to SF-12 PCS Change
 Time on Dialysis (years)SF-12 PCS Change
Time on Dialysis < 5 Years (46%, n=628)3.9 ± 0.7-0.3 ± 9.5
Time on Dialysis ≥ 5 Years (54%, n=743)7.9 ± 3.1-1.5 ± 9.7

(Mean ± SD)

Funding

  • Other NIH Support