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