Association of Initiation of Maintenance Dialysis with Functional Status and Caregiver Burden

Abstract

Background and objectives Little is known about the functional course after initiating dialysis in elderly patients with ESKD. The aim of this study was to assess the association of the initiation of dialysis in an elderly population with functional status and caregiver burden. Design, setting, participants & measurements This study included participants aged $65 years with ESKD who were enrolled in the Geriatric Assessment in Older Patients Starting Dialysis study. All underwent a geriatric assessment and a frailty screening (Fried Frailty Index and Groningen Frailty Indicator) at dialysis initiation. Functional status (activities of daily life and instrumental activities of daily life) and caregiver burden were assessed at baseline and after 6 months. Decline was defined as loss of one or more domains in functional status, stable as no difference between baseline and follow-up, and improvement as gain of one or more domains in functional status. Logistic regression was performed to assess the association between the combined outcome functional decline/death and potential risk factors. Results Of the 196 included participants functional data were available for 187 participants. Mean age was 7567 years and 33% were women. At the start of dialysis, 79% were care dependent in functional status. After 6 months, 40% experienced a decline in functional status, 34% remained stable, 18% improved, and 8% died. The prevalence of high caregiver burden increased from 23%-38% (P=0.004). In the multivariable analysis age (odds ratio, 1.05; 95% confidence interval, 1.00 to 1.10 per year older at baseline) and a high Groningen Frailty Indicator compared with low score (odds ratio, 1.97; 95% confidence interval, 1.05 to 3.68) were associated with functional decline/death. Conclusions In patients aged $65 years, functional decline within the first 6 months after initiating dialysis is highly prevalent. The risk is higher in older and frail patients. Loss in functional status was mainly driven by decline in instrumental activities of daily life. Moreover, initiation of dialysis is accompanied by an increase in caregiver burden.

Trends in assisted peritoneal dialysis over the last decade: a cohort study from the French Peritoneal Dialysis Registry

“…It has recently been shown that a high proportion of patients will observe a decline in functional status in the first 6 months after initiating dialysis. In this study, the percentage of caregivers reporting a high burden of care increased from 23 to 38% after dialysis initiation [ 36 ]. In a study from our team, compared with autonomous PD patients, patients with nurse assistance had a lower risk of transfer to HD, while those with family assistance had a similar risk of transfer to HD.…”

Frailty and Sarcopenia in Older Patients Receiving Kidney Transplantation

“…The prevalence of frailty is higher among dialysis patients, and it increases with age: 44% of dialysis patients under 40 years are frail, while this prevalence reach 78% among dialysis patients above 70 years. In addition, functional decline is highly prevalent in older patients during the first 6 months of dialysis, especially in the presence of frailty (72). Patients with CKD (62) typically present many risk factors for frailty (71), such as anemia, osteoporosis, cardiovascular disease and chronic inflammation (72, 73).…”

“…In addition, functional decline is highly prevalent in older patients during the first 6 months of dialysis, especially in the presence of frailty (72). Patients with CKD (62) typically present many risk factors for frailty (71), such as anemia, osteoporosis, cardiovascular disease and chronic inflammation (72, 73). They also experience neuroendocrine changes, like 25-OH vitamin D deficiency, insulin-resistance (73) and low testosterone levels (74), commonly associated with frailty and sarcopenia (32).…”

Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

“… 36 , 37 Our findings that higher predialysis physical health and fewer symptoms were associated with pre-emptive but not overall wait-listing may be related to the changes in HRQoL that many people experience after initiating dialysis. 38 Among those who report good physical health after starting dialysis, studies have shown higher rates of wait-listing, kidney transplantation. and posttransplantation survival.…”