Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract

Background Patients on chronic dialysis have among the highest mortality and hospitalization rates. In the non-renal literature, functional dependence is recognized as a contributor to subsequent disability, recurrent hospitalization, and increased mortality. A higher burden of functional dependence with progressive worsening of renal function has been observed in several studies, suggesting functional dependence may contribute to both morbidity and mortality in dialysis patients. Study Design Prospective cohort study Setting & Participants 7,226 hemodialysis patients from 12 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 4 (2009–2011) with self-reported data on functional status (FS). Predictor Patients’ ability to perform 13 basic and instrumental Activities of Daily Living (ADL) was summarized to create an overall FS score ranging from 1.25 (most dependent) to 13 (functionally independent). Outcome Cox regression was used to estimate the association between FS and all-cause mortality, adjusting for several demographic and clinical risk factors for mortality. Median follow-up was 17.2 months. Results The proportion of patients who could perform each ADL task without assistance ranged from 97% (eating) to 47% (doing housework). 36% of patients could perform all 13 tasks without assistance (FS=13), and 14% of patients had high functional dependence (FS < 8). Functionally independent patients were younger and had many indicators of better health status including higher quality of life. Compared with functionally independent patients, the adjusted hazard ratio for mortality was 2.37 (95% confidence interval =1.92–2.94) for patients with FS < 8. Limitations Possible non-response bias and residual confounding Conclusions We found a high burden of functional dependence across all age groups and across all DOPPS countries. When adjusting for several known mortality risk factors, including age, access type, cachexia and multi-morbidity, functional dependence was a strong, consistent predictor of mortality.

Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

“…The cohort of this study is equivalent to average dialysis patients with respect to age, underlying diseases, comorbidities, and mortality [1,24,25,38].…”

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

“…In Japan, more than half of HD patients reportedly have the ability to perform basic activities of daily living (ADL) and instrumental ADL tasks without assistance [7]. However, even HD patients who can perform ADL tasks independently show high rates of ADL difficulty, i.e., difficulty carrying out routine self-care activities.…”

Hemodiyaliz Hastalarının Günlük Yaşam Aktiviteleri, Yeti Yitimi, Depresyon ve Komorbidite Yönünden Değerlendirilmesi

“…Çalışmamızda birinci gruptaki hastaların, daha yaşlı olan ikinci gruba göre daha bağımsız oldukları belirlenmiştir. DOPPS (Dialysis Outcomes and Practice Patterns Study) faz 4 (2009-2011) çalışmasında da benzer şekilde fonksiyonel açıdan daha bağımsız olan hastaların daha genç olduğu belirlenmiştir (19). Bu nedenle hastalarımızın hangi aktivitelerini yerine getirirken daha fazla desteğe ihtiyaç duydukları belirlenmeli ve sosyal destek sistemleri değerlendirilmelidir.…”