<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Abstract

Introduction: Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients' activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients. Patients and Methods: A total of 303 elderly patients with CKD stage 3-5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models. Results: The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00-1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17-19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70-0.92, P=0.0012) were the independent risk factors of ADL impairment. Conclusion: Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.

Predictivity of the comorbidity indices for geriatric syndromes

“…Consistent with our results, many studies have shown that CCI is associated with ADLs and functionality. [ 44 – 46 ] In contrast to our result, a study in older patients from Singapore reported that CCI was not associated with LOS, which was more than 21 days. [ 30 ] However, since LOS longer than 21 days is quite a long time for general geriatric practice, this result cannot be mentioned to reflect daily geriatric practice.…”

Factors Associated With Functional Limitations in Daily Living Among Older Adults in Korea: A Cross-Sectional Study

“…People with severe functional limitations often experience particular difficulties with daily activities, which place a burden on the healthcare system [14][15][16]. Therefore, before making a healthcare plan, it was essential to identify predictive factors that were significantly related to functional limitations in the performance of basic and complex activities of daily living (ADLs and IADLs) [4,9,10]. This study developed a model to verify the relationships between demographic and health parameters and functional limitations in daily living, defined as ADL/IADL disability levels, among older adults in Korea.…”

“…Those proportions among older adults in southeastern Poland were 17% and 36%, respectively [7], they were 16.6% and 40.9% in India [6], and were 5.6% and 12.0% in Korea, respectively [8]. Such functional decline was a strong predictor of institutionalization, which leads to an increase in medical costs [9][10][11].…”

Decline in Walking Independence and Related Factors in Hospitalization for Dialysis Initiation: A Retrospective Cohort Study

“…The CCI is the most commonly used measure to assess comorbidity and is also commonly used in patients with conservative CKD and dialysis patients [ 34 , 35 , 36 ]. In dialysis patients, CCI is a strong predictor of mortality, and in older patients with conservative CKD, a higher comorbidity index is associated with functional decline [ 21 , 37 ]. Comorbidities are associated with the severity of depression, anxiety, and fatigue, which reduce the amount of physical activity in patients.…”

“…Independent variables were analyzed using two models. In Model 1, we entered items of clinical significance from among variables that showed significant differences ( p < 0.001) between the two groups, referring to previous studies [ 1 , 19 , 20 , 21 ]. In doing so, items that could be intermediate variables for causality (length of hospitalization, FIM-walking score at hospitalization, number of rehabilitations) were excluded.…”