TY - JOUR
T1 - Association of initiation of maintenance dialysis with functional status and caregiver burden
AU - Goto, Namiko A.
AU - Van Loon, Ismay N.
AU - Boereboom, Franciscus T.J.
AU - Emmelot-Vonk, Marielle H.
AU - Willems, Hanna C.
AU - Bots, Michiel L.
AU - Gamadia, Laila E.
AU - Van Bommel, Eric F.H.
AU - Van De Ven, Peter J.G.
AU - Douma, Caroline E.
AU - Vincent, Hieronymus H.
AU - Schrama, Yvonne C.
AU - Lips, Joy
AU - Hoogeveen, Ellen K.
AU - Siezenga, Machiel A.
AU - Abrahams, Alferso C.
AU - Verhaar, Marianne C.
AU - Hamaker, Marije E.
N1 - Funding Information:
We are grateful to all patients andmedical staff who participated in this project. This work was funded by Dianet Dialysis Stichting, the Cornelis de Visser Stichting, StichtingMedicina et Scientia, and AstraZeneca. The funding sources had no role in the design, data collection, analysis, manuscript preparation, interpretation, or decision to submit the manuscript for publication. Geriatric Assessment in Older Patients Starting Dialysis study investigators: Dianet Dialysis Center: Dr. Boereboom; Diakonessenhuis Utrecht: Dr. Hamaker; University Medical Center Utrecht: Dr. Abrahams, Dr. Bots, and Dr. Verhaar; St. Antonius Hospital, Nieuwegein: Dr. Vincent; Spaarne Gasthuis, Haarlem: Dr. Douma and Dr. C. Verburg; Bernhoven Hospital, Uden: Dr. Lips; Gelderse Vallei Hospital, Ede: Dr. Siezenga; Ter Gooi Hospital, Hilversum: Dr. Gamadia; Academic Medical Center, Amsterdam: I. Keur; Zaans Medical Center, Zaandam: R.J.L. Klaassen; Jeroen Bosch Hospital, Hertogenbosch: Dr. Hoogeveen; Albert Schweitzer Hospital, Dordrecht: Dr. van Bommel; St. Franciscus Hospital, Rotterdam: Dr. Schrama; Maasstad Hospital, Rotterdam: Dr. Van de Ven; and Groene Hart Hospital, Gouda: J.W. Eijgenraam.
Funding Information:
This work was funded by Dianet Dialysis Stichting, the Cornelis de Visser Stichting, Stichting Medicina et Scientia, and AstraZeneca.
Publisher Copyright:
© 2019 by the American Society of Nephrology.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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 75±7 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.
AB - 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 75±7 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.
KW - Activities of Daily Living
KW - Aged
KW - Caregivers
KW - Chronic
KW - Dialysis
KW - Elderly
KW - Follow-Up Studies
KW - Frailty
KW - Functional decline
KW - Geriatric Assessment
KW - Geriatric nephrology
KW - Kidney Failure
KW - Life
KW - Logistic Models
KW - Prevalence
KW - Renal dialysis
KW - Risk factors
UR - https://www.scopus.com/pages/publications/85069271880
U2 - 10.2215/CJN.13131118
DO - 10.2215/CJN.13131118
M3 - Article
C2 - 31248948
SN - 1555-9041
VL - 14
SP - 1039
EP - 1047
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 7
ER -