Functional Status of Elderly Adults before and after Initiation of Dialysis
Open accessAbstract
BACKGROUND: It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). METHODS: Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). RESULTS: The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. CONCLUSIONS: Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status.
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One in five dialysis patients has depressive symptoms.
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As many as one third of dialysis patients have severe cognitive impairment.
“One in five patients have depressive symptoms and up to one-third have severe cognitive impairment [17,18].”
From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [17]
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- Authors
- Kurella Tamura, M., Covinsky, K. E., Chertow, G. M., Yaffe, K., Landefeld, C. S., & McCulloch, C. E.
- Affiliations
- San Francisco VA Medical Center (US)
- University of California, San Francisco (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2009-10-15
- Volume
- 361
- Issue
- 16
- Pages
- 1539-1547
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC2789552
- OpenAlex
- W2169328204
- Cited by
- 1,064
- References
- 26
- Citations by year
- 2026: 62 · 2025: 41 · 2024: 41 · 2023: 65 · 2022: 53 · 2021: 49 · 2020: 57 · 2019: 82 · 2018: 68 · 2017: 68 · 2016: 70 · 2015: 62 · 2014: 93 · 2013: 81 · 2012: 67
- FWCI
- 39.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (K23AG028952, K24AG029812)
- National Institute of Diabetes and Digestive and Kidney Diseases (N01DK12450)
- National Center for Research Resources (KL2RR024130)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dialysis initiation, functional status, end-stage renal disease, nursing home residents, elderly patients, activities of daily living, Minimum Data Set, functional decline, nursing home admission, mortality
- MeSH terms
- Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Female, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Nursing Homes, Treatment Outcome
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