*Department of Public Health, National Cheng Kung University College of Medicine †Department of Internal Medicine, National Cheng Kung University Hospital ‡Institute of Statistical Science, Academia Sinica §Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Med Care. 2014 Jan;52(1):63-70. doi: 10.1097/MLR.0000000000000010.
Physical functional disabilities in hemodialysis (HD) patients may increase their mortality and long-term care needs. The aim of this study was to estimate the changes of proportion for different physical functional disabilities along time after beginning HD and the lifelong care needs.
We used a population-based cohort consisting of 84,657 incident HD patients in Taiwan between 1998 and 2009 to estimate the survival function and extrapolate to lifetime through a semiparametric method. The Barthel Index (BI) was used to measure the functional disability levels cross-sectionally in 1334 HD patients recruited from 9 HD centers. A BI score <50 was considered as severe disability. Lifetime care needs were obtained by extrapolating the age-stratified survival functions to lifetime and then multiplying them with proportions of different kinds of functional disabilities over time.
On average, HD patients had at least 6.4, 2.0, and 1.3 years without disability, with moderate disability, and severe disability, respectively. The most common care needs were stair-climbing and bathing, which were 3.0 and 1.7 years, respectively. HD patients were expected to have about 3 years living with disabilities for those beginning HD at an age above 35 years; however, the older the patient, the higher the proportion of functional disabilities and care needs.
HD patients are in need of long-term care and require early intervention and resource planning. The method developed in this study can also be applied to other chronic illnesses with various functional disabilities.
血液透析（HD）患者的身体功能障碍可能会增加其死亡率和长期护理需求。本研究旨在评估 HD 患者开始透析后不同身体功能障碍的比例随时间的变化以及终身护理需求。
我们使用了一个基于人群的队列，该队列包括 1998 年至 2009 年间在台湾的 84657 名新发生的 HD 患者，通过半参数方法估计生存函数并外推至终生。Barthel 指数（BI）用于在 9 个 HD 中心招募的 1334 名 HD 患者中测量横断面的功能障碍水平。BI 评分<50 被认为是严重残疾。通过将分层年龄的生存函数外推到终生，并将不同类型的功能障碍随时间的比例相乘，获得终身护理需求。
平均而言，HD 患者分别有至少 6.4、2.0 和 1.3 年没有残疾、中度残疾和严重残疾。最常见的护理需求是爬楼梯和洗澡，分别为 3.0 年和 1.7 年。对于年龄在 35 岁以上开始 HD 的患者，预计有大约 3 年的残疾生活；然而，患者年龄越大，功能障碍和护理需求的比例就越高。
HD 患者需要长期护理，需要早期干预和资源规划。本研究中开发的方法也可以应用于其他具有各种功能障碍的慢性疾病。
