Hall Rasheeda K, Rutledge Jeanette, Luciano Alison, Hall Katherine, Pieper Carl F, Colón-Emeric Cathleen
Renal Section, Durham Veterans Affairs Healthcare System, Durham, NC.
Geriatric Research Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC.
Kidney Med. 2020 Jun 12;2(4):425-431. doi: 10.1016/j.xkme.2020.03.008. eCollection 2020 Jul-Aug.
RATIONALE & OBJECTIVE: Physical function is not routinely measured in older adults receiving dialysis. We evaluated the appropriateness of repeated measurements of physical function, including Short Physical Performance Battery (SPPB), handgrip strength, and activities of daily living (ADLs), in older adults receiving dialysis.
Prospective study.
SETTING & PARTICIPANTS: 37 community-dwelling adults 65 years and older receiving in-center hemodialysis at 5 dialysis units located in North Carolina.
SPPB (an assessment of standing balance, chair stands, and gait speed), handgrip strength, and Katz and Lawton ADLs at baseline and subsequent 3-month intervals up to 6 months.
Completion rate, presence of floor or ceiling effects, and presence of clinically meaningful change in physical function measurements.
Of 55 potential participants, we enrolled 37 (67%) older adults receiving hemodialysis. Among 35 enrolled participants who completed baseline assessment in a dialysis unit, mean age was 70.1 (SD, 5) years, 46% (n = 16) were women, 77% (n = 27) were African American, and median time receiving dialysis was 2.7 (IQR, 0.6-5.0) years. There were 3 deaths within the observation period, and study retention at 3 and 6 months was 83% (n = 29) and 74% (n = 26), respectively. Participants tolerated measurements; only 2 participants did not attempt 1 of the performance-based tests at a study visit. Baseline median SPPB score, grip strength, and gait speed were 6 (IQR, 4-9), 55 (IQR, 42-70) kg, and 0.76 (IQR, 0.46-0.86) m/s, respectively. Baseline median for Katz and Lawton ADLs were 6 (IQR, 6-6) and 7 (IQR, 4-8), respectively; ceiling effects were observed for both measures. For some participants, clinically meaningful changes (improvement or decline) in SPPB score, grip strength, and gait speed occurred at each 3-month interval.
Limited geographic and ethnic variation.
SPPB, handgrip strength, and gait speed alone are appropriate measures for interval physical function assessment in community-dwelling older adults receiving in-center hemodialysis.
在接受透析的老年人中，身体功能并非常规测量项目。我们评估了对接受透析的老年人反复测量身体功能的适宜性，包括简短体能状况量表（SPPB）、握力和日常生活活动能力（ADL）。
前瞻性研究。
37名居住在社区的65岁及以上成年人，他们在北卡罗来纳州的5个透析单位接受中心血液透析。
基线时以及随后每3个月直至6个月时的SPPB（一项关于站立平衡、从椅子上站起和步态速度的评估）、握力，以及Katz和Lawton日常生活活动能力评估。
完成率、是否存在地板效应或天花板效应，以及身体功能测量中是否存在具有临床意义的变化。
在55名潜在参与者中，我们招募了37名（67%）接受血液透析的老年人。在35名在透析单位完成基线评估的入组参与者中，平均年龄为70.1（标准差，5）岁，46%（n = 16）为女性，77%（n = 27）为非裔美国人，接受透析的中位时间为2.7（四分位间距，0.6 - 5.0）年。观察期内有3人死亡，3个月和6个月时的研究保留率分别为83%（n = 29）和74%（n = 26）。参与者能够耐受测量；只有2名参与者在一次研究访视中未尝试一项基于表现的测试。基线时SPPB评分中位数、握力和步态速度分别为6（四分位间距，4 - 9）、55（四分位间距，42 - 70）千克和0.76（四分位间距，0.46 - 0.86）米/秒。Katz和Lawton日常生活活动能力评估的基线中位数分别为6（四分位间距，6 - 6）和7（四分位间距，4 - 8）；两项评估均观察到天花板效应。对于一些参与者，在每3个月的间隔中，SPPB评分、握力和步态速度出现了具有临床意义的变化（改善或下降）。
地理和种族差异有限。
对于接受中心血液透析的社区居住老年人，单独使用SPPB、握力和步态速度是进行间隔身体功能评估的适宜指标。
