Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan.
Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan.
Int Urol Nephrol. 2021 Jan;53(1):177-184. doi: 10.1007/s11255-020-02600-0. Epub 2020 Aug 14.
Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently.
This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0 years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses.
Median follow-up duration was 58 months. The incident rates were 0.02 per person-year in the higher ADL group and 0.06 per person-year in the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57-4.64) compared with that in the higher ADL group.
Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.
大多数接受血液透析的患者都感到移动任务（如日常生活活动[ADL]、步行以及上下楼梯）有困难，即使他们能够独立行走。据报道，ADL 困难（ADL 困难）是预测老年人社区居住人群死亡率的有用指标。然而，很少有研究探讨 ADL 困难与接受血液透析患者临床结局的关系。本研究旨在确定与能够独立行走的接受血液透析患者下肢移动任务相关的 ADL 困难与全因死亡率之间的关系。
这是一项回顾性研究，分析了 300 名临床稳定的门诊接受血液透析的患者（中位年龄 65.0 岁）。ADL 困难在基线时通过为接受血液透析的患者开发的新问卷进行评估。较低的分数表示较低的 ADL，即更大的 ADL 困难。根据 ADL 评分中位数将患者分为两组：ADL 较高组和 ADL 较低组。通过 Cox 回归分析估计 ADL 困难与全因死亡率之间的关联。
中位随访时间为 58 个月。ADL 较高组的发生率为 0.02 人/年，ADL 较低组的发生率为 0.06 人/年（P<0.001）。在调整了临床特征的影响后，ADL 较低组的全因死亡率的危险比为 2.70（95%置信区间 1.57-4.64），与 ADL 较高组相比。
接受血液透析的可走动患者感知到的移动任务困难与全因死亡率独立相关。
