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Clinical / Chronic Kidney Disease (CKD) / Dialysis

Quiz used in elderly could determine death risk for kidney dialysis patients of all ages

October 12, 2012
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A simple six-question quiz, typically used to assess disabilities in the elderly, could help doctors determine which kidney dialysis patients of any age are at the greatest risk of death, new Johns Hopkins research suggests.

Kidney failure mimic aging process

Transplant surgeon and lead researcher Dorry L. Segev, MD, PhD, said he believes that kidney failure mimics an accelerated body-wide aging process. For his study, published in the Journal of the American Geriatrics Society, he turned to geriatric experts to examine mortality risk in patients undergoing dialysis. They found that those who needed assistance with one or more basic activities of daily living – feeding, dressing, walking, grooming, using a toilet and bathing – were more than three times more likely to die than their more independent counterparts.

Segev and his team followed 143 patients undergoing dialysis, all recruited from a dialysis center in Baltimore between January, 2009 and March, 2010. They were followed until November 15, 2011. There were 33 deaths during the study period, and the risk of death did not vary with age.

The prevalence of disability in the activities of daily living of kidney failure patients of all ages – 41% this study – is higher than in older adults in the community at-large (5 to 8.1%of non-institutionalized adults over age 65).

At-risk dialysis patients could benefit from physical therapy

"This quiz helps us identify an at-risk group that would probably benefit from closer monitoring and maybe even physical therapy to improve their functioning," said Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study published in the Journal of the American Geriatrics Society.

Needing assistance with basic activities of daily living has been well documented in the geriatrics field as a predictor of adverse outcomes, said Segev, Johns Hopkins' director of clinical research in transplant surgery.

"The thing that puts older patients at risk for adverse outcomes is a decrease in physiological reserve," he says. "Organ systems start to deteriorate and when they don't function as well as they used to, they can't handle stressors as well as they used to. There's growing evidence that dialysis and kidney failure not only represent deterioration of kidney function but also cause deterioration of function in other organ systems."

"Measuring a dialysis patient's ability to perform activities of daily life may be an important tool," says Mara A. McAdams-DeMarco, Ph.D., a Johns Hopkins epidemiologist and contributor to the study. "This information is simple to capture, doesn't require sophisticated tests and could help us better target the right patients for intervention."
 

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