US Renal Data System 2012 Annual Data Report Collins, Allan J., MD; Foley, Robert N., MB; Herzog, Charles, MD ...
American journal of kidney diseases,
01/2013, Letnik:
61, Številka:
1
Journal Article
Background Slow walk (gait) speed predicts functional decline, institutionalization, and mortality risks in the geriatric population. A gait speed evidence base for dialysis patient outcomes is ...needed. Study Design Prospective cohort study. Setting & Participants 752 prevalent hemodialysis (HD) patients aged 20 to 92 years evaluated in 2009 to 2012 in 7 Atlanta and 7 San Francisco clinics in a US Renal Data System special study. Predictor Usual walk speed in meters per second, categorized as ≥0.6 m/s (baseline n = 575), <0.6 m/s (baseline n = 94), and unable to perform walk test (baseline n = 83). Outcomes Survival; hospitalization; activities of daily living (ADL) difficulty; 36-Item Short Form Health Survey (SF-36) Physical Function score. Measurements Cox proportional hazards models investigated gait speed and mortality over a median follow-up of 703 days. Multivariable logistic or linear regression models estimated associations of baseline gait speed with hospitalization, need for ADL assistance, and SF-36 Physical Function score after 12 months. Results Participants who walked ≥0.6 m/s had 53 (9%) deaths, those who walked <0.6 m/s had 19 (20%) deaths, and those unable to walk had 37 (44%) deaths. Adjusted mortality hazard ratios were 2.17 (95% CI, 1.19-3.98) for participants who walked <0.6 m/s and 6.93 (95% CI, 4.01-11.96) for those unable to walk, compared with participants walking ≥0.6 m/s. After 12 months, compared with baseline walk speed ≥ 1.0 m/s (n = 169 participants), baseline walk speed of 0.6 to <0.8 m/s (n = 116) was associated with increased odds of hospitalization (OR, 2.04; 95% CI, 1.19-3.49) and ADL difficulty (OR, 3.88; 95% CI, 1.46-10.33) and a −8.20 (95% CI, −13.57 to −2.82) estimated change in SF-36 Physical Function score. Limitations Cohort not highly representative of overall US in-center HD population. Conclusions Because walking challenges the heart, lungs, and circulatory, nervous, and musculoskeletal systems, gait speed provides an informative marker of health status. The association of gait speed with HD patients’ risk for functional decline warrants continued study.
US Renal Data System 2013 Annual Data Report Collins, Allan J., MD; Foley, Robert N., MB; Chavers, Blanche, MD ...
American journal of kidney diseases,
01/2014, Letnik:
63, Številka:
1
Journal Article
US Renal Data System 2011 Annual Data Report Collins, Allan J., MD; Foley, Robert N., MB; Chavers, Blanche, MD ...
American journal of kidney diseases,
01/2012, Letnik:
59, Številka:
1
Journal Article
Background Life-Space Assessment captures community mobility and social participation and quantifies the distance, frequency, and independence obtained as an older adult moves through his or her ...environment. Reduced estimated glomerular filtration rate (eGFR) is associated with decline in activities of daily living among older adults, but less is known about the association of eGFR with restrictions in mobility. Study Design Prospective observational cohort study. Setting & Participants Community-dwelling Medicare beneficiaries from the University of Alabama at Birmingham Study of Aging who had serum creatinine measured during a baseline in-home study visit and completed at least one telephone follow-up (N = 390). Predictor eGFR ≥ 60, 45-59, and <45 mL/min/1.73 m2. Outcome Life-space mobility trajectory. Measurements Life-space mobility was evaluated by telephone every 6 months for up to 4.5 years using the previously validated Life-Space Assessment. Scores using this tool range from 0-120 (higher scores indicate greater mobility). Results Mean age of the 390 participants was 77.6 ± 5.8 (SD) years, 41% were African American, 50.5% were women; 30.0% had eGFR of 45-59 mL/min/1.73 m2 , and 20.2% had eGFR < 45 mL/min/1.73 m2 . Age-, race-, and sex-adjusted mean baseline life-space mobility scores were 64.8 (95% CI, 62.0-67.6), 63.8 (95% CI, 60.3-67.4), and 58.3 (95% CI, 53.8-62.7) among those with eGFR categories ≥ 60, 45-59, and <45 mL/min/1.73 m2 , respectively. Compared with those with eGFRs ≥ 60 mL/min/1.73 m2 , a more rapid decline in life-space mobility was found among those with eGFRs < 45 mL/min/1.73 m2 , though this did not reach statistical significance ( P = 0.06); a similar effect was not seen among those with eGFRs of 45-59 mL/min/1.73 m2 ( P = 0.3). Limitations Urinary albumin or longitudinal measures of eGFR were not available. Conclusions eGFR < 45 mL/min/1.73 m2 was associated with a trend toward a more rapid decline in life-space mobility among community-dwelling older adults. Findings should be confirmed in a larger population.
Background Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was ...to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and matched nonoperated controls. Study Design We identified 150 dialysis patients who underwent NTPTX (1993−2009) at our institution and compared them with 1,044 nonoperated control patients identified in the US Renal Data System registry, matched for age, sex, race, diabetes as cause of kidney failure, years on dialysis, and dialysis modality. Survival outcomes were estimated using multivariable Cox proportional hazards models with stratification on the matching sets, adjusted for cardiovascular comorbidities, smoking, inability to ambulate/transfer, and payor status. Results During a follow-up of a mean of 3.6 years (range 0.1 month to 16.4 years), NTPTX patients had a significant reduction in the long-term risk of all-cause death (hazard ratio = 0.68; 95% CI, 0.52−0.89; p = 0.006) compared with controls. Thirty-day mortality rates for NTPTX patients and controls were 246 vs 105 per 1,000 person-years (p = 0.21). In adjusted analyses, NTPTX patients had a 37% reduced risk of all-cause death and a 33% reduced risk of cardiovascular death compared with controls. A durable reduction in mean parathyroid hormone was observed after NTPTX; from 1,776 ± 1,416.6 pg/mL to 301 ± 285.7 pg/mL (p < 0.0001). Conclusions In our center, NTPTX in dialysis patients was associated with a significant reduction in long-term risk of death compared with matched control patients, without a significantly increased short-term risk.
Although individuals with kidney disease, including those dependent on dialysis, often present clinically with signs and symptoms consistent with frailty, there is limited information about ...sociodemographic and clinical risk factors that may be associated.
Seven hundred forty-five patients undergoing hemodialysisbetween 2009 and 2011 in 7 Atlanta dialysis clinics and 7 San Francisco bay area dialysis clinics were assessed using the validated Fried frailty index (recent unintentional weight loss, reported exhaustion, low grip strength, slow walk speed, low physical activity) that defines frailty as the presence of 3 or more criteria. Study coordinators interviewed participants; measured grip strength, walk speed, and body composition; and reviewed records for clinical and laboratory parameters. Logistic regression models were used to estimate the association of patient characteristics with frailty.
In adjusted analyses, peripheral vascular disease and cardiac diseases, including dysrhythmia, atrial fibrillation, tachycardia, pericarditis, and cardiac arrest, were associated with higher odds for frailty, whereas black race and higher serum albumin concentration were associated with lower odds for frailty.
In multivariable analyses, the risk for frailty in patients undergoing hemodialysis, as assessed by the presence of 3 or more criteria that comprise the Fried frailty index, was increased in association with peripheral vascular disease and cardiac conditions, such as dysrhythmia and atrial fibrillation, and was decreased for those with higher serum albumin concentration and for blacks compared with whites. Among patients who met the Fried definition of frailty, 78% scored as frail on walk speed and 56% scored as frail on grip strength, the 2 physical performance measures.
Background Patients with end-stage renal disease reliant on maintenance hemodialysis therapy may be particularly susceptible to developing post-traumatic stress disorder (PTSD) after natural ...disasters. Study Design Cross-sectional study. Setting & Participants Patients who received treatment at 9 New Orleans, LA, metropolitan area hemodialysis units before Hurricane Katrina made landfall on August 29, 2005, were recruited for the study. Overall, 391 patients completed the interview between April and October 2006 (participation rate, 85.6%). Predictors Demographic, dialysis-related, and evacuation characteristics. Outcomes & Measurements PTSD was assessed by using the 17-item PTSD Checklist and defined using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Results Overall, 23.8% of hemodialysis patients reported symptoms consistent with PTSD. After adjustment for age and sex, black patients were 1.92 (95% confidence interval, 1.31 to 2.83) times more likely than whites to have PTSD. After age, race, and sex adjustment, PTSD was more common in hemodialysis patients who were in their first 2 years of treatment, were evacuated fewer than 2 days before the hurricane made landfall, were evacuated initially to a shelter, and missed 3 or more dialysis treatments because of Hurricane Katrina and its aftermath. Additionally, patients who remained displaced for 3 or more months were more likely to have PTSD. Limitations Data were not available to distinguish between the presence of acute, chronic, or delayed-onset PTSD. Conclusions A substantial proportion of hemodialysis patients had PTSD symptoms approximately 1 year after Hurricane Katrina. Emergency planning for hemodialysis patients should include the identification and treatment of PTSD after future disasters.
Estimating dietary intake is challenging in patients with chronic diseases. The aim of this study was to calibrate the Block Brief 2000 food frequency questionnaire (BFFQ) using 3-day food diary ...records among patients on dialysis.
Data from 3-day food diary records from 146 patients new to dialysis were reviewed and entered into National Cancer Institute self-administered 24-hour dietary recall (ASA24), a web-based dietary interview system. The information was then re-entered omitting foods reported in the diaries that were not in the BFFQ to generate a "BFFQ-restricted" set of intakes. We modeled each major dietary component (i.e., energy total calories, protein, carbohydrate, fat) separately using linear regression. The main independent variables were BFFQ-restricted food diary estimates computed as the average of the 3 days of diaries, restricted to items included in the BFFQ, with the unrestricted 3-day food diary averages as dependent variables.
The BFFQ-restricted diary energy estimate of 1,325 ± 545 kcal was 87% of the energy intake in the full food diary (1,510.3 ± 510.4, P < .0001). The BFFQ-restricted diary carbohydrate intake was 83% of the full food diary (156.7 ± 78.7 g vs. 190.4 ± 72.7, P < .0001). The BFFQ-restricted fat intake was 90% of the full-diary-reported fat intake (50.1 ± 24.1 g vs. 56.4 ± 21.6 g, P < .0001). Daily protein intake assessments were not statistically different by BFFQ-restricted diary and full diary assessment (63.1 ± 28.5 vs. 64.1 ± 21.4 g, P = .60). The associations between BFFQ-restricted diary intake and unrestricted intake were linear. Three-day diary-reported intake could be estimated from BFFQ-restricted intake with r2 ranging from 0.36 to 0.56 (P < .0001 for energy total calories, protein, carbohydrate, and fat). Final equations did not include adjustments for age, sex, or race because the patterns of associations were not significantly different.
Energy and macronutrient estimates by BFFQ are lower than estimates from 3-day food diaries, but simple calibration equations can be used to approximate total intake from BFFQ responses.
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