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Association between worsening renal function severity during hospitalization and low physical function at discharge: a retrospective cohort study of older patients with heart failure and chronic kidney disease from Japan

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Key summary points

AbstractSection Aim

To clarify the impact of the severity of worsening renal function during hospitalization on low physical function at discharge in older patients with heart failure and chronic kidney disease.

AbstractSection Findings

In this retrospective study, severely worsening renal function (grade III) during hospitalization was associated with low physical function at discharge, but moderate-to-mild worsening renal function (grades II or I) showed no such association.

AbstractSection Message

Limiting the severity of worsening renal function (grade III) during hospitalization might positively affect the physical function at discharge of older patients with heart failure and chronic kidney disease.

Abstract

Background

The number of hospitalized older patients with chronic heart failure, chronic kidney disease, and worsening renal function is rising in Japan. This study aimed to clarify the impact of the severity of worsening renal function during hospitalization on low physical function at discharge of these patients.

Methods

We included 573 consecutive heart failure patients who underwent phase I cardiac rehabilitation. Worsening renal function severity was defined according to elevation during hospitalization of baseline serum creatinine on admission: non-worsening renal function, serum creatinine < 0.2 mg/dL; worsening renal function II/I, serum creatinine ≥ 0.2 to < 0.5 mg/dL; worsening renal function III, and serum creatinine ≥ 0.5 mL/dL. Physical function was measured with the Short Performance Physical Battery. We compared background factors, clinical parameters, pre-hospitalization walking levels, Functional Independence Measure score, and physical function in the three renal function groups. Multiple regression analysis was performed with the Short Performance Physical Battery at discharge as the dependent variable.

Results

The final analysis included 196 patients (mean age 82.7 years, male 51.5%) categorized into three groups based on worsening renal function: worsening renal function grade III group (n = 55), worsening renal function grade II/I group (n = 36), and non-worsening renal function group (n = 105). There is no significant difference in walking levels before hospitalization between the three groups, but physical function at discharge was significantly lower in the worsening renal function III group. Moreover, worsening renal function III was an independent factor for low physical function at discharge.

Conclusion

Worsening of renal function during hospitalization in older patients with heart failure and chronic kidney disease was strongly associated with low physical function at discharge, even after adjusting for other potentially confounding factors, such as pre-hospitalization walking levels, walking start day, and Geriatric Nutrition Risk Index at discharge. Notably, worsening renal function of mild or moderate severity (grade II/I) did not show a significant association with low physical function.

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Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all of the participating patients in Yodogawa Christian Hospital.

Funding

This work was supported by a grant from JSPS KAKENHI (No. JP22K11392). Neither the authors nor their associated institutions report any financial relationships with industry relevant to this study.

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Authors and Affiliations

  1. Department of Rehabilitation, Yodogawa Christian Hospital, Osaka, Japan

    Ikko Kubo, Nozomu Kajisa, Hiroaki Nakamura & Kyo Kimura

  2. Department of Public Health, Graduate School of Health Sciences, Kobe University, 10-2 Tomogaoka 7-chome, Suma, Kobe, 654-0142, Japan

    Ikko Kubo, Kazuhiro P. Izawa, Asami Ogura, Masashi Kanai & Ayano Makihara

  3. Cardiovascular Stroke Renal Project (CRP), Kobe, Japan

    Ikko Kubo, Kazuhiro P. Izawa, Asami Ogura, Masashi Kanai & Ayano Makihara

  4. Department of Cardiovascular Medicine, Yodogawa Christian Hospital, Osaka, Japan

    Ryo Nishio & Daisuke Matsumoto

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  1. Ikko Kubo
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  2. Kazuhiro P. Izawa
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Contributions

Conceptualization IK and KPI. Formal analysis IK. Investigation IK, NK, HN, and KK. Data curation IK. Writing—original draft preparation IK, AO, MK, and AM. Writing—review and editing KPI, RN, and DM. Supervision KPI. Project administration KPI and DM. Funding acquisition KPI. All authors approved the manuscript for submission.

Corresponding author

Correspondence to Kazuhiro P. Izawa.

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All authors declare no conflicts of interest in relation to the work reported in this manuscript.

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All procedures performed in studies involving human and participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Kubo, I., Izawa, K.P., Kajisa, N. et al. Association between worsening renal function severity during hospitalization and low physical function at discharge: a retrospective cohort study of older patients with heart failure and chronic kidney disease from Japan. Eur Geriatr Med 14, 869–878 (2023). https://doi.org/10.1007/s41999-023-00809-7

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