Journal of Nephrology

, Volume 31, Issue 4, pp 593–602 | Cite as

Functional impairment and risk of mortality in patients on chronic hemodialysis: results of the Lazio Dialysis Registry

  • Maurizio BossolaEmail author
  • Claudia Marino
  • Anteo Di Napoli
  • Nera Agabiti
  • Luigi Tazza
  • Marina Davoli
  • On behalf of the Dialysis and Transplant Lazio Region Registry Scientific Committee
Original Article



Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of this study was to evaluate if functional impairment represents a risk factor for reduced survival in patients on chronic hemodialysis.


All incident chronic hemodialysis patients of Lazio, a large region of central Italy, registered in the Dialysis and Transplant Lazio Region Registry (DTLRR) in the period 2008–2013 were considered eligible. Inclusion criteria were: age > 18 years, resident in Lazio, still doing dialysis after 90 days from incidence date, doing hemodialysis or hemodiafiltration treatment for > 9 h/week. Patients were stratified into three classes of functional activity: total autonomy, autonomy in some activities, and not self-sufficient. Functional activity was assessed for each patient by the referring physician for the DTLRR from the ~ 90 hemodialysis units of the Lazio region. Each patient was followed from date of first dialysis treatment to the end of the study (31/12/2015) or death or renal transplant, whichever occurred first. Cox proportional hazard models were performed to obtain mortality hazard ratios (HR), 95% confidence intervals (CI), for each class of functional activity adjusting for sex, age, country of birth, city of residence, body mass index (BMI), type of nephropathy, vascular access, previous nephrology counselling, weekly hours of hemodialysis, serum albumin, hemoglobin, and presence of comorbidities (e.g. vascular diseases, coronary disease, and diabetes).


A total of 3356 patients were studied. In the whole follow-up period, 1622 deaths occurred (48%). Functional impairment was associated with the risk of mortality: compared to ‘total autonomy’, the HR for ‘autonomy in some activities’ was 1.30 [95% CI: 1.14–1.49] and for ‘not self-sufficient’ 1.71 [1.47–1.99] (p for trend < 0.05). The number of evitable deaths attributable to reduced functional activity was 237.


Functional impairment represents a risk factor for reduced survival in chronic hemodialysis patients. There is a need for early identification of patients who might benefit from interventions aimed at preventing, reversing or delaying the functional impairment.


Hemodialysis Mortality Survival Disability Functional impairment 



Members of the Lazio Dialysis Registry (on December 2017): Alfarone C, Aloisio GM, Amoroso F, Andrietti M, Baldinelli M, Barone P, Basili A, Bianchi M, Canulla F, Capobianco L, Chiappini MG, Costantini S, Cuzziol C, D’Apollo A, De Bella E, De Cicco C, De Paolis P, Della Rovere FR, Di Daniele N, Di Legge R, Di Pietro G, Di Toro Mammarella R, Felicioni R, Feriozzi S, Ferrazzano MT, Filippini A, Fini R, Firmi G, Flammini A, Forte F, Gambaro G, Gamberini M, Iamundo V, Lavini R, Lonzi M, Maggisano V, Malaguti M, Marinelli R, Mauro LM, Mazzaferro S, Morabito S, Morosetti M, Nazzaro L, Nicolais R, Nusca C, Pace G, Palumbo R, Pantano L, Paone A, Picca S, Polito P, Puliti M, Punzo G, Rifici N, Riveruzzi P, Rossi V, Rossini B, Santoboni A, Sfregola P, Shamsan H, Simonelli R, Spaziani M, Splendiani G, Stranges V, Sturnolo A, Torre MC, Treglia A, Tullio T, Valentini W, Vastano S, Vega A, Ventola F.

Members Scientific Commettee: Nera Agabiti, Carmine De Cicco, Salvatore Di Giulio, Anteo Di Napoli, Sandro Feriozzi, Giovanni Gambaro, Moreno Malaguti, Paolo Menè, Nicola Petrosillo, Stefano Picca, Luigi Tazza, Giuseppe Tisone, Maurizio Valeri.

Compliance with ethical standards

Conflict of interest

None of the authors has conflict of interest. 

Ethical approval

The study was conducted by the Department of Epidemiology of Lazio Regional Health Service, namely the regional referral center for epidemiological research which has full access to anonymized data. As a consequence, ethics approval was not required for this study.

Informed consent

For this type of study patients’ consent is not required.


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Copyright information

© Italian Society of Nephrology 2018

Authors and Affiliations

  • Maurizio Bossola
    • 1
    Email author
  • Claudia Marino
    • 2
  • Anteo Di Napoli
    • 3
  • Nera Agabiti
    • 2
  • Luigi Tazza
    • 1
  • Marina Davoli
    • 2
  • On behalf of the Dialysis and Transplant Lazio Region Registry Scientific Committee
  1. 1.Hemodialysis Unit, Institute of Clinical SurgeryCatholic University of the Sacred HeartRomeItaly
  2. 2.Department of Epidemiology Regional Health Service LazioRomeItaly
  3. 3.National Institute for Health, Migration and PovertyRomeItaly

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