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Physical function at the time of dialysis initiation is associated with subsequent mortality

Clinical and Experimental Nephrology volume 21, pages 425–435 (2017)Cite this article

Abstract

Background

In dialysis patients, physical function is associated with mortality. However, the association between physical function at the time of dialysis initiation and subsequent mortality remains unknown.

Methods

A total of 1496 patients with chronic kidney disease who initiated dialysis at 17 centers participating in the Aichi Cohort Study of the Prognosis in Patients Newly Initiated into Dialysis, a multicenter prospective cohort study, were included. The patients were divided into the high (H)-, middle (M)-, and low (L)-score groups according to Barthel index (BI) at the time of dialysis initiation, and the all-cause, cardiovascular disease (CVD)-related, and infection-related mortality rates were compared. Moreover, factors affecting all-cause mortality were investigated. The effects of BI on mortality were assessed in the patients stratified by age, sex, and history of CVD or cerebral infarction.

Results

A log-rank test for the Kaplan–Meier survival curve showed significant differences between the three groups in all-cause, CVD-related, and infection-related mortality rates (p < 0.001). Cox proportional hazard regression analysis with the step-wise method showed a significantly higher risk of all-cause mortality in the M and L groups than in the H group (M group: HR 1.612, 95 % CI 1.075–2.417; L group: HR 1.994, 95 % CI 1.468–2.709). Regardless of the age categories and the history of CVD, the risk of all-cause mortality was significantly higher in the L group than in the H group.

Conclusion

Physical function assessed by BI at the time of dialysis initiation was found to be associated with subsequent mortality.

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Acknowledgments

We acknowledge the support provided by the following investigators and members of the Aichi Cohort study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), who participated in this study: Yasuhiro Otsuka, Asami Takeda (Japanese Red Cross Nagoya Daiichi Hospital), Hirofumi Tamai (Anjo Kosei Hospital), Tomohiko Naruse (Kasugai Municipal Hospital), Kei Kurata (Tosei General Hospital), Hideto Oishi (Komaki City Hospital), Isao Aoyama (Japanese Community Healthcare Organization Chukyo Hospital), Hiroshi Ogawa (Shinseikai Daiichi Hospital), Hiroko Kushimoto (Chita City Hospital), Hideaki Shimizu (Chubu-Rosai Hospital), Junichiro Yamamoto (Tsushima City Hospital), Hisashi Kurata (Toyota Kosei Hospital), Taishi Yamakawa (Toyohashi Municipal Hospital), Takaaki Yaomura (Nagoya Medical Center), Hirotake Kasuga (Nagoya Kyouritsu Hospital), Shizunori Ichida (Japanese Red Cross Nagoya Daiichi Hospital), Shoichi Maruyama (Nagoya University Graduate School of Medicine), Seiichi Matsuo (Nagoya University Graduate School of Medicine), Noritoshi Kato (Nagoya University Graduate School of Medicine), Shigehisa Koide (Fujita Health University Hospital), and Yukio Yuzawa (Fujita Health University Hospital).

Author information

Affiliations

  1. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Daijo Inaguma

  2. Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan

    Akihito Tanaka & Hibiki Shinjo

  3. Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), Aichi, Japan

    Daijo Inaguma

Authors
  1. Daijo Inaguma
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  2. Akihito Tanaka
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  3. Hibiki Shinjo
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Corresponding author

Correspondence to Daijo Inaguma.

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Conflict of interest

The Aichi Kidney Foundation funded this study. The authors declare no competing interests.

Ethical considerations

This study was conducted by following Ethical guidelines for Clinical Research by the Japanese Ministry of Health, Labor, and Welfare (created July 30, 2003; full revision December 28, 2004; full revision July 31, 2008) and the Helsinki Declaration (revised 2013), and was approved by the clinical research ethics committees at each AICOPP group facility (the approval number: 20110823-3). The subjects received oral and written explanations of the purpose of the study and provided their consent in writing. The study was registered with the University Hospital Medical Information Network (UMIN) on January 18, 2012 (ID: 000007096).

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Cite this article

Inaguma, D., Tanaka, A. & Shinjo, H. Physical function at the time of dialysis initiation is associated with subsequent mortality. Clin Exp Nephrol 21, 425–435 (2017). https://doi.org/10.1007/s10157-016-1307-3

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  • DOI: https://doi.org/10.1007/s10157-016-1307-3

Keywords

  • Chronic kidney disease
  • Dialysis initiation
  • Physical activity
  • Survival analysis
  • Barthel index