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Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently.

Methods

This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0 years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses.

Results

Median follow-up duration was 58 months. The incident rates were 0.02 per person-year in the higher ADL group and 0.06 per person-year in the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57–4.64) compared with that in the higher ADL group.

Conclusions

Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.

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Acknowledgements

This research was supported by JSPS KAKENHI. The authors would like to thank all patients who participated in this study. The authors would also like to thank Drs. Shinya Nakajima, Tomoki Asai, Sachiko Motohashi, and Yoriko Horiguchi for performing experiments, and the hemodialysis treatment staff at the Sagami Circulatory Organ Clinic for their contributions to this study.

Funding

This research was supported by JSPS KAKENHI (Grant Numbers 26350631 and 19K11372).

Author information

Authors and Affiliations

  1. Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan

    Takaaki Watanabe, Toshiki Kutsuna, Yuta Suzuki, Takahiro Shimoda, Shohei Yamamoto, Yusuke Isobe, Keigo Imamura, Kentaro Kamiya & Atsuhiko Matsunaga

  2. Department of Physical Therapy, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan

    Toshiki Kutsuna

  3. Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Japan

    Manae Harada

  4. Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan

    Shohei Yamamoto

  5. Department of Clinical Psychology, Tsurukawa Sanatorium Hospital, Tokyo, Japan

    Yusuke Matsunaga

  6. Department of Health Science, Kitasato University School of Allied Health Sciences, Sagamihara, Japan

    Yusuke Matsunaga

  7. Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan

    Ryota Matsuzawa

  8. Department of Nephrology in Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan

    Yasuo Takeuchi

  9. Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan

    Atsushi Yoshida

  10. Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan

    Kentaro Kamiya & Atsuhiko Matsunaga

Authors
  1. Takaaki Watanabe
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  2. Toshiki Kutsuna
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  14. Atsuhiko Matsunaga
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Contributions

TW, TK, YS, NM, RM, KK, YT, AY, and AM analyzed and interpreted the patient data regarding ADL difficulty and contributed to the preparation of the manuscript. MH, TS, SY, YI, KI, and YM performed measurements of physical activity and ADL difficulty. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atsuhiko Matsunaga.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Kitasato University (2015-033).

Consent to participate

This study was performed as a part of usual care of clinic, and there was no infringement of physical and/or psychological integrity of the subjects; therefore, informed consent was not needed.

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Watanabe, T., Kutsuna, T., Suzuki, Y. et al. Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis. Int Urol Nephrol 53, 177–184 (2021). https://doi.org/10.1007/s11255-020-02600-0

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