Dismal rehabilitation in geriatric inner-city hemodialysis patients.
OBJECTIVE
To assess the extent of functional and vocational rehabilitation achieved by elderly inner-city patients sustained on maintenance hemodialysis.


METHODS
Inception cohort study of elderly patients who have end-stage renal disease using a modified Karnofsky rating system. The need for a wheelchair, participation in household activities, and effect of comorbid conditions were noted. Current status was compared with patient's recollection of functional activity level 2 years before commencing maintenance hemodialysis.


METHODS
Seven outpatient, hospital-affiliated and private hemodialysis units in Brooklyn, NY.


METHODS
One hundred four patients aged 65 years or older who were receiving maintenance hemodialysis for at least 6 months.


METHODS
A score of 76 or greater on a modified Karnofsky scale indicated independent function at a level that permitted participation in activities beyond those mandated by the hemodialysis regimen. A comorbidity score 6 or greater on a newly constructed index correlated with severe debility. Employment status was also recorded.


RESULTS
Present functional activity had deteriorated to a modified Karnofsky score of 66 +/- 12.3 (+/- SD) compared with patients' recollection of a mean score of 84 +/- 14.3 (P < .001) 2 years before initiation of hemodialysis. Diabetic patients had a lower score than nondiabetic patients. The mean comorbidity index of the entire study group was 7.8 +/- 2.9 (mean +/- SD). Within the diabetic subset, severe debility constrained 71 patients (68%) to limit all activity to their residence with the exception of travel to and from their dialysis facility. By contrast, 2 years prior to commencing dialytic therapy, 81 diabetic patients (78%) had interests and activities that took them outside their homes (P < .001). Generalized weakness was the most common explanation given for the lack of outside activity by nine patients (9%) who were wheelchair bound. Erythropoietin, though regularly administered to 87 patients (84%) in the study group, was unsuccessful in raising mean hematocrit reading above 0.28 +/- 0.05 (mean +/- SD).


CONCLUSIONS
Maintenance hemodialysis does not return inner-city elderly patients to their predialysis level of functioning. Few elderly, diabetic hemodialysis patients conduct any substantive portion of their lives outside their homes. For nondiabetic patients, the modified Karnofsky score of whites (70.4 +/- 11.9) and blacks (66.5 +/- 15.3), though low, was equivalent (P < .4).
Ifudu
O
O
Department of Medicine, State University of New York Health Science Center, Brooklyn 11203.
Mayers
J
J
Matthew
J
J
Tan
C C
CC
Cambridge
A
A
Friedman
E A
EA
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D009519:New York City; D017063:Outcome Assessment, Health Care; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People; D001741:Black or African American
D004921:Erythropoietin