title: Decreased mobility after starting dialysis is an independent risk factor for short-term mortality after initiation of dialysis.
abstract: OBJECTIVE
  Impaired mobility at the onset of dialysis is considered one of the most important risk factors for short-term mortality after initiation of dialysis in elderly patients. However, whether a decline in mobility after starting dialysis also affects mortality is unclear.
  
  
  METHODS
  A total of 202 patients (age, >75 years; mean, 80.4 ± 4.3) were enrolled in this retrospective cohort study in Yokosuka, Japan. They were divided into three subgroups by mobility: independent mobility at onset of dialysis and preservation of mobility after starting dialysis (group 1, n = 104); independent mobility at onset of dialysis and decline in mobility after starting dialysis (group 2, n = 48); and impaired mobility at onset of dialysis (group 3, n = 50). They were followed for 6 months after starting dialysis. A Cox proportional hazards model was used to evaluate the association between mobility and mortality.
  
  
  RESULTS
  A total of 24.8% of patients had impaired mobility at the start of dialysis, and 68.9% declined in mobility after starting dialysis. In multivariate Cox proportional hazards analysis, the adjusted hazard ratios of groups 2 and 3 compared with group 1 were 3.80 (95% confidence interval, 1.02-14.10) and 4.94 (95% confidence interval, 1.42-17.10), respectively.
  
  
  CONCLUSIONS
  Not only impaired mobility at the start of dialysis but also a decline in mobility after starting dialysis is associated with short-term mortality after initiation of dialysis.
authors.affiliation: Department of Nephrology, Yokosuka Kyosai Hospital, Yokosuka, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Arai
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Kanda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Chisato
authors.initials: C
authors.lastname: Yamamura
authors.forename: Suguru
authors.initials: S
authors.lastname: Hirasawa
authors.forename: Shota
authors.initials: S
authors.lastname: Aki
authors.forename: Naoto
authors.initials: N
authors.lastname: Inaba
authors.forename: Makoto
authors.initials: M
authors.lastname: Aoyagi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Teiichi
authors.initials: T
authors.lastname: Tamura
authors.forename: Sei
authors.initials: S
authors.lastname: Sasaki
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D051346:Mobility Limitation; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: dialysis; elderly; mobility; mortality; risk factor