title: Renal function and decline in functional capacity in older adults.
abstract: BACKGROUND
  longitudinal relationship between renal function, disability and mortality has not been evaluated.
  
  
  OBJECTIVE
  we investigated the temporal association between renal function and disability, and aimed to identify the influence of disability on mortality according to renal function in a cohort of older Koreans.
  
  
  METHODS
  Korean Longitudinal Study on Health and Aging is a prospective, population-based cohort.
  
  
  METHODS
  community-dwelling Koreans ≥65 years of age.
  
  
  METHODS
  Korean version of activities of daily living (ADL), Instrumental activities of daily living (IADL) and all-cause mortality.
  
  
  RESULTS
  a total of 984 participants were followed for 5 years with a 70.9% participation rate. The participants were categorized into three groups according to their baseline estimated glomerular filtration rates (eGFRs) (Group I, ≥60; Group II, 45-59; and Group III, <45 ml/min/1.73 m(2)). Baseline eGFR was higher in participants who maintained functional status compared with participants who died or had disability at follow-up examination. The incidence of ADL/IADL decline was 13, 12.5 and 29.5% in participants who showed improvement, no change, and decline in renal function, respectively (P = 0.01). The hazard ratio for mortality in the subgroup with IADL disability was 1.87 (95% CI: 1.10-3.20, P = 0.022) in Group I, and 2.53 (95% CI: 1.57-4.09, P<0.001) in Groups II and III after adjustment.
  
  
  CONCLUSIONS
  impaired renal function was related to disability and ADL/IADL decline. The effect of ADL/IADL disability on mortality was more prominent in participants with impaired eGFR.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea Department of Internal Mecidine, Seoul National University College of Medicine, Seoul, Korea Renal Institute, Clinical Research Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea.
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea.
authors.forename: Sejoong
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea Department of Internal Mecidine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Na
authors.affiliation: Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea.
authors.forename: Ki Woong
authors.initials: KW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea Department of Internal Mecidine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Dong-Wan
authors.initials: DW
authors.lastname: Chae
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea Department of Internal Mecidine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Cheol-Ho
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hopsital, Seongnam, Korea Department of Internal Mecidine, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kwang-Il
authors.initials: KI
authors.lastname: Kim
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000375:Aging; D002423:Cause of Death; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D056910:Republic of Korea; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: chronic kidney disease; disability; mortality; older adults; older people