title: Functional impairment is associated with an increased risk of mortality in patients on chronic hemodialysis.
abstract: Functional impairment is associated with adverse outcomes in older people, as well as in patients on chronic hemodialysis. The aim of the present study was to determine the characteristics associated with functional impairment in chronic hemodialysis, and to evaluate if functional impairment represents a risk factor for reduced survival in chronic hemodialysis.
  
  
  
  All 132 chronic hemodialysis referring to the Hemodialysis Service of the Catholic University, Rome, Italy between November 2007 and May 2015 were included. All patients underwent comprehensive geriatric assessment; functional ability was estimated using two questionnaires exploring independency in bathing, dressing, toileting, transferring, continence, feeding (ADLs), and independency in using the telephone, shopping, food preparation, housekeeping, laundering, traveling, taking medications, and handling finances (IADLs). Functional impairment was diagnosed in presence of dependence in one or more ADLs/IADLs. Mood was assessed using the 30-item Geriatric Depression Scale. Logistic regression was used to evaluate factors associated with functional impairment. The association between functional impairment and survival was assessed by Cox regression.
  
  
  
  ADLs impairment was present in 34 (26 %) participants, while IADLs impairment was detected in 64 (48 %) subjects. After a follow up of 90 months, 55 (42 %) patients died. In logistic regression, depressive symptoms were associated with ADLs and IADLs impairment (OR 1.12; 95 % CI = 1.02-1.23; OR 1.16; 95 % CI = 1.02-1.33; respectively). In Cox regression, ADLs impairment was associated with mortality (HR 2.47; 95 % CI-1.07-5.67) while IADLs impairment was not associated with reduced survival (HR .80; 95 % CI-.36-1.76).
  
  
  
  Functional impairment is associated with depressive symptoms; also, impairment in the ADLs represents a risk factor of reduced survival in chronic hemodialysis. These associations and their potential implication should be assessed in dedicated studies.
authors.affiliation: Department of Surgery, Hemodialysis Service, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy. maubosso@tin.it.
authors.forename: Maurizio
authors.identifier: 0000-0003-1627-0235
authors.initials: M
authors.lastname: Bossola
authors.affiliation: Department of Clinical Chemistry, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Di Stasio
authors.affiliation: Department of Gerontology, Geriatrics and Psychiatry, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Antocicco
authors.affiliation: Department of Surgery, Hemodialysis Service, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy.
authors.forename: Gilda
authors.initials: G
authors.lastname: Pepe
authors.affiliation: Department of Surgery, Hemodialysis Service, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tazza
authors.affiliation: Department of Gerontology, Geriatrics and Psychiatry, Catholic University of the Sacred Hearth, Largo A. Gemelli, 8 - 00168, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Zuccalà
authors.affiliation: Department of Medicine, Unit of Geriatrics, Campus Bio-Medico di Roma University, Rome, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Laudisio
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000523:psychology; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D012384:Rome / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015996:Survival Rate
keywords: ADLs; Depression; End-stage renal disease; Hemodialysis; IADLs impairment; Mortality