title: Physical function at the time of dialysis initiation is associated with subsequent mortality.
abstract: BACKGROUND
  In dialysis patients, physical function is associated with mortality. However, the association between physical function at the time of dialysis initiation and subsequent mortality remains unknown.
  
  
  METHODS
  A total of 1496 patients with chronic kidney disease who initiated dialysis at 17 centers participating in the Aichi Cohort Study of the Prognosis in Patients Newly Initiated into Dialysis, a multicenter prospective cohort study, were included. The patients were divided into the high (H)-, middle (M)-, and low (L)-score groups according to Barthel index (BI) at the time of dialysis initiation, and the all-cause, cardiovascular disease (CVD)-related, and infection-related mortality rates were compared. Moreover, factors affecting all-cause mortality were investigated. The effects of BI on mortality were assessed in the patients stratified by age, sex, and history of CVD or cerebral infarction.
  
  
  RESULTS
  A log-rank test for the Kaplan-Meier survival curve showed significant differences between the three groups in all-cause, CVD-related, and infection-related mortality rates (p < 0.001). Cox proportional hazard regression analysis with the step-wise method showed a significantly higher risk of all-cause mortality in the M and L groups than in the H group (M group: HR 1.612, 95 % CI 1.075-2.417; L group: HR 1.994, 95 % CI 1.468-2.709). Regardless of the age categories and the history of CVD, the risk of all-cause mortality was significantly higher in the L group than in the H group.
  
  
  CONCLUSIONS
  Physical function assessed by BI at the time of dialysis initiation was found to be associated with subsequent mortality.
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. inaguma@nagoya2.jrc.or.jp.|Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), Aichi, Japan. inaguma@nagoya2.jrc.or.jp.
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.affiliation: Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Tanaka
authors.affiliation: Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
authors.forename: Hibiki
authors.initials: H
authors.lastname: Shinjo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D003141:Communicable Diseases / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Barthel index; Chronic kidney disease; Dialysis initiation; Physical activity; Survival analysis