A closer look at the trajectory of physical functioning in chronic hemodialysis.
in chronic hemodialysis, physical functioning (PF) is known to be poor. We set out to assess to what extent chronic dialysis patients are able to maintain a good physical condition over time and what the influence of age is on the trajectory of PF.



we used data form 714 prevalent hemodialysis patients, enrolled in the CONvective TRAnsport STudy (CONTRAST). The PF subscale of the KDQOL SF-36 was assessed at baseline (n = 679) and during 2 years of follow-up (n = 298). Baseline PF score (0-100) was categorized into tertiles (good, intermediate and low). Change of PF of ≥ 5 points was considered clinically relevant. A regression model was applied to assess factors related to 'decline of PF (≥5 points)/low PF (0-33) at follow-up'.



during follow-up, only 15.3 % (1 out of 6) of patients succeeded in maintaining a good physical condition, the remainder deteriorated or died. Of the older patients (≥75) only 3.6% remained in a good physical condition. Factors related to decline/low PF were increasing age (odds ratio [OR] = 1.96 [95% CI: 1.03-3.72] for 65-74 years and OR = 2.38 [95%CI: 1.17-4.84] for ≥75 years compared to <65 years) and albumin (OR = 1.10 [95%CI: 1.01-1.18] per g/L decrease).



very few hemodialysis patients maintain a good physical condition over a 2-year time span. Especially in older patients, physical performance is poor and decline is faster than in the healthy population. These findings should be taken into account when considering dialysis in older patients and more emphasis should be placed to attempts for improving physical condition.
Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands.|Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands.
Ismay
I
van Loon
Department of Geriatric Medicine, Diakonessenhuis, Zeist, Utrecht, Netherlands.
Marije E
ME
Hamaker
Dianet Dialysis Center, Brennerbaan 100, Utrecht 3524 BN, Netherlands.|Department of Internal Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands.
Franciscus T J
FTJ
Boereboom
Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands.
Muriel P C
MPC
Grooteman
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands.
Peter J
PJ
Blankestijn
Department of Internal Medicine, Maasstad Ziekenhuis, Rotterdam, Netherlands.
Rene M A
RMA
van den Dorpel
Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands.
Menso J
MJ
Nubé
Department of Internal Medicine, VU Medical Center, Utrecht, Netherlands.
Piet M
PM
Ter Wee
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands.
Marianne C
MC
Verhaar
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
Michiel L
ML
Bots
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009664:Norway; D016017:Odds Ratio; D011788:Quality of Life; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chronic kidney disease; hemodialysis; older people; physical functioning; quality of life