Oct. 12, 2012 A simple six-question quiz, typically used to assess disabilities in the elderly, could help doctors determine which kidney dialysis patients of any age are at the greatest risk of death, new Johns Hopkins research suggests.
Believing that kidney failure mimics an accelerated body-wide aging process transplant surgeon Dorry L. Segev, M.D., Ph.D., and his colleagues turned to geriatric experts to examine mortality risk in patients undergoing dialysis. They found that those who needed assistance with one or more basic activities of daily living -- feeding, dressing, walking, grooming, using a toilet and bathing -- were more than three times more likely to die than their more independent counterparts.
"This quiz helps us identify an at-risk group that would probably benefit from closer monitoring and maybe even physical therapy to improve their functioning," says Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study published in the Journal of the American Geriatrics Society.
Needing assistance with basic activities of daily living has been well documented in the geriatrics field as a predictor of adverse outcomes, says Segev, Johns Hopkins' director of clinical research in transplant surgery.
"The thing that puts older patients at risk for adverse outcomes is a decrease in physiological reserve," he says. "Organ systems start to deteriorate and when they don't function as well as they used to, they can't handle stressors as well as they used to. There's growing evidence that dialysis and kidney failure not only represent deterioration of kidney function but also cause deterioration of function in other organ systems."
More than 600,000 people in the United States are on dialysis because their kidneys can no longer efficiently filter toxins from the blood and remove them from the body. Dialysis often must be done several times a week for several hours at a time, a time-consuming and draining ordeal required to keep patients with kidney failure alive. Segev and his team followed 143 patients undergoing dialysis, all recruited from a dialysis center in Baltimore between January, 2009 and March, 2010. They were followed until November 15, 2011. There were 33 deaths during the study period, and the risk of death did not vary with age.
The prevalence of disability in the activities of daily living of kidney failure patients of all ages -- 41 percent in this study -- is strikingly higher than in older adults in the community at-large (5 to 8.1 percent of non-institutionalized adults over age 65).
"Measuring a dialysis patient's ability to perform activities of daily life may be an important tool," says Mara A. McAdams-DeMarco, Ph.D., a Johns Hopkins epidemiologist and contributor to the study. "This information is simple to capture, doesn't require sophisticated tests and could help us better target the right patients for intervention."
This study was supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation.
Other Johns Hopkins researchers involved in the study include Andrew Law, Sc.M.; Jacqueline M. Garonzik-Wang, M.D.; Luis Gimenez, M.D.; Bernard G. Jaar, M.D., M.P.H.; and Jeremy D. Walston, M.D.
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- Mara A. McAdams-DeMarco, Andrew Law, Jacqueline M. Garonzik-Wang, Luis Gimenez, Bernard G. Jaar, Jeremy D. Walston, Dorry L. Segev. Activity of Daily Living Disability and Dialysis Mortality: Better Prediction Using Metrics of Aging. Journal of the American Geriatrics Society, 2012; 60 (10): 1981 DOI: 10.1111/j.1532-5415.2012.04161.x
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