期刊
KIDNEY360
卷 2, 期 4, 页码 629-638出版社
AMER SOC NEPHROLOGY
DOI: 10.34067/KID.0005802020
关键词
chronic kidney disease; adverse outcomes; CKD; ESKD; functional assessments; IADL; MMSE; SPPB
资金
- National Institute of Diabetes and Digestive and Kidney Diseases [R01 DK084017]
- University of Maryland, Baltimore, Institute for Clinical & Translational Research (ICTR)
- National Center for Advancing Translational Sciences (NCATS) Clinical Translational Science Award (CTSA) [1UL1TR003098]
- University of Maryland School of Medicine, Summer Program in Obesity, Diabetes, and Nutrition Research Training (UMSOM SPORT) grant [T35-DK095737]
This study found that as performance-based functional assessment scores decreased, the risk of death and adverse outcomes in CKD patients increased. Specifically, low SPPB performers had the highest risk. This suggests that various performance-based functional assessments may have significant implications for the prognosis of CKD patients.
Background The comparative utility of performance-based functional assessments in predicting adverse outcomes in CKD is unknown. To examine their relative utility, we examined three performance-based functional assessments in an observational cohort of patients with CKD. Methods We recruited 350 participants with stage II-V, predialysis CKD. Participants were administered three performance-based functional assessments: Short Physical Performance Battery (SPPB), Modified Mini-Mental Status Exam (M3SE), and Lawton Instrumental Activities of Daily Living (IADL). Scores were dichotomized on the basis of the median and combined into a summary score. Outcomes included 50% GFR reduction, ESKD, and death. We used Cox proportional hazards to assess the association of performance-based functional assessments with outcomes. Results Compared with high performers, low SPPB performers had the highest adjusted rate of death, ESKD, or 50% reduction in GFR (HR, 1.96; 95% CI, 1.28 to 2.99). Low SPPB had the strongest association with death when adjusted for multiple covariates (HR, 2.43; 95% CI, 1.36 to 4.34). M3SE performance was not associated with any adverse outcome. None of the performance-based functional assessments were associated with ESKD, but a low IADL score was associated with a lower hazard ratio for ESKD or 50% decline GFR (HR, 0.49; 95% CI, 0.24 to 1.00). Conclusions Low SPPB score was the strongest predictor of death and all adverse outcomes as a composite. Future trials should determine if outcomes for patients with CKD who have poor physical performance and low SPPB scores are improved by targeted interventions.
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