A new study shows that patients undergoing dialysis have decreased functioning as measured by their ability to perform activities for daily living (ADLs).

CKD and dialysis

Patients who have CKD, or chronic kidney disease, are on a continuum of stages. In the first stage, kidney dysfunction is so low as not to be recognized. In the end stage, kidney dysfunction is complete and a person cannot live without many hours of dialysis. There is no cure for kidney dysfunction, and the only chance at regeneration is a transplant. Patients can live for years on dialysis, but will not get better without a new kidney. 

Dialysis and activities for daily living

The study covered 187 patients over the age of 65 and followed them for a 6 month period. At the end, 40% had declined in functionality, while 8% had died, 18% actually improved in functionality, and 34% remained the same. 

The study also showed that caregiver responsibilities increased along with dialysis, with 38% saying that their burden was high, as opposed to only 23% before.

The authors of the study noted that age had a lot to do with the decline. The loss of functionality for all patients was shown their their loss of ability to perform functions independently, as measured through instrumental ADLs, and as the patients aged, the decline became more prominent. ADLs refer to activities such as taking care of their personal  hygiene and doing their own laundry. As they decline in functionality, the burden on their caregiver increases proportionately. 

The mean age of the study group was 75, and about one third of the group were women. About half of the group had kidney failure due to vular issues, and 19% because of diabetes. These were the most common causes of kidney failure in the study group. Researchers studied the patients at one period and then again at a period of 6 months later. The baseline factors assessed were patient functionality based on activities for daily living, instrumental activities for daily living (IADLs), and the load on the caregivers. IADLs are a level above ADLs – they refer to the patient’s ability to  take care of their homes, prepare their own food, manage their finances, and move around within their communities.

This study was different from previous, similar studies since this covered dialysis in the general elderly population, whereas previous studies were smaller and selected the study group from nursing facilities or other places where patients were already at a health decline.

Conclusions and recommendations

The authors of the study say that we can see from this study that dialysis has a strong negative effect on the health and functionality on the elderly population. Once we have this information, doctors should use it to help identify dialysis patients at risk of declining functionality and help with prevention as well as aiding in ADLs. They should also monitor the caregivers and offer respite care and other aid as necessary. 

At Hudson View Center for Rehabilitation in Bergen Country, New Jersey, our excellent staff of doctors, nurses and therapists can help patients on dialysis as well as give some much-needed assistance to home caregivers.

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