Quiz Could Determine Patients' Death Risk

Photo: Dialysis device

A quiz testing physiological
reserves can determine a dialysis
patient's death risk;© panther-
media.net/Katja Pfannenschmidt

Believing that kidney failure mimics an accelerated body-wide aging process Dorry L. Segev, associate professor of surgery at the Johns Hopkins University School of Medicine, 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, leader of the study. According to him, needing assistance with basic activities of daily living has been well documented in the geriatrics field as a predictor of adverse outcomes.

"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 cannot handle stressors as well as they used to. There is growing evidence that dialysis and kidney failure not only represent deterioration of kidney function but also cause deterioration of function in other organ systems."

"Measuring a dialysis patient's ability to perform activities of daily life may be an important tool," says Mara A. McAdams-DeMarco, a Johns Hopkins epidemiologist. "This information is simple to capture, does not require sophisticated tests and could help us better target the right patients for intervention."

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.

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.

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).

MEDICA.de; Source: John Hopkins Medicine