Functional Disability in Older Adults Maintained on Peritoneal Dialysis Therapy

Abstract

♦ Background: Older in-center hemodialysis patients have a high burden of functional disability. However, little is known about patients on home chronic peritoneal dialysis (PD). As patients opting for home dialysis are expected to play a greater role in their own dialysis care, we hypothesized that a relatively low number of PD patients would require help with basic self-care tasks (ADL) and instrumental activities of daily living (IADL). ♦ Methods: We used a cross-sectional study design to measure the proportion of patients aged 65 years and older undergoing outpatient PD who needed help with day-to-day activities. Patients living in nursing homes were excluded from the study. Functional dependence in ADL and IADL tasks were measured by the Barthel and Lawton Scales. Physical performance measures used included the timed up-and-go (TUG) test, chair stands and Folstein mini-mental score (MMSE).♦ Results: A total of 74 of 76 (97%) eligible PD patients participated. Patients had a mean age of 76.2 ± 7.5 years. Thirty-six percent had impaired MMSE scores, 69% were unable to stand from a chair without the use of their arms and 51% had abnormal TUG scores. Only 8 patients (11%) were fully independent for both ADL and IADL activities. Dependence in one or more ADL activity was reported by 64% of participants, while 89% reported dependence in one or more IADL. ♦ Conclusions: Impaired physical and functional performance is common in older patients maintained on PD. Collaborative geriatric-renal programs may be beneficial within the dialysis community.

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis

“…The observation that PD patients on continuous ambulatory PD were more likely to fall than those on continuous cycler PD would seem to support the idea that those living a more active lifestyle experience an increased fall risk. However, in our study, the patients reported similar levels of functional dependence to that seen in the HD population (21). Furthermore, we have no clear explanation of the observation that patients maintained on PD reported requiring more help with ambulation than those maintained on HD, yet objectively had a better average gait speed.…”

Geriatric Assessment, Falls and Rehabilitation in Patients Starting or Established on Peritoneal Dialysis

“…Cognitive dysfunction appears equally common and severe as in the HD population, as does functional decline (8,9). Functional decline may manifest in multiple ways.…”

“…In a small single-center study of patients aged 65 years and older established on PD, only 11% of patients reported being fully independent in all activities of daily living. Of those with some form of dependence, many had only mild impairments; however, 64% had limitations affecting personal care (9). The presence of functional limitations does not appear to deter from the use of PD as a dialysis modality (10), particularly as assisted PD is increasingly available, but it may impact on quality of life and lead to high levels of caregiver stress (11,12).…”

Physical function was related to mortality in patients with chronic kidney disease and dialysis

“…8,9 Patients with CKD are often impaired in terms of working, walking, and cognition; they experience difficulties in the activities of daily living (ADL). [12][13][14] Exercise capacity in patients with dialysis is low compared to the age-predicted value. Exercise training may improve physical activity and increased physical activity can prevent muscle loss in patients with CKD.…”