P1543FACTORS ASSOCIATED WITH CHANGE IN FUNCTIONAL STATUS IN HEMODIALYSIS PATIENTS
Authors: Imamura Keigo , Suzuki Yuta , Yamamoto Shohei , Harada Manae , Ito Haruka , Yamabe Sachi , Yoshikoshi Shun , Kamiya Kentaro , Yosida Atsusi , Matsunaga Atsuhiko 
Published: June 2020

Abstract

Background and Aims
Hemodialysis (HD) patients have poor functional capacity. Expert clinical practice guidelines strongly recommend an assessment of functional status (FS) and treatment strategies in chronic kidney disease patients. A previous study demonstrated a high level of disability in daily activities in most HD patients, and a dose-response association was seen between poor FS at baseline and adverse clinical outcomes in HD patients. Moreover, a recent study reported that patients with a decline in FS over a 1-year period are at an elevated risk of mortality. Therefore, identifying factors that predict a decline in FS is important for developing treatment strategies. The purpose of this study was to investigate the factors that predict this decline in HD patients.

Method
A total of 146 outpatients (mean age of 66.1±11.0 years; 48% were female) undergoing maintenance HD thrice a week at an HD center were included. FS was assessed based on the ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs) as self-reported on the Katz Index of Independence and the Lawton-Brody IADL scale, respectively The Katz Index of Independence examines five tasks of ADLs, and the Lawton-Brody IADL scale examines eight tasks of IADLs. Both have been validated in the general population. We then calculated the FS score by combining the scores of the Katz Index of Independence and Lawton-Brody IADL scale in accordance with the algorithm developed in a previous study, and the assessments were conducted at baseline and after 1 year. We classified patients into two groups based on having or not having at least a 1-point decline in the FS score. Background factors such as age, sex, body mass index, comorbidities score, hemodialysis time, primary kidney disease, hemoglobin level, and geriatric nutritional risk index were collected at baseline. In addition, for physical function, the usual gait speed and handgrip strength and for body composition, the skeletal muscle mass by bioelectrical impedance analysis were analyzed at baseline. To investigate factors predicting a decline in FS 1 year later, logistic regression analysis was used.

Results
Over the study period, 29.5% of the patients showed a decline in the FS score. Patients who showed a decline were older (71.2 years vs. 64.0 years), had weaker handgrip strength (22.9 kg vs. 24.8 kg), and exhibited slower usual gait speed (1.06 m/s vs. 1.22 m/s) than those who did not show decline at baseline. To predict a decline in FS 1 year later, age (odds ratio: 1.07, 95% confidence interval [CI]:1.02-1.13, p=0.003) and usual gait speed (odds ratio: 0.17, 95% CI: 0.03-0.96, p=0.04) were determined as significant factors.

Conclusion
Gait speed was a predictor of a decline in FS after 1 year. These findings underscore the significance of gait speed assessment in addition to monitoring the patient's FS. Moreover, intervention in maintaining gait speed may be essential in preventing the FS from deteriorating over time.