Impaired activities of daily living (ADLs) have been shown to cause reduced physical activity and can predict the occurrence of cardiovascular events in older community-dwelling adults. Recently, in addition to the life expectancy, the percentage of elderly Japanese patients undergoing maintenance haemodialysis (HD) has increased. Although >50% of patients undergoing HD retain the ability to perform ADLs without assistance, most patients undergoing HD report difficulties with performing ADLs related to mobility. To our knowledge, no study has investigated the association between difficulties with ADLs and cardiovascular events in patients undergoing HD.
This study investigated the association between difficulties with ADLs and cardiovascular events in patients undergoing HD.
This study included 300 outpatients (178 men, 122 women, mean age 64.1±10.9 years) undergoing maintenance HD thrice a week at an HD centre. Exclusion criteria for the study were hospitalisation =3 months prior to study enrolment, and the need for assistance with walking. Baseline clinical characteristics including age, sex, body mass index, the Geriatric Nutritional Risk Index, the primary cause of end-stage renal disease, time of initiation of HD, comorbidities, and haemoglobin and serum albumin levels were recorded. Difficulties with ADLs were assessed using a questionnaire describing perceived difficulty with mobility among patients undergoing HD . Patients were instructed to rate the perceived difficulty in performing 12 tasks related to mobility on a scale of 1–5 (1=not possible, 2=severe difficulty, 3=moderate difficulty, 4=mild difficulty, and 5=ease with performing task). Patients were classified into 3 groups based on tertiles of the ADL difficulty score (low, middle, and high difficulty groups). The log-rank test, Kaplan–Meier analysis, and Cox proportional hazards regression analysis were used to investigate the association between difficulties with ADLs and cardiovascular events.
During the follow-up period (median duration 52 months), 54 patients (18.0%) demonstrated cardiovascular events. Of these 54 patients, 12 (22.2%), 19 (35.2%), and 23 (42.6%) patients were from the low, middle, and high difficulty groups, respectively. Kaplan–Meier analysis followed by the log-rank test showed that the incidence of cardiovascular events in the high difficulty group was significantly higher than that in the low difficulty group (P <0.01). After adjusting for the effects of clinical characteristics, the hazard ratio for the incidence of cardiovascular events in the high difficulty group was 2.28 (95% confidence interval 1.08–4.82, P=0.03) compared with the low difficulty group.
Difficulties with ADLs were significantly associated with cardiovascular events in clinically stable patients undergoing HD.