Nephrologists are only too familiar with dialysis patients challenged by disabilities and myriad health issues.
But a recent study by Johns Hopkins University found that a simple quiz to determine how well dialysis patients perform daily living tasks could help doctors better identify at-risk patients who need close monitoring and extra help.
The study, which appeared in the October issue of the Journal of the American Geriatrics Society, followed 143 patients who were recruited from a Baltimore dialysis center between January 2009 and March 2010 and monitored until November 2011. Study participants' average age was 60.6, and 41 percent had at least one activities of daily living (ADL) disability, or the inability to eat, dress, walk, groom, use the toilet or bathe without assistance.
Researchers used a simple quiz that asks patients about their ability to perform daily living tasks to gauge their level of disability. The quiz is typically used to assess disability in the elderly.
The study found that disability was associated with 3.37 times higher mortality in the patients, with similar results in adults younger than 65. The patients' other diseases, including peripheral vascular disease, rheumatoid arthritis, hypertension, chronic obstructive pulmonary disease and diabetes mellitus, were also factored into the study.
Dr. Dorry Segev said he and fellow researchers wanted to perform the study to get a better idea of which patients would do well on dialysis and which were at highest risk for decline and death. That way, doctors could identify at-risk patients faster and come up with suggestions to help improve their survival while on dialysis, said Segev, associate professor of surgery, epidemiology and biostatistics at Johns Hopkins.
"The thing that motivated this was clinical evidence that patients with kidney failure undergoing dialysis seem to undergo this physiologic aging that happens to other people only much later in life," said Segev, who also directs clinical research on transplant surgery. "These six simple questions end up being a very surprisingly accurate screen for people who are at risk."
Segev noted that patients of all ages on dialysis have a high prevalence of ADL disability, at least five times higher than people over age 65.
"So this is a population that while chronologically young is physiologically quite old," Segev said.
Interventions for such patients could include physical or occupational therapy, as well as closer monitoring so doctors could catch problems before they lead to further decline and death.
Segev and colleagues are also studying the effect of the quiz and the role of frailty in predicting outcomes for kidney transplant patients. If patients aren't likely to do well after a transplant, "prehabilitation," or strength training to prevent injuries, might help them better tolerate the procedure, Segev said.
"The goal is to identify the people who we think might benefit from those interventions," he said.
Dr. Vinod Bansal, who directs the chronic dialysis program at Loyola University Health System, said the study showed the often overlooked importance of closely monitoring dialysis patients for functional ability. ADL disabilities could affect the patient's willingness or ability to comply with often strict medication and dietary regimens, he said.
"I think it's one of the so-called slightly neglected areas," Bansal said. "It needs to be emphasized because it may have some bearing on their total outcome."
Bansal and his colleagues recently performed an informal 12-week study in which health professionals and volunteers held short, informal, friendly chats with patients about the importance of taking medications on time and the value of programming ring reminders on cellphones They also advised them to eat unsalted almonds and an apple daily to prevent constipation, and to increase physical activity by using a pedometer. The study found that 24 percent of patients had stabilized lab values and 76 percent showed improvement as a result of the conversations. The results were presented at a spring National Kidney Foundation meeting.
"These patients come three times a week to the dialysis unit, and it becomes part of their social circle," said Bansal about the importance of having a positive and supportive rapport with patients.Copyright © 2015, The Baltimore Sun