Decreased mobility after starting dialysis is an independent risk factor for short-term mortality after initiation of dialysis

摘要

Aim Impaired mobility at the onset of dialysis is considered one of the most important risk factors for short-term mortality after initiation of dialysis in elderly patients. However, whether a decline in mobility after starting dialysis also affects mortality is unclear. Methods A total of 202 patients (age, >75 years; mean, 80.4±4.3) were enrolled in this retrospective cohort study in Yokosuka, Japan. They were divided into three subgroups by mobility: independent mobility at onset of dialysis and preservation of mobility after starting dialysis (group 1, n=104); independent mobility at onset of dialysis and decline in mobility after starting dialysis (group 2, n=48); and impaired mobility at onset of dialysis (group 3, n=50). They were followed for 6 months after starting dialysis. A Cox proportional hazards model was used to evaluate the association between mobility and mortality. Results A total of 24.8% of patients had impaired mobility at the start of dialysis, and 68.9% declined in mobility after starting dialysis. In multivariate Cox proportional hazards analysis, the adjusted hazard ratios of groups 2 and 3 compared with group 1 were 3.80 (95% confidence interval, 1.02-14.10) and 4.94 (95% confidence interval, 1.42-17.10), respectively. Conclusion Not only impaired mobility at the start of dialysis but also a decline in mobility after starting dialysis is associated with short-term mortality after initiation of dialysis. Summary at a Glance This retrospective Japanese study evaluated the influence of mobility at the time of, and after, commencing haemodialysis in a cohort of patients aged over 75 years. Mobility and its maintenance were associated with improved short-term survival even after adjusting for some comorbid conditions. However, whether these findings are generalizable to other populations or preventable require further larger scale studies.