Abstract
The number of elderly hemodialysis patients is constantly increasing worldwide. This population has a high burden of comorbid conditions, which impair daily activities. The aim of the study was to analyze problems of disability in hemodialysis patients in the context of cardiovascular (CV) complications and vascular condition. In this cross-sectional study, 129 patients (mean age 64.5) were enrolled. The degree of disability in Barthel index (Bi) and 10-year cardiovascular risk (QRISK®3) were assessed. A Mobil-O-Graph monitor was used for measuring hemodynamic parameters. Only 6.2% of patients were professionally active, 19% used a wheelchair for transport, and 16% used crutches. More than half (51%) were independent in everyday activities reaching 80–100 points on Bi. The rest, with Bi < 80, were considered as dependent. The most common causes of disability were CV complications. The independent group (80–100 points) was characterized by significantly lower pulse wave velocity (PWV) and lower QRISK®3 compared to dependent patients. The degree of disability negatively correlated with age, PWV, and QRISK®3. Multivariate logistic regression revealed that disability (Bi < 80) was independently associated with CV events in the past adjusted odds ratio (adj.OR) 4.83 (95% confidence interval (95% CI): 1.74–13.41) and higher PWV adj.OR 1.45 (95% CI: 1.15–1.82). Our results indicate that CV diseases are the most important cause of functional impairment.
Highlights
Patients aged 75 years or older represent the fastest growing segment of the subjects starting dialysis [1]. This population has a high burden of comorbid conditions, including cardiovascular (CV) diseases, which lead to disability and the need for continuous care resulting from problems in performing activities of daily living (ADLs)
The most common causes of disability were heart problems, including heart failure in 20.9% of the patients, lower limb ischemia, diabetic foot, and amputation in 13.2%, and cerebrovascular event in 10.9%, followed by weakness associated with dialysis and degenerative joints disease
Cardiovascular diseases of heart, brain, and blood vessels as a leading cause of disability were more frequently observed in comparison to the independent group of patients
Summary
Patients aged 75 years or older represent the fastest growing segment of the subjects starting dialysis [1] This population has a high burden of comorbid conditions, including cardiovascular (CV) diseases, which lead to disability and the need for continuous care resulting from problems in performing activities of daily living (ADLs). In this group, ADLs disability is strong and independent predictor of mortality [2]. Some data indicate that the musculoskeletal system involvement may significantly decrease the physical function of patients with end-stage renal disease [4] In many cases, both CV diseases and disturbances of the musculoskeletal system may coexist, leading to extend functional disability (FD). We hypothesized that the leading cause of functional impairment are cardiovascular complications, as a consequence of changes in vascular system
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