Abstract
ObjectivesTo survey by measuring patient’s functional status which is crucial when end-stage renal disease patients begin a dialysis program. The influence of the disease on patients can be examined by the measurement of Karnofsky Performance Status (KPS) scores, together with a quality of life survey, and clinical variables.MethodsThe details for the dataset in the study were collected from patients receiving regular hemodialysis (HD) in one hospital, which were available retrospectively for 1166 patients during the 5-year study period. KPS scores were applied for quantifying functional status. To identify risk factors for functional status, clinical factors including demographics, laboratory data, and HD vintage were selected. This study applied a classification and regression tree approach (CART) and logistic regression to determine risk factors on functional impairment among HD patients.ResultsTen risk factors were identified by CART and regression model (age, primary kidney disease subclass, treatment years, hemoglobin, albumin, creatinine, phosphorus, intact parathyroid hormone, ferritin, and cardiothoracic ratio). The results of logistic regression with selected interaction models showed older age or higher hematocrit, blood urea nitrogen, and glucose levels could significantly increase the log-odds of obtaining low KPS scores at in-person visits.ConclusionsIn interaction results, the combination of older age with higher albumin level and higher creatinine level with longer HD treatment years could significantly decrease the log-odds of a low KPS score assessment during in-person visits. Age, hemoglobin, albumin, urea, creatinine levels, primary kidney disease subclass, and HD duration are the major determinants for functional status in HD patients.
Highlights
Dialysis therapy is the mainstay of treatment for endstage renal disease (ESRD)
The classification and regression tree approach (CART) analysis results showed that the pattern of risk factors differed across the main node of age, and that outcomes were not related to dialysis adequacy, and were not strongly related to Hb levels
We present two tools to investigate the clinical variables related to functional status measured by Karnofsky Performance Status (KPS) in HD patients
Summary
Dialysis therapy is the mainstay of treatment for endstage renal disease (ESRD). In recent years, equal importance has been placed on dialysis adequacy, and on quality of life (QoL) in order to reduce mortality in dialysis patients [1,2,3,4,5,6]. A previous study reported that poor functional status scores were associated with mortality after a 3-year follow-up in hemodialysis (HD) patients [7]. Owing to the noted pitfalls in the original KPS scale, a modified version of the KPS was proposed in order to study the functional status of dialysis patients [7, 13]. It consists of 14 different levels of activity, ranging from < 30 (hospitalized, progressive disability process) to ≥ 96 (normal function). Based on the aforementioned background, a KPS measurement is frequently used to complement medical information, together with a QoL survey, and clinical variables to examine the influence of the disease on patients
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