Independence in activities of daily living for end-stage renal disease patients: biomedical and demographic correlates.

Abstract

Factors associated with physical well-being were examined in a population-based sample of adult end-stage renal disease (ESRD) patients in Michigan (n = 459). The dependent variables were two measures of physical functioning: (1) a ten-item measure of activities of daily living (ADL), and (2) the 45-item physical dysfunction dimension of the Sickness Impact Profile (SIP). Independent variables included four modalities of treatment (in-center hemodialysis, continuous ambulatory peritoneal dialysis [CAPD], related transplant, and cadaver transplant); primary cause of ESRD (eg, diabetes, glomerulonephritis); comorbidity (other illnesses besides primary cause of ESRD); and demographic characteristics (sex, race, age, marital status, education). ADL and SIP unadjusted mean scores differed significantly by category for each of the eight study factors (analysis of variance [ANOVA], P less than 0.0001), with the exception of sex for SIP means. The highest levels of dependency in ADL were reported by patients who were older, female, black, widowed, less educated, treated with in-center hemodialysis, had diabetes as the primary cause of ESRD, and/or reported more comorbidity. The partial effect of each factor on the dependent measures with adjustment for the seven other factors was assessed using analysis of covariance (ANCOVA). In the ADL analysis, sex, race, age, primary cause of kidney failure, and comorbidity were significant factors (probability values ranging from 0.05 for race to 0.0001 for sex, primary cause of ESRD, and comorbidity). The SIP physical dysfunction measure gave slightly different results. Race, age, primary cause of ESRD, comorbid status, and modality of treatment were significantly related to physical dysfunction (P less than 0.05 to P less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)