Abstract
BackgroundThe impact of length of hospital stay on activities of daily living (ADLs) has not specifically been investigated among dialysis patients. Therefore, we attempt to verify the association between the length of hospital stay and the decline in ADLs among hemodialysis patients.MethodsThis prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). We included 2442 hemodialysis patients aged ≥40 years from the J-DOPPS phase V (2012–2015) and subsequently excluded those who had already lost basic activities of daily living (BADLs) as demonstrated by dependency in at least three of the five BADLs at baseline and for whom changes in ADLs had been evaluated for less than 90 days. The main exposure was the cumulative length of hospital stay during the follow-up period. The primary outcomes were a decline in at least one of the five BADLs and eight instrumental activities of daily living (IADLs). We compared risk ratios (RRs) for 30-day increments for hospital stays with 10-year increments for age and having diabetes.ResultsA total of 849 patients were included in the statistical analysis. The cumulative length of hospital stay was significantly associated with a risk of decline in ADLs (adjusted RRs [95% confidence intervals] per 30-day increments: 1.42 [1.15 to 1.75] for BADLs, 1.38 [1.13 to 1.68] for IADLs). The adjusted RRs [95% CI] for 10-year increments in age were 1.20 [0.96 to 1.50] and 1.21 [1.00 to 1.47]. The adjusted RRs [95% CI] for having diabetes were 1.36 [0.97 to 1.91] for BADLs and 1.38 [1.04 to 1.84] for IADLs.ConclusionThe impact of a 30-day increment in the cumulative length of hospital stay on the decline in ADLs was comparable to that of a 10-year increase in age and having diabetes.
Highlights
The impact of length of hospital stay on activities of daily living (ADLs) has not been investigated among dialysis patients
Design, and setting This prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (JDOPPS). It is a part of the Dialysis Outcomes and Practice Patterns Study (DOPPS), which is an international longitudinal study conducted on hemodialysis patients
Association between cumulative length of hospital stay and declines in Basic Activity of Daily Living (BADL) and Instrumental Activity of Daily Living (IADL) The cumulative length of hospital stay was associated with an increased risk of decline in BADLs (adjusted risk ratio (RR), 1.012, 95% confidence interval (CI) [1.005 to 1.020], P = 0.002) and IADLs (adjusted RR, 1.011, 95% CI [1.004 to 1.019], P = 0.003)
Summary
The impact of length of hospital stay on activities of daily living (ADLs) has not been investigated among dialysis patients. The strategies used to reduce the number of hospitalizations might not clear-cut for hemodialysis patients, since they frequently have to visit hospitals to ensure effective care management (e.g., management of vascular access). For this population, reducing the total length of hospital stay might be a more realistic target. No study has evaluated the association between length of hospital stay and functional impairment in hemodialysis patients, in particular, to date. In the current study, we aim to clarify the associations of the length of hospital stay and the number of hospitalizations with declines in BADLs and IADLs
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