Abstract
BackgroundThe risk of adverse events associated with peritoneal dialysis (PD) in elderly patients has not been thoroughly investigated. The purpose of this study was to assess the association between physical function and hospitalization in elderly PD patients.MethodsThis is a single-center prospective observational cohort study. Thirty-three aged patients (74.8 ± 5.9 years) participated in a 6-min walk distance, short physical performance battery (SPPB), lower extremity muscle strength, and 10-m walk speed. All subjects were followed until hospitalization to the end of the follow-up period.ResultsThe 6-min walk distance was 332 ± 112.5 m; SPPB was 11 (8.3–12) points; the lower extremity muscle strength was 36.6 ± 9.6%; 10-m walk speed was 1.1± 0.2 m/s. During the follow-up, 19 patients (57.5%) were hospitalized. In the Kaplan-Meier survival analysis and log-rank test, a lower 6-min walk distance and PD vintage were significantly associated with hospitalization (p<0.05). After adjustment for PD vintage in Cox proportional analysis, the 6-min walk distance remained associated with hospitalization (95% confidence interval, 0.98–0.99).ConclusionLower exercise tolerance assessed by the 6-min walk distance was significantly associated with hospitalization in elderly PD patients. Our findings indicate that measurement and intervention of exercise intolerance are essential to predict the clinical outcomes of elderly PD patients.Trial registrationThis study was prospectively registered at inception in the UMIN Clinical Trials Registry under identification number UMIN000038405.
Highlights
The number of elderly patients with end-stage renal disease (ESRD) and those undergoing peritoneal dialysis (PD) is rising in Japan
Of these 37 patients, three patients refused to participate in the study, and one patient was excluded due to medical reasons (Fig. 1)
After adjustment for PD vintage in Cox proportional analysis, the 6-min walk distance remained associated with hospitalization (Table 5, hazard ratios (HR) 0.96, 95% confidence interval (CI) 0.98–0.99)
Summary
The number of elderly patients with end-stage renal disease (ESRD) and those undergoing peritoneal dialysis (PD) is rising in Japan. Transfer from PD to in-center hemodialysis (HD) can be related to modality-associated complications, such as peritonitis or tunnel infections, catheter malfunction, and patient factors, such as stroke, worsening vision, or abdominal catastrophes unrelated to PD [3]. The risk of peritonitis, a major factor in PD withdrawal, was associated with the age at PD initiation, diabetes mellitus nephropathy, and the use of a sterile tubing welder device [4]. Prior HD therapy, catheter-related infections, hepatitis C viral infection [5], and hyponatremia [6] were associated factors for peritonitis. The risk of adverse events associated with peritoneal dialysis (PD) in elderly patients has not been thoroughly investigated. The purpose of this study was to assess the association between physical function and hospitalization in elderly PD patients
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