Member's paper - Kidney Health Education and Research Group

Abstract

Physical function impairment among patients on dialysis and kidney transplant recipients

Ghazi, W., Ahuja, R., Doucette, C., Ahmad, Z., Edwards, N., Peipert, J., Bartlett, S., Li, M., Howell, D., Novak, M., Mucsi, I.

2022

International Society for Quality-of-Life Research (ISOQOL) Annual Conference

Full Abstract
Aim: Patients treated with dialysis are sedentary and have impaired physical function (PF) which is associated with poor quality of life and clinical outcomes. Kidney transplant (KT) provides better outcomes; however, many KT recipients are also sedentary and have low PF. PF can be assessed using the Patient Reported Outcomes Measurement Information System (PROMIS) PF item bank, administered as either computer adaptive testing (CAT) or short form (4, 6, 8, 10 or 20 item) questionnaire. Here we aim to assess PF impairment among patients on dialysis and KT recipients. Methods: In a secondary analysis of data obtained from a cross-sectional convenience sample of patients on dialysis and KT recipients in Toronto, participants completed PROMIS PF (4 item short form or CAT), and legacy questionnaires, including the EQ-5D-5L. Moderate/severe PF impairment were defined as T score ≤40. We assessed the independent association between PF impairment and treatment modality using multivariable linear and logistic regression models. Covariables included: age, sex, hemoglobin, albumin, Charlson Comorbidity Index, diabetes, and time since starting renal replacement therapy. Results: Of the 718 participants, 415 were KT recipients and 303 were on dialysis. The mean (SD) age was 56 (17) years with 60% male. Median (Interquartile Range) of treatment time was 3.4 (4.8) years for patients on dialysis and 6.9 (12.1) years for KT. Mean (SD) PF score for KT vs Dialysis was 47 (10) vs 36 (9) (p<0.001). Moderate/severe PF impairment was less frequent among KT recipients s as compared to patients on dialysis (25% vs 70%). Similarly, 38% of KT recipients reported at least some “problems walking” on the EQ-5D-5L mobility item compared to 66% patients on dialysis (p<0.001). In a multivariable adjusted linear regression model, KT was associated with higher PF scores (B=5.08, p<0.001; 95% CI: 3.06–7.1). Similarly, KT was independently associated with lower odds of moderate PF impairment (OR: 0.34, p<0.001; CI: 0.2 – 0.5). Conclusion: Substantially higher proportion of patients on dialysis had moderate/severe PF impairment compared to KT. In future research, we will compare performance-based measures with PROMIS and investigate if exercise interventions can reverse PF impairment in this patient population.

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