Impaired mobility at dialysis initiation: impact on outcome in elderly and senile patients

Kurylovich K.A.

1st City Clinical Hospital, Minsk, Republic of Belarus

Introduction. Impaired mobility is common among patients aged 60 years or older admitted for chronic dialysis (CD). Objective: to assess the impact of impaired mobility on survival in patients aged 60 years or older at the onset of CD and to compare mortality predictors (MP) between groups with preserved and impaired mobility. Material and methods. Data analysis of 231 patients aged 60 years or older at the onset of CD: 65 patients with preserved mobility (group 1) and 166 patients with impaired mobility (group 2). Results. Median survival for group 1 was 693 days, for group 2 – 255 days, 1-year survival for group 1 was 77.2±5.4%, for group 2 was 42.3±4.1%, 2-year survival for group 1 was 49.3±7.4%, for group 2 was 29.7±4.3%. Multivariate analysis, MP for group 1: age > 71 years (hazard ratio – HR=3.3, 95% confidence interval – CI 1.4–7.7; p=0.005), calcium>2.3 mmol/l (HR=8.8, 95% CI 2.2–35.9; p=0.002) and cholesterol≤2.9 mmol/l (HR=11.5, 95% CI 3.7–35.4; p<0.001); MP for group 2: age>65 years (HR=3.5, 95% CI 1.3–9.3; p=0.014), history of myocardial infarction (HR=5, 95% CI 1.4–17.6; p=0.013), and serum albumin≤30 g/L (HR=11.8, 95% CI 3.9–35.4; p<0.001). Discussion. Treatment of patients in both groups should include prevention of malnutrition. In group 1, correction of hypercalcemia and tertiary hyperparathyroidism are useful strategies. In group 2, palliative dialysis and transition to continuous ambulatory peritoneal dialysis may be considered to reduce the burden on the cardiovascular system. Conclusion. Impaired mobility at dialysis initiation is an important prognostic factor and should be recognized when prescribing treatment to patients aged 60 years or older.

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About the Authors

Krystsina A. Kurylovich – Nephrologist, Hemodialysis Department, 1st City Clinical Hospital. Address: 64 Nezavisimosti Ave., Minsk, 220013; tel.: + 375 44 7 403295;
e-mail: khruns89@gmail.com. ORCID: 0000-0002-9112-4863

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