Association Between Kidney Function, Rehabilitation Outcome, and Survival in Older Patients Discharged From Inpatient Rehabilitation

Doyle, Edward M.; Sloan, Joanne M.; Goodbrand, James A.; McMurdo, Marion E.T.; Donnan, Peter T.; McGilchrist, Mark M.; Frost, Helen; Witham, Miles D.

Abstract

Background
Chronic kidney disease (CKD) is common in older people, but it is unclear if it affects survival and rehabilitation outcomes independent of comorbid conditions and physical function in this population.

Study Design
Cohort analysis of prospective, routinely collected, linked clinical data sets.

Setting & Participants
Patients discharged from a single inpatient geriatric rehabilitation center over a 12-year period.
Predictors
Admission estimated glomerular filtration rate (eGFR) category as a predictor of improvement in the 20-point Barthel score (activities of daily living measure) during rehabilitation; discharge eGFR category and Barthel score as predictors of survival postdischarge.

Outcomes
Survival postdischarge was modeled using Cox regression analyses, unadjusted and adjusted for age, sex, morbidities (ischemic heart disease, chronic obstructive pulmonary disease, stroke, diabetes, and heart failure), Barthel score and eGFR category on discharge, and serum calcium, hemoglobin, and albumin levels. The effect of admission eGFR category on change in Barthel score during admission was modeled using analysis of covariance, adjusted for admission, Barthel score, and comorbid conditions.

Results
3,012 patients were included; mean age, 84 years. 2,394 patients died during a mean follow-up of 8.3 years. Compared with patients with eGFR of 60 to 89 mL/min/1.73 m2, adjusted HRs for death were 1.26 (95% CI, 1.13-1.40), 1.45 (95% CI, 1.29-1.63), and 1.68 (95% CI, 1.42-1.99) for eGFR categories of 45 to 59, 30 to 44, and

• Journal Article Type: Article
• Acceptance Date: Apr 21, 2015
• Online Publication Date: Jun 2, 2015
• Publication Date: 2015-11
• Deposit Date: Oct 12, 2017
• Journal: American Journal of Kidney Diseases
• Print ISSN: 0272-6386
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 66
• Issue: 5
• Pages: 768-774
• DOI: https://doi.org/10.1053/j.ajkd.2015.04.041
• Keywords: Nephrology, chronic kidney disease (CKD), reduced renal function, geriatricBarthel score, activities of daily living (ADLs)
• Public URL: http://researchrepository.napier.ac.uk/Output/997145