Document Detail

Dismal rehabilitation in geriatric inner-city hemodialysis patients.
MedLine Citation:
PMID:  8258883     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To assess the extent of functional and vocational rehabilitation achieved by elderly inner-city patients sustained on maintenance hemodialysis.
DESIGN: Inception cohort study of elderly patients who have end-stage renal disease using a modified Karnofsky rating system. The need for a wheelchair, participation in household activities, and effect of comorbid conditions were noted. Current status was compared with patient's recollection of functional activity level 2 years before commencing maintenance hemodialysis.
SETTING: Seven outpatient, hospital-affiliated and private hemodialysis units in Brooklyn, NY.
PATIENTS: One hundred four patients aged 65 years or older who were receiving maintenance hemodialysis for at least 6 months.
MAIN OUTCOME MEASURES: A score of 76 or greater on a modified Karnofsky scale indicated independent function at a level that permitted participation in activities beyond those mandated by the hemodialysis regimen. A comorbidity score 6 or greater on a newly constructed index correlated with severe debility. Employment status was also recorded.
RESULTS: Present functional activity had deteriorated to a modified Karnofsky score of 66 +/- 12.3 (+/- SD) compared with patients' recollection of a mean score of 84 +/- 14.3 (P < .001) 2 years before initiation of hemodialysis. Diabetic patients had a lower score than nondiabetic patients. The mean comorbidity index of the entire study group was 7.8 +/- 2.9 (mean +/- SD). Within the diabetic subset, severe debility constrained 71 patients (68%) to limit all activity to their residence with the exception of travel to and from their dialysis facility. By contrast, 2 years prior to commencing dialytic therapy, 81 diabetic patients (78%) had interests and activities that took them outside their homes (P < .001). Generalized weakness was the most common explanation given for the lack of outside activity by nine patients (9%) who were wheelchair bound. Erythropoietin, though regularly administered to 87 patients (84%) in the study group, was unsuccessful in raising mean hematocrit reading above 0.28 +/- 0.05 (mean +/- SD).
CONCLUSIONS: Maintenance hemodialysis does not return inner-city elderly patients to their predialysis level of functioning. Few elderly, diabetic hemodialysis patients conduct any substantive portion of their lives outside their homes. For nondiabetic patients, the modified Karnofsky score of whites (70.4 +/- 11.9) and blacks (66.5 +/- 15.3), though low, was equivalent (P < .4).
O Ifudu; J Mayers; J Matthew; C C Tan; A Cambridge; E A Friedman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JAMA     Volume:  271     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1994 Jan 
Date Detail:
Created Date:  1994-01-14     Completed Date:  1994-01-14     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  29-33     Citation Subset:  AIM; IM    
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MeSH Terms
Activities of Daily Living*
African Continental Ancestry Group
Age Factors
Aged, 80 and over
Cohort Studies
Diabetes Mellitus / epidemiology
Erythropoietin / therapeutic use
European Continental Ancestry Group
Karnofsky Performance Status
Kidney Failure, Chronic / epidemiology,  therapy*
New York City
Outcome Assessment (Health Care)*
Renal Dialysis* / statistics & numerical data
Sex Factors
Time Factors
Urban Population / statistics & numerical data
Reg. No./Substance:
Comment In:
JAMA. 1994 Jan 5;271(1):67-8   [PMID:  8258892 ]
JAMA. 1994 Jul 27;272(4):274   [PMID:  8068135 ]
JAMA. 1994 Jul 27;272(4):274   [PMID:  8028135 ]
JAMA. 1994 Jul 27;272(4):274-5; author reply 276   [PMID:  8028136 ]
JAMA. 1994 Jul 27;272(4):275; author reply 276   [PMID:  8028137 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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