Patients with end-stage renal disease (ESRD) may become dependent upon dialysis. It is not clear whether patients are able to maintain their same level of independence after initiation of dialysis treatment. In the October 15, 2009 issue of the New England Journal of Medicine, a new study indicates that, among nursing home residents with ESRD, the initiation of dialysis is associated with a significant and lasting decline in functional status.

Investigators from the Stanford University School of Medicine used a national registry of patients undergoing dialysis in order to identify 3,702 nursing home residents who started dialysis treatment between June 1998 and October 2000. Functional status was measured by assessing each patient’s degree of dependence in seven activities of daily living. The investigators found that 39% of nursing home residents were able to maintain their functional status for three months after starting dialysis. However, by 12 months after initiation of dialysis, 58% of the ESRD patients in the study had died and only 13% of the nursing home residents had been able to maintain the level of independence they’d had prior to starting dialysis. This decline in functional status was independent of age, gender, and race.

According to this study, nursing home residents with ESRD experience a substantial and sustained decline in functional status after the initiation of dialysis. Further research is needed to determine whether community-dwelling residents also demonstrate increased levels of dependence after starting dialysis.
 

Source:

NEJM. 2009;361:1539-1547.