Perceived difficulty in activities of daily living and survival in patients receiving maintenance hemodialysis

Purpose Most patients receiving hemodialysis have perceived difficulty in mobility tasks, such as basic activities of daily living (ADL), ambulation, and walking up or down stairs, even if they can ambulate independently. Perceived difficulty in performing ADL (ADL difficulty) is reportedly a useful predictor of mortality in older community-dwelling people. However, very few studies have examined the association of ADL difficulty with clinical outcomes in patients receiving hemodialysis. This study aimed to identify the association between ADL difficulty related to mobility tasks of lower limbs and all-cause mortality in patients receiving hemodialysis who are able to ambulate independently. Methods This retrospective study analyzed 300 clinically stable outpatients (median age, 65.0 years) receiving hemodialysis. ADL difficulty was evaluated at baseline with a novel questionnaire developed for patients receiving hemodialysis. Lower scores indicated lower ADL, i.e., greater ADL difficulty. The patients were divided into two groups by the median ADL score: a higher ADL group and a lower ADL group. The association between ADL difficulty and all-cause mortality was estimated by Cox regression analyses. Results Median follow-up duration was 58 months. The incident rates were 0.02 per person-year in the higher ADL group and 0.06 per person-year in the lower ADL group (P < 0.001). After adjusting for the effects of clinical characteristics, the hazard ratio for all-cause mortality in the lower ADL group was 2.70 (95% confidence interval 1.57-4.64) compared with that in the higher ADL group. Conclusions Perceived difficulty in mobility tasks was independently associated with all-cause mortality among ambulatory patients receiving hemodialysis.