Association between kidney function, rehabilitation outcome, and survival in older patients discharged from inpatient rehabilitation

Edward M. Doyle, Joanne M. Sloan, James A. Goodbrand, Marion E. T. McMurdo, Peter T. Donnan, Mark M. McGilchrist, Helen Frost, Miles D. Witham (Lead / Corresponding author)

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    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 89mL/min/1.73m(2), 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 <30mL/min/1.73m(2), respectively. The relationship between discharge Barthel score and survival was similar within each discharge eGFR category (HRs of 0.95, 0.93, 0.92, 0.95, and 0.90 per Barthel score point within eGFR categories of ≥90, 60-89, 45-59, 30-44, and <30mL/min/1.73m(2); P for interaction = 0.2). Similar improvements in Barthel score between admission and discharge were seen for each admission eGFR category.

    LIMITATIONS: Single-center study using routinely collected clinical data.

    CONCLUSIONS: eGFR category and Barthel score are independent risk markers for survival in older rehabilitation patients, but advanced CKD does not preclude successful rehabilitation.

    Original languageEnglish
    Pages (from-to)768-774
    Number of pages7
    JournalAmerican Journal of Kidney Diseases
    Volume66
    Issue number5
    Early online date2 Jun 2015
    DOIs
    Publication statusPublished - Nov 2015

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    Glomerular Filtration Rate
    Inpatients
    Rehabilitation
    Kidney
    Survival
    Chronic Renal Insufficiency
    Rehabilitation Centers
    Activities of Daily Living
    Geriatrics
    Chronic Obstructive Pulmonary Disease
    Myocardial Ischemia
    Albumins
    Hemoglobins
    Cohort Studies
    Heart Failure
    Stroke
    Regression Analysis
    Calcium
    Morbidity
    Serum

    Cite this

    @article{6c61d1e37adb4e9dba20bfc68750638a,
    title = "Association between kidney function, rehabilitation outcome, and survival in older patients discharged from inpatient rehabilitation",
    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 89mL/min/1.73m(2), 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 <30mL/min/1.73m(2), respectively. The relationship between discharge Barthel score and survival was similar within each discharge eGFR category (HRs of 0.95, 0.93, 0.92, 0.95, and 0.90 per Barthel score point within eGFR categories of ≥90, 60-89, 45-59, 30-44, and <30mL/min/1.73m(2); P for interaction = 0.2). Similar improvements in Barthel score between admission and discharge were seen for each admission eGFR category.LIMITATIONS: Single-center study using routinely collected clinical data.CONCLUSIONS: eGFR category and Barthel score are independent risk markers for survival in older rehabilitation patients, but advanced CKD does not preclude successful rehabilitation.",
    author = "Doyle, {Edward M.} and Sloan, {Joanne M.} and Goodbrand, {James A.} and McMurdo, {Marion E. T.} and Donnan, {Peter T.} and McGilchrist, {Mark M.} and Helen Frost and Witham, {Miles D.}",
    note = "Copyright {\circledC} 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.",
    year = "2015",
    month = "11",
    doi = "10.1053/j.ajkd.2015.04.041",
    language = "English",
    volume = "66",
    pages = "768--774",
    journal = "American Journal of Kidney Diseases",
    issn = "0272-6386",
    publisher = "Elsevier",
    number = "5",

    }

    TY - JOUR

    T1 - Association between kidney function, rehabilitation outcome, and survival in older patients discharged from inpatient rehabilitation

    AU - Doyle, Edward M.

    AU - Sloan, Joanne M.

    AU - Goodbrand, James A.

    AU - McMurdo, Marion E. T.

    AU - Donnan, Peter T.

    AU - McGilchrist, Mark M.

    AU - Frost, Helen

    AU - Witham, Miles D.

    N1 - Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

    PY - 2015/11

    Y1 - 2015/11

    N2 - 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 89mL/min/1.73m(2), 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 <30mL/min/1.73m(2), respectively. The relationship between discharge Barthel score and survival was similar within each discharge eGFR category (HRs of 0.95, 0.93, 0.92, 0.95, and 0.90 per Barthel score point within eGFR categories of ≥90, 60-89, 45-59, 30-44, and <30mL/min/1.73m(2); P for interaction = 0.2). Similar improvements in Barthel score between admission and discharge were seen for each admission eGFR category.LIMITATIONS: Single-center study using routinely collected clinical data.CONCLUSIONS: eGFR category and Barthel score are independent risk markers for survival in older rehabilitation patients, but advanced CKD does not preclude successful rehabilitation.

    AB - 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 89mL/min/1.73m(2), 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 <30mL/min/1.73m(2), respectively. The relationship between discharge Barthel score and survival was similar within each discharge eGFR category (HRs of 0.95, 0.93, 0.92, 0.95, and 0.90 per Barthel score point within eGFR categories of ≥90, 60-89, 45-59, 30-44, and <30mL/min/1.73m(2); P for interaction = 0.2). Similar improvements in Barthel score between admission and discharge were seen for each admission eGFR category.LIMITATIONS: Single-center study using routinely collected clinical data.CONCLUSIONS: eGFR category and Barthel score are independent risk markers for survival in older rehabilitation patients, but advanced CKD does not preclude successful rehabilitation.

    U2 - 10.1053/j.ajkd.2015.04.041

    DO - 10.1053/j.ajkd.2015.04.041

    M3 - Article

    C2 - 26048443

    VL - 66

    SP - 768

    EP - 774

    JO - American Journal of Kidney Diseases

    JF - American Journal of Kidney Diseases

    SN - 0272-6386

    IS - 5

    ER -