TY - JOUR
T1 - Physical Resilience Phenotype Trajectories in Incident Hemodialysis
T2 - Characterization and Mortality Risk Assessment
AU - Hladek, Melissa D.
AU - Zhu, Jiafeng
AU - Crews, Deidra C.
AU - McAdams-DeMarco, Mara A.
AU - Buta, Brian
AU - Varadhan, Ravi
AU - Shafi, Tariq
AU - Walston, Jeremy D.
AU - Bandeen-Roche, Karen
N1 - Funding Information:
The authors would like to acknowledge the original CHOICE study researchers and participants for their contributions to this work. This work was supported by grants UH2AG056933 and UH3AG056933 from the National Institute on Aging, National Institutes of Health. KBR, RV, TS, JDW, DCC, MDH designed the study. JZ and KBR analyzed the data. MDH, BB, and KBR drafted the manuscript. All authors (MDH, JZ, DCC, MMD, BB, RV, TS, JDW, and KBR) contributed to interpretation of results, and revisions of the manuscript. All authors read and approved the final manuscript.
Funding Information:
This work was supported by grants UH2AG056933 and UH3AG056933 from the National Institute on Aging, National Institutes of Health .
Publisher Copyright:
© 2022 International Society of Nephrology
PY - 2022/9
Y1 - 2022/9
N2 - Introduction: Although life-saving, the physiologic stress of hemodialysis initiation contributes to physical impairment in some patients. Mortality risk assessment following hemodialysis initiation is underdeveloped and does not account for change over time. Measures of physical resilience, the ability of a physiologic state to overcome physiologic stressors, may help identify patients at higher mortality risk and inform clinical management. Methods: We created 3 resilience categories (improving, stable, and declining) for trajectories of 4 phenotypes (physical function [PF], mental health [MH], vitality [VT], and general health [GH]) using SF-36 data collected the first year after hemodialysis initiation in the Choices for Healthy Outcomes in Caring for ESKD (CHOICE) study on 394 adults aged more than 55 years. Using mixed effects and Cox proportional hazard modeling, we assessed mortality following the first year on dialysis by resilience categories for each phenotype, adjusting for baseline phenotype and other confounders defined a priori over 4 years average follow-up. Results: Based on global Wald tests, statistically significant associations of PF (P = 0.03) and VT (P = 0.0004) resilience categories with mortality were found independent of covariates. Declining PF trajectory was associated with higher mortality risk (hazard ratio [HR] = 1.32; 95% confidence interval [CI], 1.05–1.66), whereas improving VT trajectory was associated with lower mortality risk (HR= 0.73; 95% CI, 0.53 to 1.00), each as compared to stable trajectory. Conclusion: Decreased resilience in PF and VT was independently associated with mortality. Phenotypic trajectories provide added value to baseline markers and patient characteristics when evaluating mortality. Hence, resilience measures hold promise for targeting population health interventions to the highest risk patients.
AB - Introduction: Although life-saving, the physiologic stress of hemodialysis initiation contributes to physical impairment in some patients. Mortality risk assessment following hemodialysis initiation is underdeveloped and does not account for change over time. Measures of physical resilience, the ability of a physiologic state to overcome physiologic stressors, may help identify patients at higher mortality risk and inform clinical management. Methods: We created 3 resilience categories (improving, stable, and declining) for trajectories of 4 phenotypes (physical function [PF], mental health [MH], vitality [VT], and general health [GH]) using SF-36 data collected the first year after hemodialysis initiation in the Choices for Healthy Outcomes in Caring for ESKD (CHOICE) study on 394 adults aged more than 55 years. Using mixed effects and Cox proportional hazard modeling, we assessed mortality following the first year on dialysis by resilience categories for each phenotype, adjusting for baseline phenotype and other confounders defined a priori over 4 years average follow-up. Results: Based on global Wald tests, statistically significant associations of PF (P = 0.03) and VT (P = 0.0004) resilience categories with mortality were found independent of covariates. Declining PF trajectory was associated with higher mortality risk (hazard ratio [HR] = 1.32; 95% confidence interval [CI], 1.05–1.66), whereas improving VT trajectory was associated with lower mortality risk (HR= 0.73; 95% CI, 0.53 to 1.00), each as compared to stable trajectory. Conclusion: Decreased resilience in PF and VT was independently associated with mortality. Phenotypic trajectories provide added value to baseline markers and patient characteristics when evaluating mortality. Hence, resilience measures hold promise for targeting population health interventions to the highest risk patients.
KW - dynamical systems
KW - end-stage kidney disease
KW - health-related quality of life
KW - risk prediction
UR - http://www.scopus.com/inward/record.url?scp=85134581475&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85134581475&partnerID=8YFLogxK
U2 - 10.1016/j.ekir.2022.06.009
DO - 10.1016/j.ekir.2022.06.009
M3 - Article
AN - SCOPUS:85134581475
SN - 2468-0249
VL - 7
SP - 2006
EP - 2015
JO - Kidney International Reports
JF - Kidney International Reports
IS - 9
ER -