Associations of Performance-Based Functional Assessments and Adverse Outcomes in CKD

Abstract

Background: The comparative utility of performance-based functional assessments in predicting adverse outcomes in CKD is unknown. To examine their relative utility, we examined three performance-based functional assessments in an observational cohort of patients with CKD.

Methods: We recruited 350 participants with stage II-V, predialysis CKD. Participants were administered three performance-based functional assessments: Short Physical Performance Battery (SPPB), Modified Mini-Mental Status Exam (M3SE), and Lawton Instrumental Activities of Daily Living (IADL). Scores were dichotomized on the basis of the median and combined into a summary score. Outcomes included 50% GFR reduction, ESKD, and death. We used Cox proportional hazards to assess the association of performance-based functional assessments with outcomes.

Results: Compared with high performers, low SPPB performers had the highest adjusted rate of death, ESKD, or 50% reduction in GFR (HR, 1.96; 95% CI, 1.28 to 2.99). Low SPPB had the strongest association with death when adjusted for multiple covariates (HR, 2.43; 95% CI, 1.36 to 4.34). M3SE performance was not associated with any adverse outcome. None of the performance-based functional assessments were associated with ESKD, but a low IADL score was associated with a lower hazard ratio for ESKD or 50% decline GFR (HR, 0.49; 95% CI, 0.24 to 1.00).

Conclusions: Low SPPB score was the strongest predictor of death and all adverse outcomes as a composite. Future trials should determine if outcomes for patients with CKD who have poor physical performance and low SPPB scores are improved by targeted interventions.

Clinical trial registry name and registration number: Safe Kidney Care Cohort Study, NCT01407367.

Keywords: CKD; ESKD; IADL; MMSE; SPPB; adverse outcomes; chronic kidney disease; functional assessments.

Conflict of interest statement

All authors have nothing to disclose.

Copyright © 2021 by the American Society of Nephrology.

Figures

Graphical abstract

Figure 1.

Kaplan–Meier plots of high (thick line) versus low-performance (thin line) groups for each performance-based functional assessment and a summary of all with the outcome of death. Log-rank statistic P value. IADL, Lawton Instrumental Activities of Daily Living; M3SE, Modified Mini-Mental Status Exam; SPPB, Short Physical Performance Battery.

Figure 2.

Kaplan–Meier plots of high (thick line) versus low-performance (thin line) groups for each performance-based functional assessment and a summary of all with the composite outcome. Log-rank statistic P value. IADL, Lawton Instrumental Activities of Daily Living; M3SE, Modified Mini-Mental Status Exam; SPPB, Short Physical Performance Battery.