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

Area of Science:

• Nephrology
• Geriatrics
• Functional Assessment

Background:

• The predictive value of functional assessments for adverse outcomes in chronic kidney disease (CKD) remains unclear.
• This study investigated the comparative utility of three performance-based functional assessments in predialysis CKD patients.

Purpose of the Study:

• To determine the relative utility of the Short Physical Performance Battery (SPPB), Modified Mini-Mental Status Exam (M3SE), and Lawton Instrumental Activities of Daily Living (IADL) in predicting adverse outcomes in CKD.
• To identify which functional assessment is the strongest predictor of composite adverse outcomes, including 50% GFR reduction, end-stage kidney disease (ESKD), and death.

Main Methods:

• An observational cohort study included 350 participants with stage II-V predialysis CKD.
• Participants underwent SPPB, M3SE, and IADL assessments. Scores were dichotomized by median and combined into a summary score.
• Cox proportional hazards models were used to analyze the association between functional assessments and adverse outcomes.

Main Results:

• Low SPPB scores were significantly associated with the highest rates of death, ESKD, or 50% GFR reduction (HR, 1.96).
• Low SPPB demonstrated the strongest association with death (HR, 2.43) after adjusting for covariates.
• M3SE performance showed no association with adverse outcomes. Low IADL scores were linked to a reduced hazard ratio for ESKD or 50% GFR decline (HR, 0.49).

Conclusions:

• Low SPPB score is the most potent predictor of mortality and composite adverse events in patients with CKD.
• Future clinical trials should investigate whether targeted interventions can improve outcomes for CKD patients with poor physical performance and low SPPB scores.