Related Experiment Video
Updated: Sep 28, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Associations of Performance-Based Functional Assessments and Adverse Outcomes in CKD
Mitchell D Belkin1, Rebecca M Doerfler1, Lee-Ann Wagner1
1Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Insights
The Short Physical Performance Battery (SPPB) is the strongest predictor of adverse outcomes in chronic kidney disease (CKD) patients, including death and kidney failure. Further research should explore interventions for those with low SPPB scores.
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.
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.
Related Concept Videos
01:25Chronic Kidney Disease I: Introduction
01:28Chronic Kidney Disease III: Interprofessional Care
01:18Chronic Kidney Disease IV: Nursing Management
01:24Chronic Kidney Disease II: Clinical Manifestations
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention