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The impact of kidney dysfunction on functional outcomes in a convalescent rehabilitation ward: a retrospective cohort
Hiroki Yabe1, Aki Tabata2, Shintaro Iio3
1Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Japan.
Background:
Chronic kidney disease (CKD) impairs physical function and activities of daily living, yet the relationship between CKD severity and inpatient rehabilitation outcomes in patients who have not started dialysis remains unclear.
Methods:
We conducted a retrospective cohort analysis of 10 832 patients admitted to a convalescent rehabilitation ward between April 2014 and March 2023. Patients were stratified by CKD stage based on estimated glomerular filtration rate and grouped into mild or no kidney dysfunction (stages 1-3a) and advanced kidney dysfunction (stages 3b-5). Functional outcomes were evaluated using the Functional Independence Measure at admission and discharge. Key outcomes were functional independence measure gain, functional independence measure efficiency (functional independence measure gain per hospital day), functional independence measure effectiveness (proportion of potential improvement achieved) and length of stay. Between-group and stage-based comparisons were performed using analysis of covariance adjusting for confounders.
Results:
Among the 10 832 patients (mean age 73.1 ± 14.9 years), 3361 (31.0%) had CKD stages 3a-5. Individuals in the kidney dysfunction group were older and had lower serum albumin and hemoglobin than those in the non-kidney dysfunction group. Compared to patients with mild or no kidney dysfunction, those in the kidney dysfunction group had shorter length of stay (52.6 ± 31.7 vs 59.6 ± 39.4 days, P < .001), lower gain in functional independence measure (14.6 ± 14.4 vs 16.9 ± 15.5 points, P < .001), and reduced functional independence measure effectiveness (0.34 ± 0.35 vs 0.40 ± 0.39, P < .001), whereas functional independence measure efficiency did not differ between groups (P = .98).
Conclusions:
Kidney dysfunction was independently associated with less functional improvement and worse functional independence measure effectiveness during convalescent rehabilitation, partially due to shorter hospitalization and reduced total rehabilitation dose. Tailored rehabilitation programs that address kidney dysfunction-related vulnerabilities, including nutritional and metabolic optimization, may enhance recovery outcomes in this population.
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