{"corpus_id":14024716,"paper_sha":"ea9223683100fbf60abeabd61e3925bd27108a31","doi":"10.1056/NEJMoa0904655","arxiv_id":null,"pmid":19828531,"pmcid":"PMC2789552","mag_id":2169328204,"dblp_id":null,"acl_id":null,"title":"Functional status of elderly adults before and after initiation of dialysis.","year":2009,"publication_date":"2009-10-15","venue":"New England Journal of Medicine","journal":{"name":"The New England journal of medicine","pages":"\n          1539-47\n        ","volume":"361 16"},"journal_issn":null,"journal_title":null,"publication_types":["JournalArticle","Study"],"pubmed_pub_types":["Evaluation Study","Journal Article","Research Support, N.I.H., Extramural"],"s2_fields_of_study":["Medicine"],"reference_count":31,"citation_count":975,"influential_citation_count":20,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Activities of Daily Living","mj":true,"ui":"D000203"},{"d":"Age Factors","mj":false,"ui":"D000367"},{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Aged, 80 and over","mj":false,"ui":"D000369"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Kidney Failure, Chronic","mj":false,"qs":[{"q":"mortality","mj":false,"ui":"Q000401"},{"q":"physiopathology","mj":false,"ui":"Q000503"},{"q":"therapy","mj":true,"ui":"Q000628"}],"ui":"D007676"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Nursing Homes","mj":false,"ui":"D009735"},{"d":"Renal Dialysis","mj":true,"ui":"D006435"},{"d":"Treatment Outcome","mj":false,"ui":"D016896"}],"chemicals":null,"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://www.nejm.org/doi/pdf/10.1056/NEJMoa0904655?articleTools=true","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/ea9223683100fbf60abeabd61e3925bd27108a31","s2_open_access_license":null,"s2_open_access_status":"BRONZE","pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"BACKGROUND: It is unclear whether functional status before dialysis is maintained after the initiation of this therapy in elderly patients with end-stage renal disease (ESRD). METHODS: Using a national registry of patients undergoing dialysis, which was linked to a national registry of nursing home residents, we identified all 3702 nursing home residents in the United States who were starting treatment with dialysis between June 1998 and October 2000 and for whom at least one measurement of functional status was available before the initiation of dialysis. Functional status was measured by assessing the degree of dependence in seven activities of daily living (on the Minimum Data Set-Activities of Daily Living [MDS-ADL] scale of 0 to 28 points, with higher scores indicating greater functional difficulty). RESULTS: The median MDS-ADL score increased from 12 during the 3 months before the initiation of dialysis to 16 during the 3 months after the initiation of dialysis. Three months after the initiation of dialysis, functional status had been maintained in 39% of nursing home residents, but by 12 months after the initiation of dialysis, 58% had died and predialysis functional status had been maintained in only 13%. In a random-effects model, the initiation of dialysis was associated with a sharp decline in functional status, indicated by an increase of 2.8 points in the MDS-ADL score (95% confidence interval [CI], 2.5 to 3.0); this decline was independent of age, sex, race, and functional-status trajectory before the initiation of dialysis. The decline in functional status associated with the initiation of dialysis remained substantial (1.7 points; 95% CI, 1.4 to 2.1), even after adjustment for the presence or absence of an accelerated functional decline during the 3-month period before the initiation of dialysis. CONCLUSIONS: Among nursing home residents with ESRD, the initiation of dialysis is associated with a substantial and sustained decline in functional status.","claims":[{"public_id":"cl_5a811c79772e44ca4f3139fc85e1850d","status":"active","text":"Among 3702 United States nursing home residents starting dialysis between June 1998 and October 2000, the median MDS-ADL score increased from 12 before dialysis initiation to 16 after dialysis initiation.","confidence":0.95,"contributors":[{"id":136,"public_id":"3c2apqe3ut","public_label":"Anonymous (3c2apqe3ut)","roles":["extraction"],"url":"https://sah.borca.ai/u/3c2apqe3ut"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale 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associated with a sharp decline in functional status, indicated by a 2.8-point increase in MDS-ADL score independent of age, sex, race, and functional-status trajectory before dialysis initiation.","confidence":0.96,"contributors":[{"id":136,"public_id":"3c2apqe3ut","public_label":"Anonymous (3c2apqe3ut)","roles":["extraction"],"url":"https://sah.borca.ai/u/3c2apqe3ut"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_81b9e7d02cf56d453bc783c6fdf9bf86"},{"public_id":"cl_f0eb57ab58528029b77ab987588d1540","status":"active","text":"The functional-status decline associated with dialysis initiation remained substantial after adjustment for accelerated functional decline during the 3-month period before dialysis initiation.","confidence":0.93,"contributors":[{"id":136,"public_id":"3c2apqe3ut","public_label":"Anonymous (3c2apqe3ut)","roles":["extraction"],"url":"https://sah.borca.ai/u/3c2apqe3ut"},{"id":2,"public_id":"4715169a40","public_label":"AK (4715169a40)","roles":["review"],"url":"https://sah.borca.ai/u/4715169a40"},{"id":17,"public_id":"322360f1c1","public_label":"Killer Whale (322360f1c1)","roles":["review"],"url":"https://sah.borca.ai/u/322360f1c1"}],"url":"https://sah.borca.ai/claims/cl_f0eb57ab58528029b77ab987588d1540"},{"public_id":"cl_14c725780d7965fc06db49dd915a8ace","status":"active","text":"Three months after dialysis initiation, functional status had been maintained in 39% of nursing home residents.","confidence":0.94,"contributors":[{"id":136,"public_id":"3c2apqe3ut","public_label":"Anonymous (3c2apqe3ut)","roles":["extraction"],"url":"https://sah.borca.ai/u/3c2apqe3ut"},{"id":2,"public_id":"4715169a40","public_label":"AK 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