Association of CKD With Disability in the United States

作者：Plantinga Laura C^*; Johansen Kirsten; Crews Deidra C; Shahinian Vahakn B; Robinson Bruce M; Saran Rajiv; Burrows Nilka Rios; Williams Desmond E; Powe Neil R

来源：American Journal of Kidney Diseases, 2011, 57(2): 212-227.

DOI：10.1053/j.ajkd.2010.08.016

• Chronic kidney disease
• disability
• activities of daily living
• limitations
• employment
• physical functioning
• cognitive functioning

Background: Little is known about disability in early-stage chronic kidney disease (CKD).
Study Design: Cross-sectional national survey (National Health and Nutrition Examination Survey 19992006).
Setting & Participants: Community-based survey of 16,011 noninstitutionalized US civilian adults (aged >20 years).
Predictor: CKD, categorized as no CKD, stages 1 and 2 (albuminuria and estimated glomerular filtration rate [eGFR] >= 60 mL/min/1.73 m(2)), and stages 3 and 4 (eGFR, 15-59 mL/min/1.73 m(2)).
Outcome: Self-reported disability, defined by limitations in working, walking, and cognition and difficulties in activities of daily living (ADL), instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity.
Measurements: Albuminuria and eGFR assessed from urine and blood samples; disability, demographics, access to care, and comorbid conditions assessed using a standardized questionnaire.
Results: Age-adjusted prevalence of reported limitations generally was significantly greater with CKD: for example, difficulty with ADL was reported by 17.6%, 24.7%, and 23.9% of older (>= 65 years) and 6.8%, 11.9%, and 11.0% of younger (20-64 years) adults with no CKD, stages 1 and 2, and stages 3 and 4, respectively. CKD also was associated with greater reported limitations and difficulty in other activities after age adjustment, including instrumental ADL, leisure and social activities, lower-extremity mobility, and general physical activity. Other demographics, socioeconomic status, and access to care generally only slightly attenuated the observed associations, particularly in older individuals; adjustment for cardiovascular disease, arthritis, and cancer attenuated most associations such that statistical significance no longer was achieved.
Limitations: Inability to establish causality and possible unmeasured confounding.
Conclusion: CKD is associated with a higher prevalence of disability in the United States. Age and other comorbid conditions account for most, but not all, of this association. Am J Kidney Dis. 57(2):212-227.

• 出版日期2011-2