Determinants of Functional Status in End Stage Kidney Disease Patients on Maintenance Haemodialysis at Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: Functional status refers to an individual’s ability to conduct activities of daily living and includes functions such as feeding  oneself, maintaining personal hygiene and transferring. Maintenance haemodialysis in End Stage Kidney Disease (ESKD) patients is linked  to a significant decline in functional status and this decline is an important prognostic factor affecting the outcomes of this group  of patients.

Objectives: The primary objective was to establish the functional status of ESKD patients on maintenance haemodialysis at  the Kenyatta National Hospital (KNH) Renal Unit and grade it using the Karnofsky Performance Status scale. The secondary objective was  to determine the selected factors associated with better physical function among ESKD patients on maintenance haemodialysis.  

Methods: This was a cross-sectional descriptive tudy in which 82 patients with ESKD undergoing maintenance haemodialysis (>3 months)  at the KNH Renal Unit were recruited. Relevant sociodemographic and clinical data was collected, and the Karnofsky Performance Status (KPS) scale was used to assess the functional status of the participants. The SPSS version 25 software was used for  data entry and to perform the analyses. The participants’ sociodemographic and clinical characteristics were summarized into percentages, means, standard deviations and median. Functional status was assessed using the KPS scale and categorized into either  functionally dependent or independent and summarized as a percentage. A chisquare test of association and logistic regression was used to evaluate the relationship between functional status and the selected variables.

Results: The participants enrolled in the study  were 82 with the median age being 46 years (inter-quartile range 34-58 years). Functional status was assessed with 44 (53.7%)  participants being categorized as independent (KPS score 80-100%) and 38 (46.3%) being functionally dependent (KPS score <80%). In the  univariable logistic regression model, age, dialysis vintage and fluid overload were significant predictors of functional status. The  multivariable model demonstrated that dialysis vintage was a significant predictor at a 5% significance level.

Conclusion: Patients with  ESKD undergoing haemodialysis at the KNH Renal Unit have a high prevalence of functional status impairment at 46.3%. Younger age,  longer dialysis vintage and normal fluid status were the significant predictors of better physical function.