TY - JOUR
T1 - Association of CKD with disability in the United States
AU - Plantinga, Laura C.
AU - Johansen, Kirsten
AU - Crews, Deidra C.
AU - Shahinian, Vahakn B.
AU - Robinson, Bruce M.
AU - Saran, Rajiv
AU - Burrows, Nilka Ros
AU - Williams, Desmond E.
AU - Powe, Neil R.
N1 - Funding Information:
Support: This project was supported under a cooperative agreement from the Centers for Disease Control and Prevention (CDC) through the Association of American Medical Colleges (AAMC) , grant number U36/CCU319276 , AAMC ID numbers MM-0997-07/07 and MM-1143-10/10 . Report contents are solely the responsibility of the authors and do not necessarily represent the official views of the AAMC or CDC. Dr Crews is supported by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation . Dr Powe is partially supported by grant K24DK02643 from the National Institute of Diabetes and Digestive and Kidney Diseases , Bethesda, MD.
PY - 2011/2
Y1 - 2011/2
N2 - 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 1999-2006). 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 m2). 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.
AB - 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 1999-2006). 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 m2). 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.
KW - Chronic kidney disease
KW - activities of daily living
KW - cognitive functioning
KW - disability
KW - employment
KW - limitations
KW - physical functioning
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U2 - 10.1053/j.ajkd.2010.08.016
DO - 10.1053/j.ajkd.2010.08.016
M3 - Article
C2 - 21036441
AN - SCOPUS:78751621007
SN - 0272-6386
VL - 57
SP - 212
EP - 227
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -