Unplanned hemodialysis initiation was associated with lower Barthel Index at admission (83.0 vs 92.6, p=0.029), higher Clinical Frailty Scale (4.8 vs 3.9, p=0.038), lower SPPB gait scores (2.1 vs 3.7, p=0.026), and longer hospital stay (38.8 days vs 14.5 days, p=0.001) compared to planned initiation.
Cohort (n=32)
No
Does unplanned initiation of hemodialysis impair physical function and activities of daily living compared to planned initiation in patients with end-stage renal disease?
Unplanned initiation of hemodialysis is associated with worse physical function, higher frailty, and limited functional recovery during hospitalization compared to planned initiation.
Effect estimate: p=0.029 for BI at admission; p=0.026 for SPPB gait; p=0.038 for CFS; p=0.001 for length of hospital stay
Absolute Event Rate: 83% vs 92.6%
p-value: p=0.029
Abstract Background This study aimed to examine the impact of planned versus unplanned initiation of hemodialysis on physical function and activities of daily living (ADL) during the induction phase. Methods This single-center retrospective cohort study was conducted at Shizuoka Saiseikai General Hospital. Thirty-two patients with chronic kidney disease who started hemodialysis between June 2022 and August 2023 were included and classified into either the planned or unplanned initiation group. Physical function was assessed at admission and discharge using the Barthel Index (BI), Functional Independence Measure (FIM) mobility score, 10-m walking speed (10MWS), grip strength, isometric knee extensor strength (IKES), Short Physical Performance Battery (SPPB), and Clinical Frailty Scale (CFS). Comparisons between groups in the planned initiation and unplanned initiation groups were made using the unpaired t -test or χ 2 test, and linear mixed models were used for pre- and post-admission and discharge comparisons. Results Compared with the planned group, the unplanned initiation group showed significantly lower BI scores (83.0 versus 92.6, p = 0.029), lower SPPB gait scores (2.1 versus 3.7, p = 0.026), and higher CFS scores (4.8 versus 3.9, p = 0.038) at admission. The length of hospital stay was also significantly longer in the unplanned group (38.8 days versus 14.5 days, p = 0.001). Although the unplanned group demonstrated improvements in BI and grip strength during hospitalization, the gain in grip strength was significantly smaller than in the planned group. Conclusions Unplanned hemodialysis initiation was associated with impaired physical function, higher frailty, limited functional recovery through rehabilitation, and prolonged hospitalization. These findings highlight the need for early and structured rehabilitation interventions in patients undergoing unplanned dialysis initiation to mitigate physical decline during the induction phase.
Nagata et al. (2026) conducted a cohort in Patients with chronic kidney disease initiating hemodialysis, adults with end-stage renal disease (n=32). Unplanned hemodialysis initiation vs. Planned hemodialysis initiation was evaluated on Physical function at admission and discharge measured by Barthel Index (BI), Short Physical Performance Battery gait score (SPPB gait), Clinical Frailty Scale (CFS), grip strength, length of hospital stay (p=0.029 for BI at admission; p=0.026 for SPPB gait; p=0.038 for CFS; p=0.001 for length of hospital stay, p=0.029). Unplanned hemodialysis initiation was associated with lower Barthel Index at admission (83.0 vs 92.6, p=0.029), higher Clinical Frailty Scale (4.8 vs 3.9, p=0.038), lower SPPB gait scores (2.1 vs 3.7, p=0.026), and longer hospital stay (38.8 days vs 14.5 days, p=0.001) compared to planned initiation.