Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

Functional dependence is a state of diminished physical capacity in which a person is unable to perform tasks often regarded as fundamental for day-to-day life. Across various medical fields, functional dependence has been shown to contribute to disability, hospitalization, and increased mortality. Dialysis Outcomes and Practice Patterns Study (DOPPS) researchers investigated whether functional dependence also contributes to morbidity and mortality in long-term dialysis patients, who have among the highest mortality and hospitalization rates.

Researchers examined self-reported data for functional status from over 7,000 hemodialysis patients from 12 countries in the DOPPS. Patients reported their ability to perform 13 activities of daily living (see tables below), and their responses were summarized to create an overall functional status score. Only 36% of patients could perform all 13 tasks without assistance, and 14% had high functional dependence. Statistical analyses showed that these patients with high functional dependence had the highest mortality rates and lowest quality-of-life scores.

Dr. Vanita Jassal, the lead author of the paper, remarked, “What is surprising is the relatively high proportion of younger dialysis patients who also experience hardship when doing household activities that are otherwise considered a normal part of life. It explains in part the observation that patients maintained on dialysis report low self-esteem with regard to their role in society and the family.”

Researchers found a high burden of functional dependence and concluded that functional dependence was a strong consistent predictor of mortality.


Patient responses to questions about tasks they are able to perform

Able to perform the task without assistance Yes No
Eating 97% 3%
Getting dressed 91% 9%
Bathing 82% 18%
Using the toilet 95% 5%
Transferring from bed to chair 94% 6%


Ability to perform the task Need no help Need some help Unable to do at all
Using the telephone 91% 7% 2%
Getting places beyond walking distance 59% 27% 14%
Grocery shopping 59% 25% 16%
Preparing meals 64% 21% 15%
Doing housework or handyman work 47% 33% 21%
Doing laundry 58% 21% 21%
Taking medications 84% 12% 4%
Managing money 81% 13% 6%


CITATION:Jassal SV, Karaboyas A, Comment LA, Bieber BA, Morgenstern H, Sen A, Gillespie BW, De Sequera P, Marshall MR, Fukuhara S, Robinson BM, Pisoni RL, Tentori F. Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis. 2016;67(2):283-92.
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