Association of life-space mobility with physical and depressive status in older hemodialysis patients: the REPnet-HD study

Abstract

Introduction: Low physical function and depressive symptoms are frequent in older patients undergoing hemodialysis. This study aimed to investigate the association between life-space mobility (LSM), low physical function, and depressive symptoms in older patients undergoing hemodialysis. Methods: This multicenter cross-sectional study included outpatients undergoing hemodialysis registered at 12 facilities in the REPnet-HD study. LSM was measured using the Life-Space Assessment. Patients were classified into four groups (normal, depressive symptoms alone, low physical function alone, and combined conditions) according to low physical function (Short Physical Performance Battery < 10 points) and depressive symptoms (Hospital Anxiety and Depression Scale > 6 points). The association among low LSM (< 60 points), physical function, and depressive symptoms was assessed using logistic regression analysis. Results: Our analysis included 231 patients (aged 74 [70–78] years old; female, 40.7%; dialysis vintage, 5.5 [2.1–9.8] years). In the adjusted logistic regression analysis using reference with normal, the low LSM was significantly associated with depressive symptoms alone (odds ratio [OR] 2.38, 95% confidence interval [CI] 1.09–5.20, P = 0.03), low physical function alone (OR 3.53, 95% CI 1.35–9.19, P = 0.009), and combined conditions (OR 10.54, 95% CI 4.16–26.75, P < 0.001). The association between low LSM and combined conditions was maintained even when the reference used low physical function alone (P = 0.04) and depressive symptoms alone (P < 0.01). Conclusions: The low LSM in older patients undergoing hemodialysis was independently associated with low physical function and depressive symptoms. The combined condition of low physical function and depressive symptoms may strongly affect restricted LSM.