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Background <p>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.</p> Methods <p>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 <i>t</i>-test or <i>χ</i><sup>2</sup> test, and linear mixed models were used for pre- and post-admission and discharge comparisons.</p> Results <p>Compared with the planned group, the unplanned initiation group showed significantly lower BI scores (83.0 versus 92.6, <i>p</i> = 0.029), lower SPPB gait scores (2.1 versus 3.7, <i>p</i> = 0.026), and higher CFS scores (4.8 versus 3.9, <i>p</i> = 0.038) at admission. The length of hospital stay was also significantly longer in the unplanned group (38.8&#xa0;days versus 14.5&#xa0;days, <i>p</i> = 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.</p> Conclusions <p>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.</p>

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The impact of planned versus unplanned initiation of hemodialysis on physical function during hospitalization in patients with end-stage renal disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Arisa Nagata,
  • Hiroki Yabe,
  • Ren Takahashi,
  • Tomoya Yamaguchi,
  • Kei Ikeno,
  • Akashi Togawa

摘要

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 χ2 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.