EVALUATION OF FUNCTIONAL CAPACITY OF PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

End-stage renal disease (ESRD) signifies the terminal stage of chronic kidney disease, marked by irreversible loss of renal function requiring renal replacement therapy for survival. Patients on maintenance hemodialysis frequently exhibit diminished physical performance and impaired quality of life due to anemia, malnutrition, and metabolic derangements. In developing countries such as Pakistan, socioeconomic limitations and lack of rehabilitation strategies further aggravate these outcomes. Objective: To evaluate the functional capacity of patients with ESRD undergoing maintenance hemodialysis and determine its association with clinical and biochemical parameters. Study Design: A quasi-experimental study. Settings: Dialysis Centre, Department of Nephrology, Mayo Hospital, Lahore, Pakistan. Duration of Study: 15^th March 2025 to 15^th June 2025. Methods: A total of 100 clinically stable ESRD patients aged ≥18 years, receiving maintenance hemodialysis for at least 3 months, were enrolled using non-probability consecutive sampling. Functional capacity was assessed using the Six-Minute Walk Test (6MWT) following American Thoracic Society guidelines. Laboratory parameters, including hemoglobin, serum albumin, C-reactive protein (CRP), ferritin, transferrin saturation (TSAT), calcium, phosphorus, parathyroid hormone (PTH), and dialysis adequacy (Kt/V), were measured. Data were analyzed using SPSS v26. The independent-samples t-test was applied to assess associations between 6MWT distance and clinical variables; p < 0.05 was considered statistically significant. Results: The mean age of participants was 48.6 ± 13.4 years, with 63% being male. The mean BMI was 23.9 ± 3.8 kg/m², mean dialysis duration 3.2 ± 1.6 years, and mean Kt/V 1.3 ± 0.3. The mean 6MWT distance was 382.7 ± 74.1 m, with 56% of patients exhibiting reduced functional capacity (<400 m). Functional capacity was significantly greater among patients with hemoglobin ≥10 g/dL (417.6 ± 66.2 m vs 357.8 ± 69.3 m, p = 0.021), serum albumin >3.5 g/dL (401.2 ± 70.4 m vs 355.9 ± 60.5 m, p = 0.018), and dialysis duration <3 years (404.3 ± 72.1 m vs 362.5 ± 75.6 m, p = 0.037). No significant associations were found for gender, BMI, or CRP levels. Conclusion: Over half of the ESRD patients on maintenance hemodialysis demonstrated reduced functional capacity, predominantly associated with anemia, hypoalbuminemia, and prolonged dialysis duration. Addressing these modifiable factors through targeted anemia management, nutritional optimization, and integration of structured intradialytic exercise programs may substantially improve physical function and quality of life in this population.