A new study has found that kidney patients begin to show functional decline within six months of initiating dialysis – and the older and more frail the patient, the more abilities are lost, investigators said. Caregiver burden increases as well, they found.

The Netherlands-based study included 187 participants aged 65 years and older with end-stage renal disease who underwent a geriatric assessment and a frailty screening at dialysis initiation. Researchers assessed functional status and caregiver burden at baseline and after six months.

Forty percent of the participants lost functional status – defined as the ability to conduct activities of daily living. Thirty-four remained stable, 18% improved, and 8% died. The risk of functional decline or death was higher in participants who were older and those who were frail. In addition, caregivers reporting a high burden of care increased from 23% to 38%.

“We have shown that functional decline in older adults is highly prevalent and is mainly due to a loss of independence in instrumental activities of daily living – activities such as medication intake, laundry, and food preparation,” wrote lead author Namiko Goto, M.D.

The results suggest that an individual’s health-related goals should be assessed before dialysis begins, Goto wrote. “This could be useful for physicians, patients, and caregivers as they discuss whether to start dialysis. In addition, interventions such as physical activity programs may be initiated to prevent functional decline in patients at high risk,” she explained.

In an editorial accompanying the study, kidney transplant patient and dialysis center owner Daniel L. Abel described the toll dialysis takes on patients’ lives: “Old or young, frail or strong, the physical ramifications of our lives on dialysis can be devastating and life-changing in ways that are unique and individual. We depend on our medical team to recognize and respect these differences, and when we aren’t wearing our agony on our sleeve, insight and kindness go a long way,” he said.

More than 661,000 Americans have kidney failure. Of these, 468,000 individuals are on dialysis, according to the National Institutes of Health.

The study and editorial were published in the June issue of the Clinical Journal of American Society of Nephrology.