{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:07:53Z","timestamp":1791234473373,"version":"4.1.0"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objectives<\/jats:title>\n                    <jats:p>The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting, participants, &amp; measurements<\/jats:title>\n                    <jats:p>We identified 40,615 Medicare beneficiaries \u226565 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as \u2265100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (\u22641, 2, 3, and 4\u20136) with 6-month mortality, LTC, and functional impairment were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with \u22641 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4\u20136 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.01260216","type":"journal-article","created":{"date-parts":[[2016,10,12]],"date-time":"2016-10-12T22:10:24Z","timestamp":1476310224000},"page":"2218-2224","source":"Crossref","is-referenced-by-count":17,"title":["Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation"],"prefix":"10.2215","volume":"11","author":[{"given":"C. Barrett","family":"Bowling","sequence":"first","affiliation":[{"name":"Department of Veterans Affairs, Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center (VAMC), Decatur, Georgia;"},{"name":"Division of General Medicine and Geriatrics, Department of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Plantinga","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Geriatrics, Department of Medicine,"},{"name":"Division of Renal Medicine, Department of Medicine,"},{"name":"Department of Epidemiology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasheeda K.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Geriatric Research, Education and Clinical Center and"},{"name":"Renal Section, Durham VAMC, Durham, North Carolina; and"},{"name":"Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Mirk","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs, Birmingham\/Atlanta Geriatric Research, Education, and Clinical Center, Atlanta Veterans Affairs Medical Center (VAMC), Decatur, Georgia;"},{"name":"Division of General Medicine and Geriatrics, Department of Medicine,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Zhang","sequence":"additional","affiliation":[{"name":"Rehabilitation\/Quality of Life Special Studies Center, United States Renal Data System, and"},{"name":"Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Kutner","sequence":"additional","affiliation":[{"name":"Rehabilitation\/Quality of Life Special Studies Center, United States Renal Data System, and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,10,12]]},"reference":[{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1681\/ASN.2013050491","article-title":"Healthcare intensity at initiation of chronic dialysis among older adults.","volume":"25","author":"Wong","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1056\/NEJMoa0904655","article-title":"Functional status of elderly adults before and after initiation of dialysis.","volume":"361","author":"Kurella Tamura","year":"2009","journal-title":"N Engl J Med"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12882-015-0021-9","article-title":"Underreporting of nursing home utilization on the CMS-2728 in older incident dialysis patients and implications for assessing mortality risk.","volume":"16","author":"Bowling","year":"2015","journal-title":"BMC Nephrol"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jamda.2013.01.004","article-title":"End-stage renal disease in nursing homes: a systematic review.","volume":"14","author":"Hall","year":"2013","journal-title":"J Am Med Dir Assoc"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"1612","DOI":"10.1056\/NEJMc0905289","article-title":"Loss of independence in patients starting dialysis at 80 years of age or older.","volume":"361","author":"Jassal","year":"2009","journal-title":"N Engl J Med"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1046\/j.1525-139X.2002.00033.x","article-title":"Dialysis in nursing homes.","volume":"15","author":"Tong","year":"2002","journal-title":"Semin Dial"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.2215\/CJN.00880114","article-title":"Nondisease-specific problems and all-cause mortality among older adults with CKD: the REGARDS Study.","volume":"9","author":"Bowling","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/jgs.12214","article-title":"Nondisease-specific problems and all-cause mortality in the REasons for Geographic and Racial Differences in Stroke study.","volume":"61","author":"Bowling","year":"2013","journal-title":"J Am Geriatr Soc"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.2215\/CJN.08170910","article-title":"CMS 2728: what good is it?","volume":"5","author":"Eggers","year":"2010","journal-title":"Clin J Am Soc Nephrol"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"845","DOI":"10.2215\/CJN.06840712","article-title":"The USRDS: what you need to know about what it can and can\u2019t tell us about ESRD.","volume":"8","author":"Foley","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1097\/MLR.0b013e31817925d2","article-title":"Ability of Medicare claims data to identify nursing home patients: a validation study.","volume":"46","author":"Koroukian","year":"2008","journal-title":"Med Care"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"M174","DOI":"10.1093\/geronj\/49.4.M174","article-title":"MDS Cognitive Performance Scale.","volume":"49","author":"Morris","year":"1994","journal-title":"J Gerontol"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2215\/CJN.01170905","article-title":"Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS).","volume":"2","author":"Bradbury","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1681\/ASN.V7102169","article-title":"Early death in dialysis patients: risk factors and impact on incidence and mortality rates.","volume":"7","author":"Soucie","year":"1996","journal-title":"J Am Soc Nephrol"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1001\/jama.292.17.2115","article-title":"Hospitalization, restricted activity, and the development of disability among older persons.","volume":"292","author":"Gill","year":"2004","journal-title":"JAMA"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/gerona\/glt109","article-title":"Aging and chronic kidney disease: the impact on physical function and cognition.","volume":"69","author":"Anand","year":"2014","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/ki.2010.336","article-title":"Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies.","volume":"79","author":"Kurella Tamura","year":"2011","journal-title":"Kidney Int"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.2215\/CJN.11001013","article-title":"Accidental falls and risk of mortality among older adults on chronic peritoneal dialysis.","volume":"9","author":"Farragher","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.2215\/CJN.01650506","article-title":"Falls and fall-related injuries in older dialysis patients.","volume":"1","author":"Cook","year":"2006","journal-title":"Clin J Am Soc Nephrol"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"428","DOI":"10.2215\/CJN.03510414","article-title":"Utilization of acute care among patients with ESRD discharged home from skilled nursing facilities.","volume":"10","author":"Hall","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1053\/j.ajkd.2013.07.022","article-title":"Community mobility among older adults with reduced kidney function: a study of life-space.","volume":"63","author":"Bowling","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1053\/j.ajkd.2013.11.017","article-title":"Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD.","volume":"63","author":"Tong","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1056\/NEJMsa012528","article-title":"Understanding the treatment preferences of seriously ill patients.","volume":"346","author":"Fried","year":"2002","journal-title":"N Engl J Med"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"177","DOI":"10.7326\/0003-4819-146-3-200702060-00006","article-title":"Octogenarians and nonagenarians starting dialysis in the United States.","volume":"146","author":"Kurella","year":"2007","journal-title":"Ann Intern Med"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1093\/ndt\/gfm153","article-title":"Dialysis or not? A comparative survival study of patients over 75 years with chronic kidney disease stage 5.","volume":"22","author":"Murtagh","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1056\/NEJMsa010285","article-title":"A controlled trial of inpatient and outpatient geriatric evaluation and management.","volume":"346","author":"Cohen","year":"2002","journal-title":"N Engl J Med"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1001\/jamainternmed.2014.4298","article-title":"Post-acute care: who belongs where?","volume":"175","author":"Jenq","year":"2015","journal-title":"JAMA Intern Med"},{"key":"B31-20230813","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1681\/ASN.V113520","article-title":"Validation of comorbid conditions on the end-stage renal disease medical evidence report: the CHOICE study. Choices for Healthy Outcomes in Caring for ESRD.","volume":"11","author":"Longenecker","year":"2000","journal-title":"J Am Soc Nephrol"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201612000-00018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:20Z","timestamp":1786368980000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201612000-00018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,12]]},"references-count":28,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.01260216","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,12]]}}}