Prognostic value of functional capacity assessed by the Glittre Activities of Daily Living test in hemodialysis patients: a prospective observational study.

INTRODUCTION: Hemodialysis patients present high morbidity and mortality rates. Functional capacity has emerged as a significant marker of mortality risk across populations, and the Glittre Activities of Daily Living (Glittre-ADL) test assesses it through tasks simulating daily activities. This study aimed to investigate the prognostic value of functional capacity, as assessed by the Glittre-ADL test, in hemodialysis patients. METHODS: This was a prospective observational study conducted in a Brazilian reference hemodialysis center, involving patients aged 18 years or older who underwent dialysis three times weekly for at least three months. Baseline measurements were taken from April 2019 onward, and patients were followed until August 2024 to assess mortality. Clinical, anthropometric, and biochemical parameters were evaluated, and functional capacity was assessed through the Glittre-ADL test. Data were analyzed using Fine-Gray subdistribution hazards models, ROC curve analysis, Harrell's C-index, and Kaplan-Meier survival analysis. Cutoff values were determined, and positive and negative predictive values were calculated. Confidence intervals were estimated using bootstrap resampling (1,000 replicates). RESULTS: Seventy-six eligible patients were included. The median follow-up time was 38.33 (2.50-77.73) months. The Glittre-ADL test (HR: 1.003 [95%CI 1.001-1.006]; p = 0.03) and age (HR: 1.049 [95%CI 1.020-1.078]; p < 0.001) were independently associated with mortality. The optimal cutoff value for the Glittre-ADL test for identifying mortality risk was ≥268.5 seconds (AUC = 0.86; 95%CI 0.77-0.94; p < 0.0001). CONCLUSIONS: Performance in the Glittre-ADL test was associated with prognosis and accurately identified mortality risk among hemodialysis patients.