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Cheng M, He M, Ning L, Gan H, Liu H, Liu Q, Shi F, Luo Y, Zeng Z. Association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis: a systematic review and meta-analysis. Ren Fail 2024; 46:2367716. [PMID: 39099468 DOI: 10.1080/0886022x.2024.2367716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 08/06/2024] Open
Abstract
OBJECTIVES The aim of this study was to determine the strength of the association between frailty and adverse outcomes in patients undergoing maintenance hemodialysis. DESIGN A systematic review and meta-analysis. SETTING AND PARTICIPANTS Patients aged ≥18 years who were undergoing maintenance hemodialysis. METHODS PubMed, Web of Science, Embase, the Cochrane Library, Scopus, the China Knowledge Resource Integrated Database, the Wanfang Database and the Weipu Database were searched from inception until 11 April 2024. The reviewers independently selected the studies, extracted the data and evaluated the quality of the studies. Stata 15.1 software was used to perform the meta-analysis. RESULTS A total of 36 articles were included in this study, including 56,867 patients. The primary outcome events in this study were mortality, hospitalization, and vascular access events. The secondary outcomes were depression, cognitive impairment, falls, fracture, sleep disturbances, and quality of life. This study suggested that frailty was associated with mortality in patients undergoing maintenance hemodialysis [hazard ratio (HR), 1.97; 95% CI, 1.62-2.40]. Frailty increased the risk of mortality in patients [odds ratio (OR), 2.33; 95% CI, 1.47-3.68]. In addition, we found that frailty was significantly associated with hospitalization in patients undergoing maintenance hemodialysis (OR, 2.47; 95% CI, 1.52-4.03). Patients who were undergoing maintenance hemodialysis and who were frail had a greater risk of hospitalization [RR, 1.47; 95% CI, 1.05-2.08] and emergency visits (RR, 2.28; 95% CI, 1.78-2.92). The results of this study also suggested that frailty was associated with a greater risk of vascular access events (HR, 1.72; 95% CI, 1.50-1.97). Finally, frailty increased the risk of depression (OR, 4.31; 95% CI, 1.83-10.18), falls and fractures, and reduced quality of life. CONCLUSIONS The findings of this study suggested that frailty was an important predictor of adverse outcomes in patients undergoing maintenance hemodialysis. In the future, medical staff should regularly evaluate signs of weakness, formulate individual diagnosis and treatment plans, adjust dialysis plans according to the patient's condition, and reduce the occurrence of adverse events. REGISTRATION The study protocol was registered on PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, number: CRD42023486239).
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Affiliation(s)
- Min Cheng
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Mei He
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Liping Ning
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Haoyue Gan
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Hangcheng Liu
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Qin Liu
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Feifei Shi
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Ying Luo
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
| | - Zhi Zeng
- School of Nursing, North Sichuan Medical University, Nanchong, China
- Nursing Department of Mianyang Central Hospital/School of Medicine, Affiliated to University of Electronic Science and Technology of China, Mianyang, China
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Bulbul E, Namoglu SS. The frailty in older hemodialysis patients and associations with depression, functional status, dialysis adequacy. Ther Apher Dial 2024; 28:727-734. [PMID: 38828537 DOI: 10.1111/1744-9987.14164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION The aim of this study was to determine the level of frailty in older hemodialysis patients and to examine the relationship between their functional capacity, depression, and laboratory variables. METHOD This was a cross-sectional study, and the data were collected 243 dialysis patients aged 65 and over between May 2021 and May 2022. RESULTS The frailty rate was 49%. A statistically significant positive correlation was found between the frailty and age, hemodialysis vintage, and the number of hospitalizations. The frailty was negatively correlated with body mass index, Kt/V, Albumin, and parathyroid hormone. There was a statistically significant positive correlation between frailty and depression and a negative correlation between functional capacity. CONCLUSION A relationship was found between frailty and depression, functional capacity, and laboratory variables. In addition, the variables affecting the level of frailty in geriatric dialysis patients included dialysis vintage, dialysis adequacy, number of hospitalizations, albumin level, and patient weight.
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Affiliation(s)
- Elif Bulbul
- Internal Medicine Nursing Department, Istanbul, Turkey
| | - Selda Selimoglu Namoglu
- Dialysis Department, Istanbul Medipol University, Health Vocational School, Istanbul, Turkey
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Antoun J, Shepherd AI, Corbett J, Sangala NC, Lewis RJ, Lane E, Saynor ZL. Cardiac dysfunction in dialysing adults with end-stage kidney disease is associated with exercise intolerance: A pilot observational study. Physiol Rep 2024; 12:e70050. [PMID: 39256617 PMCID: PMC11387153 DOI: 10.14814/phy2.70050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/29/2024] [Accepted: 09/01/2024] [Indexed: 09/12/2024] Open
Abstract
People with end-stage kidney disease (ESKD) often exhibit impaired cardiac structure and function, which may contribute to poor exercise capacity. This study used multimodal exercise testing to investigate the central and peripheral mechanisms of exercise limitation in adults with ESKD, also comparing in-centre hemodialysis (ICHD) to home hemodialysis (HHD). Seventeen adults (55.5 ± 14.5 years; n = 14 male; n = 12 HHD) participated. Resting cardiac examinations, followed by submaximal cycling cardiopulmonary exercise testing (CPET) and functional exercise testing, revealed cardiac structural abnormalities (increased left ventricular mass) and cardiac injury. Aerobic fitness in adults with ESKD was low, with pulmonary oxygen uptake (V̇O2) at the gas exchange threshold (GET) occuring at 39 ± 8% predicted V̇O2peak. O2 pulse, an estimate of stroke volume (SV), was higher in HHD at rest (p = 0.05, ES = 0.58) and during unloaded cycling (p = 0.05, ES = 0.58) compared to ICHD. However, thoracic bioreactance derived SV at the GET was significantly higher in adults receiving ICHD versus HHD (p = 0.01, ES = 0.74). In adults with ESKD, cardiac output was positively associated with V̇O2 at the GET (r = 0.61, p = 0.04). This study highlights prevalent exercise dysfunction in adults with ESKD undergoing dialysis, with potential distinct differences between in-centre and home hemodialysis, mechanistically linked to underlying cardiac abnormalities.
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Affiliation(s)
- Joe Antoun
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
- Academic Department of Renal Medicine, Wessex Kidney CentrePortsmouth Hospitals University NHS TrustPortsmouthUK
| | - Anthony I. Shepherd
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
- Academic Department of Renal Medicine, Wessex Kidney CentrePortsmouth Hospitals University NHS TrustPortsmouthUK
| | - Jo Corbett
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
| | - Nicholas C. Sangala
- Academic Department of Renal Medicine, Wessex Kidney CentrePortsmouth Hospitals University NHS TrustPortsmouthUK
| | - Robert J. Lewis
- Academic Department of Renal Medicine, Wessex Kidney CentrePortsmouth Hospitals University NHS TrustPortsmouthUK
| | - Emma Lane
- Physical Activity, Health and Rehabilitation Thematic Research Group, School of Sport, Health and Exercise Sciences, Faculty of Science and HealthUniversity of PortsmouthPortsmouthUK
- Queen Alexandra HospitalPortsmouth Hospitals University NHS TrustPortsmouthUK
| | - Zoe L. Saynor
- School of Health Sciences, Faculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- National Institute for Health and Care Research, Southampton Biomedical Research CentreUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
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Chan GCK, Kalantar-Zadeh K, Ng JKC, Tian N, Burns A, Chow KM, Szeto CC, Li PKT. Frailty in patients on dialysis. Kidney Int 2024; 106:35-49. [PMID: 38705274 DOI: 10.1016/j.kint.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 05/07/2024]
Abstract
Frailty is a condition that is frequently observed among patients undergoing dialysis. Frailty is characterized by a decline in both physiological state and cognitive state, leading to a combination of symptoms, such as weight loss, exhaustion, low physical activity level, weakness, and slow walking speed. Frail patients not only experience a poor quality of life, but also are at higher risk of hospitalization, infection, cardiovascular events, dialysis-associated complications, and death. Frailty occurs as a result of a combination and interaction of various medical issues in patients who are on dialysis. Unfortunately, frailty has no cure. To address frailty, a multifaceted approach is necessary, involving coordinated efforts from nephrologists, geriatricians, nurses, allied health practitioners, and family members. Strategies such as optimizing nutrition and chronic kidney disease-related complications, reducing polypharmacy by deprescription, personalizing dialysis prescription, and considering home-based or assisted dialysis may help slow the decline of physical function over time in subjects with frailty. This review discusses the underlying causes of frailty in patients on dialysis and examines the methods and difficulties involved in managing frailty among this group.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ning Xia Medical University, Yin Chuan, China
| | - Aine Burns
- Division of Nephrology, University College London, Royal Free Hospital, London, UK
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China; Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China.
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Nair D, Liu CK, Raslan R, McAdams-DeMarco M, Hall RK. Frailty in Kidney Disease: A Comprehensive Review to Advance Its Clinical and Research Applications. Am J Kidney Dis 2024:S0272-6386(24)00836-9. [PMID: 38906506 DOI: 10.1053/j.ajkd.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/23/2024]
Abstract
Frailty is a multisystem syndrome of decreased physiologic reserve that has been shown to strongly and independently predict morbidity and mortality. Frailty is prevalent in patients living with kidney disease and occurs earlier in individuals with kidney disease as compared to the general population. In this comprehensive review, we examine clinical and research applications of frailty in kidney disease populations. Specifically, we clarify the definition of frailty and address common misconceptions, review the mechanisms and epidemiology of frailty in kidney disease, discuss challenges and limitations in frailty measurement, and provide updated evidence related to risk factors for frailty, its associated adverse outcomes, and interventions. We further add to the literature in this topic by highlighting the potential applications of frailty measurement in the care of patients with kidney disease and conclude with our recommendations for future research related to this important syndrome.
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Affiliation(s)
- Devika Nair
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee; Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
| | - Christine K Liu
- Geriatric Research and Education Clinical Center, Veteran Affairs Palo Alto Health Care System, Palo Alto, California; Section of Geriatric Medicine, Division of Primary Care and Population Health, School of Medicine, Stanford University, Stanford, California
| | - Rasha Raslan
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Mara McAdams-DeMarco
- Department of Surgery, Langone Health and Grossman School of Medicine, New York University, New York, New York; Department of Population Health, Langone Health and Grossman School of Medicine, New York University, New York, New York
| | - Rasheeda K Hall
- Department of Medicine, School of Medicine, Duke University, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina.
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Okada H, Ono A, Tomori K, Inoue T, Hanafusa N, Sakai K, Narita I, Moriyama T, Isaka Y, Fukami K, Itano S, Kanda E, Kashihara N. Development of a prognostic risk score to predict early mortality in incident elderly Japanese hemodialysis patients. PLoS One 2024; 19:e0302101. [PMID: 38603695 PMCID: PMC11008820 DOI: 10.1371/journal.pone.0302101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Information of short-term prognosis after hemodialysis (HD) introduction is important for elderly patients with chronic kidney disease (CKD) and their families choosing a modality of renal replacement therapy. Therefore, we developed a risk score to predict early mortality in incident elderly Japanese hemodialysis patients. MATERIALS AND METHODS We analyzed data of incident elderly HD patients from a nationwide cohort study of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) to develop a prognostic risk score. Candidate risk factors for early death within 1 year was evaluated using multivariate logistic regression analysis. The risk score was developed by summing up points derived from parameter estimate values of independent risk factors. The association between risk score and early death was tested using Cox proportional hazards models. This risk score was validated twice by using an internal validation cohort derived from the JRDR and an external validation cohort collected for this study. RESULTS Using the development cohort (n = 2,000), nine risk factors were retained in the risk score: older age (>85), yes = 2, no = 0; sex, male = 2, female = 0; lower body mass index (<20), yes = 2, no = 0; cancer, yes = 1, no = 0; dementia, yes = 3, no = 0; lower creatinine (<6.5 mg/dL), yes = 1, no = 0; lower albumin (<3.0 g/dL), yes = 3, no = 0; normal or high calcium (≥8.5 mg/dL), yes = 1, no = 0; and higher C reactive protein (>2.0 mg/dL), yes = 2, no = 0. In the internal and external validation cohorts (n = 739, 140, respectively), the medium- and high-risk groups (total score, 6 to 10 and 11 or more, respectively) showed significantly higher risk of early death than the low-risk group (total score, 0 to 5) (p<0.001). CONCLUSION We developed a prognostic risk score predicting early death within 1 year in incident elderly Japanese HD patients, which may help detect elderly patients with a high-risk of early death after HD introduction.
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Affiliation(s)
- Hirokazu Okada
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Atsushi Ono
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
- Department of Nephrology, SUBARU Health Insurance Association Ota Memorial Hospital, Ota, Japan
| | - Koji Tomori
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Tsutomu Inoue
- Department of Nephrology, Saitama Medical University, Irumagun, Japan
| | - Norio Hanafusa
- Department of Medicine, Blood Purification, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University, Tokyo, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Fukami
- Department Medicine, Division of Nephrology, Kurume University School of Medicine, Fukuoka, Japan
| | - Seiji Itano
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Eiichiro Kanda
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
| | - Naoki Kashihara
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
- Geriatric Medical Center, Kawasaki Medical School, Okayama, Japan
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Chen YT, Lai TS, Tsao HM, Lai CF, Yang SY, Chen YM. Clinical implications of frailty in peritoneal dialysis patients - A prospective observational study. J Formos Med Assoc 2024; 123:248-256. [PMID: 37468410 DOI: 10.1016/j.jfma.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/14/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Frailty is an age-related condition that predicts adverse outcomes. The study was aimed to investigate the clinical implications of frailty evolution in patients undergoing peritoneal dialysis (PD). METHOD In this prospective study, all new-onset (<6 months) and prevalent (≧6 months) PD patients completed frailty assessment at entry and 6 months by a semiautomated frailty index of 80 risk factors (FI80) which also contained the 5 components of Fried frailty phenotype. A score ≧13/80 (FI80 > 0.16) or ≧3/5 (frailty phenotype) was designated to define frailty. RESULT 337 PD patients were recruited (new-onset 23.4%, prevalent 76.6%). Two hundred (59.3%) and 163 (48.4%) patients were frail by FI80 and frailty phenotype, respectively. Predictors for frailty were old age, dialysis, diabetes mellitus, gout and sleep disorder. New-onset patients aged <55 years displayed the best evolution of frailty over 6 months (stable or improved, n = 29/47, 61.7% by FI80, p = 0.0293), compared with other groups. Survival analysis found that frail patients exhibited the worse outcomes (overall death and hospitalization). Poisson regression showed frailty was associated with increased utilizations of outpatient and ER services; however multivariate Cox models identified only diabetes, gout and low body mass index (<19 kg/m2), but not frailty, predicted overall death and hospitalizations. CONCLUSION Frailty is a common medical condition in PD patients, and the status of which can be stabilized or improved in new-onset, young patients at least over the short term. Compared with frailty, certain comorbidities (diabetes and gout) and undernutrition appeared to be more robust in the prediction of adverse outcomes.
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Affiliation(s)
- Yi-Ting Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Blood Purification, Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Mei Tsao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Fu Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yo Yang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
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Mannaa M, Pfennigwerth P, Fielitz J, Gollasch M, Boschmann M. Mammalian target of rapamycin inhibition impacts energy homeostasis and induces sex-specific body weight loss in humans. J Cachexia Sarcopenia Muscle 2023; 14:2757-2767. [PMID: 37897143 PMCID: PMC10751400 DOI: 10.1002/jcsm.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 07/28/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Previous data from a 2-year randomized controlled trial (CRAD001ADE12) indicated that mammalian target of rapamycin (mTOR) inhibition by everolimus slowed cyst growth in patients with autosomal-dominant polycystic kidney disease (ADPKD). During the trial, we noted body weight loss in some patients, particularly in women. We hypothesized that everolimus causes body weight reduction by reduced food intake and/or metabolic changes, which could lead to cachexia. METHODS Within a sub-analysis of the CRAD001ADE12 trial, body weight course was investigated regarding sex-specific differences in 433 adult ADPKD patients (everolimus, n = 215; placebo, n = 218). One hundred four out of 111 patients who participated in the clinical trial centre in Berlin were evaluated under everolimus/placebo therapy (on drug: everolimus, n = 48; placebo, n = 56) and after therapy (off drug: everolimus, n = 15; placebo, n = 18). Eating habits and nutrient/caloric intake were evaluated by validated questionnaires. Systemic and local metabolism was evaluated in four patients after an oral glucose load (OGL) by using calorimetry and adipose/muscle tissue microdialysis. RESULTS Within the 2-year CRAD001ADE12 trial, a significant body weight loss was observed in female patients on everolimus versus placebo (P = 0.0029). Data of the Berlin Cohort revealed that weight loss was greater in women on everolimus versus men (P < 0.01). After 9 months, women and men had lost 2.6 ± 3.8 and 0.8 ± 1.5 kg (P < 0.05) in body weight, respectively, and after 21 months, they had lost 4.1 ± 6.6 and 1.0 ± 3.3 kg (P < 0.05), respectively. On everolimus, caloric intake was significantly lower in women versus men (1510 ± 128 vs. 2264 ± 216 kcal/day, P < 0.05), caused mainly by a lower fat and protein intake in women versus men. Cognitive restraints, disinhibition and hunger remained unchanged. In a subgroup of patients resting metabolic rate was unchanged whereas OGL-induced thermogenesis was reduced (7 ± 2 vs. 11 ± 2 kcal, P < 0.05). Fasting and OGL-induced fat oxidation was increased (P < 0.05) on versus off everolimus. In adipose tissue, fasting lipolytic activity was increased, but lipolytic activity was inhibited similarly after the OGL on versus off everolimus, respectively. In skeletal muscle, postprandial glucose uptake and aerobic glycolysis was reduced in patients on everolimus. CONCLUSIONS mTOR inhibition by everolimus induces body weight reduction, specifically in female patients. This effect is possibly caused by a centrally mediated reduced food (fat and protein) intake and by centrally/peripherally mediated increased fat oxidation (systemic) and mobilization (adipose tissue). Glucose uptake and oxidation might be reduced in skeletal muscle. This could lead to cachexia and, possibly, muscle wasting. Therefore, our results have important implications for patients recieving immune-suppressive mTOR inhibition therapy.
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Affiliation(s)
- Marwan Mannaa
- Department of Internal Medicine and GeriatricsUniversitätsmedizin GreifswaldGreifswaldGermany
| | - Pia Pfennigwerth
- Experimental and Clinical Research Center, a co‐operation between Charité – Universitätsmedizin and the Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
| | - Jens Fielitz
- Klinik und Poliklinik für Innere Medizin BUniversitätsmedizin GreifswaldGreifswaldGermany
- DZHK (German Center for Cardiovascular Research), partner site GreifswaldGreifswaldGermany
| | - Maik Gollasch
- Department of Internal Medicine and GeriatricsUniversitätsmedizin GreifswaldGreifswaldGermany
- Department of Nephrology and Medical Intensive CareCharité – Universitätsmedizin BerlinBerlinGermany
| | - Michael Boschmann
- Experimental and Clinical Research Center, a co‐operation between Charité – Universitätsmedizin and the Max Delbrück Center for Molecular Medicine in the Helmholtz AssociationBerlinGermany
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Ye L, Tang X, Zhang H, Ge S, Yin L, Zhou Y, Chang J. Prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China: A cross-sectional Study. J Adv Nurs 2023; 79:3522-3534. [PMID: 37186471 DOI: 10.1111/jan.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
AIMS To examine the prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China. DESIGN A cross-sectional study. METHOD From January to July 2017, using the convenience sampling method, a total of 503 maintenance haemodialysis patients from six hospitals in Lianyungang, China, were recruited for this study. The participants' socio-demographic, lifestyle factors and health information were assessed using a general information questionnaire. Frailty was evaluated based on the Fried frailty phenotype. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population, including age, sex, living alone, employment, educational level, body mass index, per capita monthly household income, smoking status, exercise status, primary diagnosis, dialysis age, frequency of dialysis, vascular access, congestive heart failure, other cardiac diseases, cerebrovascular disease, peripheral blood diseases, pain, albumin level and haemoglobin level. RESULTS Among the 503 participants with an average age of 53.02 years (standard deviation 14.99), 178 had pre-frailty (35.3%) and were mostly young and middle-aged. The prevalence of pre-frailty among participants <60 years old was more than 40%. Regression analysis showed that lack of exercise, dialysis age ≤12 months, congestive heart failure and other cardiac diseases were positively associated with pre-frailty. Two hundred and eighteen participants were frail (43.3%), most of whom were aged ≥60. The prevalence of frailty in participants ≥60 was 71.4%. Regression analysis showed that advanced age, being female, obesity, low per capita monthly household income, lack of exercise, diabetes as the primary disease, dialysis age ≤12 months, congestive heart failure, other cardiac diseases, pain and low albumin level, were positively associated with frailty. In addition, more than half of the participants hardly exercised (64.6%), while lack of exercise was a risk factor for pre-frailty and frailty. A third of the participants had pain (33.4%), while pain was an independent risk factor for pre-frailty and frailty in these participants. CONCLUSION Pre-frailty and frailty are common in patients with maintenance haemodialysis. Most of the elderly maintenance haemodialysis patients are frail, and most of the young and middle-aged patients are pre-frail. Clinicians should actively screen the pre-frailty and frailty among patients with maintenance haemodialysis, especially those with dialysis age ≤12 months. Many factors affect pre-frailty and frailty in this population. Tailored intervention measures should be designed and implemented based on these factors, giving priority to exercise guidance and pain management for patients to help them prevent or reverse pre-frailty and frailty.
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Affiliation(s)
- Liqin Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Hailin Zhang
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Song Ge
- Department of Natural Sciences/Nursing, University of Houston-Downtown, Texas, Houston, USA
| | - Lixia Yin
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Ying Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
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10
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Liu Y, Luo X, Deng S, Chen J, Zhang L, Huang Y, Hu H. Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis. Semin Dial 2023; 36:278-293. [PMID: 37313761 DOI: 10.1111/sdi.13162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.
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Affiliation(s)
- Yixiu Liu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiju Luo
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Siyan Deng
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jing Chen
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
| | - Lu Zhang
- Xi'an Medical University, Xi'an, Shan'xi, China
| | - Ying Huang
- Hemodialysis Center, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huagang Hu
- School of Nursing, Suzhou Medical College of Soochow University, Suzhou, China
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11
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Chen X, Zhu X, Han P, Zhang Y, He M, Zhang Y, Liu J, Tang J, Zhang Y, Zheng Y, Zhang Z, Li M, Guo Q. Sarcopenia is associated with mild-to-moderate chronic kidney disease in Chinese community-dwelling older men but not in women. J Int Med Res 2022; 50:3000605221136683. [PMID: 36446755 PMCID: PMC9716608 DOI: 10.1177/03000605221136683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To determine whether a relationship exists between sarcopenia, including its individual components (muscle mass, muscle strength and gait speed), and mild-to-moderate chronic kidney disease (CKD) in Chinese older adults. METHODS This cross-sectional study comprised participants aged ≥60 years from Tianjin and Shanghai, China, who joined a national free physical examination program between 2014 and 2019, and consented to study inclusion. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (2019 version). Mild-to-moderate CKD was defined as estimated glomerular filtration rate (eGFR) between 45 ml/min/1.73 m2 and 60 ml/min/1.73 m2. RESULTS A total of 1627 participants were included (mean age, 69.32 ± 6.17 years; 43.8% male). Sarcopenia was significantly associated with mild-to-moderate CKD in men but not women. Among three physical performance components, slow gait speed (odds ratio 1.89, 95% confidence interval 1.38, 2.58) was associated with mild-to-moderate CKD in both men and women after adjusting for all other variables. CONCLUSIONS Sarcopenia was closely associated with mild-to-moderate CKD in older men, and slow gait speed was related to mild-to-moderate CKD in men and women. These findings may help guide better diagnosis and management of CKD in the context of slow gait speed, and facilitate earlier CKD detection and appropriate intervention in older adults.
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Affiliation(s)
- Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyan Zhu
- Department of Rehabilitation Medicine, Shanghai Herson Rehabilitation Hospital, Shanghai, China
| | - Peipei Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuanyuan Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Mian He
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yuhui Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jinghuan Liu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Jiawei Tang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yisong Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yaqing Zheng
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fujian, China
| | - Ziwei Zhang
- Department of Rehabilitation Medicine, Fujian Provincial Hospital, Fujian, China
| | - Ming Li
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China,Qi Guo, Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, 1500 Zhouyuan Road, Pudong New District, Shanghai, 201318, China.
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12
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Schoot TS, Goto NA, van Marum RJ, Hilbrands LB, Kerckhoffs APM. Dialysis or kidney transplantation in older adults? A systematic review summarizing functional, psychological, and quality of life-related outcomes after start of kidney replacement therapy. Int Urol Nephrol 2022; 54:2891-2900. [PMID: 35513758 PMCID: PMC9534800 DOI: 10.1007/s11255-022-03208-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND In older patients, the choice between kidney transplantation (KT) and dialysis may be complicated because of a high prevalence of comorbidities and geriatric syndromes. Ideally, this decision-making process focusses on older patients' outcome priorities, which frequently include functional, psychological, and quality of life (QOL)-related outcomes. PURPOSE This systematic review aims to summarize functional, psychological (including cognition), and QOL-related outcomes after start of kidney replacement therapy (KRT) in older adults. METHODS We searched PubMed and Embase for research that investigated change in these variables after start of KRT in patients aged ≥ 60 years. Data were extracted using the summary measures reported in the individual studies. Risk of bias was assessed with the ROBINS-I tool. RESULTS Sixteen observational studies (prospective n = 9, retrospective n = 7; KT-recipients n = 3, dialysis patients n = 13) were included. The results show that QOL improves in the majority of the older KT recipients. After start of dialysis, QOL improved or remained stable for most patients, but this seems less prevalent than after KT. Functional status decreases in a substantial part of the older dialysis patients. Furthermore, the incidence of serious fall injuries increases after start of dialysis. Nutritional status seems to improve after start of dialysis. CONCLUSION The interpretability and comparability of the included studies are limited by the heterogeneity in study designs and significant risk of bias in most studies. Despite this, our overview of functional, psychological (including cognition), and QOL-related outcomes is useful for older adults and their clinicians facing the decision between KT and dialysis.
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Affiliation(s)
- Tessa S Schoot
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
- Department of Nephrology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
| | - Namiko A Goto
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob J van Marum
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
- Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
- Department of Elderly Care Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Angèle P M Kerckhoffs
- Department of Nephrology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
- Department of Geriatric Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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13
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Talmon A, Cohen N, Raif Y, Ginzburg K. Sense of mastery among older adults and its relation to invalidating childhood experiences. Aging Ment Health 2022; 26:2186-2194. [PMID: 34669542 DOI: 10.1080/13607863.2021.1993130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
ObjectivesSense of mastery, a well-recognized resource for older adults, has been shown to be related to early life experiences, especially parent-child interactions. Yet while there are indications that a reduced sense of mastery is related to early experiences of child maltreatment, this association has not been studied among older adults. The aim of this study was to examine the relation between experiences of childhood parental invalidation and sense of mastery among older adults, through the mediation of self-objectification and perceived disrupted body boundaries.Methods: Three-hundred-and-sixteen older adults (Mean = 72.24; SD = 8.12 years; range: 60-94) filled out a battery of questionnaires assessing their levels of exposure to childhood parental invalidation experiences, sense of self-objectification, disrupted body boundaries, and sense of masteryResults: A structural equation modeling (SEM) analysis supported the hypothesized research model. More specifically, two significant indirect effects were observed, according to which the association between invalidating childhood experiences and sense of mastery was mediated by both self-objectification and by disrupted body boundaries.Conclusion: As these results suggest that early life experiences continue to affect individuals' sense of self in older age, they should be considered an important factor for evaluation and intervention.
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Affiliation(s)
- Anat Talmon
- Psychology Department, Stanford University, Stanford, CA, USA
| | - Noa Cohen
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yael Raif
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Karni Ginzburg
- The Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Yabe H, Kono K, Yamaguchi T, Yamada N, Ishikawa Y, Yamaguchi Y, Azekura H. Effect of intradialytic exercise on geriatric issues in older patients undergoing hemodialysis: a single-center non-randomized controlled study. Int Urol Nephrol 2022; 54:2939-2948. [PMID: 35524833 DOI: 10.1007/s11255-022-03205-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study investigated the effect of 1 year of intradialytic exercise on older hemodialysis patients with geriatric issues. METHODS Forty-six patients aged ≥ 70 years were non-randomly assigned to two groups (exercise group: 27, control group: 19). Intradialytic exercise consisted of 30 min of aerobic exercise using a cycle ergometer, and resistance training comprising four exercises using an elastic tube three times per week for 1 year. Handgrip strength, leg extremity muscle strength, 10-m walk speed, short physical performance battery, serum albumin, Geriatric Nutritional Risk Index (GNRI), geriatric depression scale, frailty, and mobility were each assessed before and after the intervention. RESULTS The control group exhibited a significant reduction in handgrip strength, 10-m walking speed, serum albumin, and GNRI after intervention compared to baseline (p < 0.05). Conversely, no significant reductions were observed in the exercise group. The ΔGNRI (effect size, 0.69; 95% confidence interval [CI] - 5.21, - 0.1; p < 0.05) and Δserum albumin (effect size, 0.72; 95% CI - 0.31, - 0.02; p < 0.05) before and after the intervention declined significantly less in the exercise group than in the control group. Other between-group values were not significantly different. The number of frail patients and patients requiring walking assistance exhibited no significant intra-group or between-group differences before and after the intervention. CONCLUSION Intradialytic exercise prevented the worsening of nutritional status and physical function in the exercise group compared to the control group. Exercise therapy during dialysis is an important aspect of patient care that helps prevent functional decline in older patients.
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Affiliation(s)
- Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
| | - Kenichi Kono
- Department of Physical Therapy, School of Health Sciences at Narita, International University of Health and Welfare, Narita, Chiba, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Naomi Yamada
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Yumiko Ishikawa
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Yoshiko Yamaguchi
- Department of Nursing, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
| | - Hisanori Azekura
- Department of Nephrology, Sanaru Sun Clinic, Hamamatsu, Shizuoka, Japan
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15
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Zemp DD, Giannini O, Quadri P, Rabuffetti M, Tettamanti M, de Bruin ED. Gait disorders in CKD patients: muscle wasting or cognitive impairment? A cross-sectional pilot study to investigate gait signatures in Stage 1-5 CKD patients. BMC Nephrol 2022; 23:72. [PMID: 35189838 PMCID: PMC8862207 DOI: 10.1186/s12882-022-02697-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Instrumental gait analysis in nephrology is widely neglected, although patients with chronic kidney disease (CKD) show brain changes due to cerebrovascular disease and metabolic disorders that can potentially influence gait quality. Our study assesses the association between CKD stages and gait parameters, to understand the prevalent status of brain related gait parameters (i.e. variability) and of performance related parameters (i.e. gait speed, stride length). We hypothesize that gait changes are detectable already in early stages of CKD. METHODS Forty-five participants distributed in 5 CKD severity groups underwent an instrumental gait analysis via a triaxial accelerometer affixed to the lower trunk under single- and dual-task conditions. In addition to spatio-temporal parameters, variability and dual-task cost of gait were extracted. A battery of clinical assessments was conducted with the aim of helping to better explain the findings of the gait analysis. A correlation analysis was made to investigate a linear relation between gait parameters and CKD severity. RESULTS Statistically significant correlations (Pearson correlation coefficient) with CKD severity were found for gait speed (p < 0.01, r = -0.55, 95% CI [-0.73;-0.30]), stride length ( p < 0.01, r = -0.40, 95% CI [-0.62;-0.12]), step length (p < 0.01, r = -0.41, 95% CI [-0.63;-0.13], coefficient of variance (CV) of step length (p = 0.01, r = 0.36, 95% CI [0.08;0.59]), gait regularity (p < 0.01, r = -0.38, 95% CI [-0.61;-0.10]), dual-task cost of gait speed (p < 0.01, r = 0.40, 95% CI [0.13;0.62]) and dual-task cost of stride time (p = 0.03, r = 0.32, 95% CI [0.03;0.57]). Adjustment for age and gender confirmed all results except for gait regularity. With increasing severity of renal failure, Handgrip strength, Time for the Expanded Timed Get Up and Go test, executive functions, haemoglobin, and haematocrit, worsen. CONCLUSIONS The correlation of CKD severity with spatio-temporal parameters (performance indices mainly relatable to peripheral functionality) and with variability of gait (related to central factors) supported by the results of the clinical assessments, suggests that gait disturbance in CKD patients is not only due to metabolic factors that lead to muscle wasting, but also to brain changes that affect motor control. This suggests that the treatment of renal disease should include cognitive aspects in addition to metabolic and functional factors.
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Affiliation(s)
- Damiano D. Zemp
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland
| | - Olivier Giannini
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Division of Nephrology, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Pierluigi Quadri
- Geriatric Service, Ospedale Regionale di Mendrisio, EOC, Mendrisio, Switzerland
- Department of Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | | | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eling D. de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- OST – Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
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16
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Zemp DD, Giannini O, Quadri P, Tettamanti M, Berwert L, Lavorato S, Pianca S, Solcà C, de Bruin ED. A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis. Front Med (Lausanne) 2022; 9:682198. [PMID: 35186984 PMCID: PMC8854975 DOI: 10.3389/fmed.2022.682198] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/05/2022] [Indexed: 12/19/2022] Open
Abstract
BackgroundPatients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.MethodsThe patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.ResultsAt baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.ConclusionOur results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.
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Affiliation(s)
- Damiano D. Zemp
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Service of Geriatrics, EOC, Ospedale Regionale di Mendrisio EOC, Mendrisio, Switzerland
| | - Olivier Giannini
- Department of Medicine, EOC, Bellinzona, Switzerland
- Division of Nephrology, EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Pierluigi Quadri
- Service of Geriatrics, EOC, Ospedale Regionale di Mendrisio EOC, Mendrisio, Switzerland
- Department of Medicine, EOC, Bellinzona, Switzerland
| | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Lorenzo Berwert
- Department of Medicine, EOC, Bellinzona, Switzerland
- Division of Nephrology, EOC, Lugano, Switzerland
| | | | | | - Curzio Solcà
- Service of Nephrology, Centro Dialisi Nefrocure e Clinica Luganese Moncucco, Lugano, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health, OST - Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- *Correspondence: Eling D. de Bruin
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Li C, Chen L, He L, Zhang Y, Chen H, Liu Y, Tang S, Zheng H. Study on the relationship between sarcopenia and its components and anorexia in elderly maintenance haemodialysis patients. Nurs Open 2021; 9:1096-1104. [PMID: 34907670 PMCID: PMC8859065 DOI: 10.1002/nop2.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
AIM This study aimed to investigate the current situation of sarcopenia and anorexia of elderly maintenance haemodialysis patients and analyse the influencing factors. DESIGN A cross-sectional design was used in this study. METHODS One hundred and twelve elderly patients on MHD in 3 haemodialysis centres in Sichuan, China, were selected. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia (AWGS). Anorexia was assessed with the Functional Assessment of Anorexia Cachexia Therapy/Anorexia Cachexia Subscale (FAACT/ACS). The relationship between sarcopenia and anorexia was analysed by logistic regression. RESULTS The prevalences of sarcopenia and severe sarcopenia in elderly MHD patients were 52.7% and 39.3%, respectively, and the prevalence of anorexia was 25.9%. Severe sarcopenia was independently associated with anorexia, and weekly exercise frequency was independently associated with anorexia. The low SMI value and slow gait speed were strongly associated with anorexia. This study complied with the STROBE checklist.
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Affiliation(s)
- Chao Li
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Li He
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingjun Zhang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Hui Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuan Liu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Sikai Tang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Haotian Zheng
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
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The Frailty Phenotype in Hemodialysis Patients and its Association with Biochemical Markers of Mineral Bone Disorder, Inflammation and Nutrition. ACTA ACUST UNITED AC 2021; 60:42-48. [PMID: 34333883 DOI: 10.2478/rjim-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Frailty is a state of increased vulnerability to physical stressors. It is common in patients with end-stage renal disease (ESRD) who are on hemodialysis (HD).The aim of this study was to analyze the presence of frailty phenotype among HD patients and to evaluate their interrelationship with different biochemical markers. METHODS For the frailty assessment the Frailty Phenotype by Fried et al. was used, where frailty was reported if three of the following criteria were met: unintentional weight loss, self-reported exhaustion, weakness, slow walking speed and low physical activity. From 281 HD patients, 126 patients were frail, 58 were pre-frail (two criteria were met) and the rest of the study population were robust (97 patients). BMI was calculated for all patients and venous blood samples were taken to determine laboratory parameters for bone alkaline phosphatase (BAP), phosphate (P), potassium (K), C-reactive protein (CRP) and albumin. RESULTS Patients who were on HD longer than 60 months have more characters of frailty. (p=0.019). A statistically significant positive correlations between frailty score and BAP (rho = 0.189; p = 0.001), and CRP (rho = 0.233; p < 0.001) were observed, and significant negative correlations between frailty score and albumin (rho = - 0.218; p < 0.001) and K (rho = - 0.198; p = 0.001). CONCLUSIONS The associations of frailty with markers of mineral bone disorder, inflammation and nutrition indicate the importance of these parameters in the indirect assessment of the frailty phenotype in HD patients.
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19
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Zemp DD, Giannini O, Quadri P, Rabuffetti M, Tettamanti M, de Bruin ED. Signatures of Gait Movement Variability in CKD Patients Scheduled for Hemodialysis Indicate Pathological Performance Before and After Hemodialysis: A Prospective, Observational Study. Front Med (Lausanne) 2021; 8:702029. [PMID: 34395481 PMCID: PMC8355421 DOI: 10.3389/fmed.2021.702029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/30/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The frailty status of hemodialysis patients is well-known, but the role of the therapy in the frailty process is not yet clear. Nowadays gait analysis in nephrology is neglected, although gait performance is known to be related to frailty and kidney function. We hypothesized that gait quality and physical activity level is already affected before, and does not change because of the start of hemodialysis. Methods: Fourteen patients (72.3 ± 5.7 years old) in a pre-dialysis program underwent an instrumental gait analysis and their physical activity was monitored for a week. This protocol was repeated 3, 6, 12, and 24 months after the first hemodialysis session. Results: At baseline, our sample showed a conservative gait with pathologic gait variability, high dual-task cost, and a sedentary lifestyle. No statistically significant change was found in any parameter in the analyzed period, but there was a tendency toward an improvement of gait quality and physical activity in the first year of treatment, and a decline in the second year. Conclusion: Elderly patients in the pre-dialysis stage show a conservative gait, however variability was in a pathological range and did not change post-hemodialysis. This hints toward changes in the central nervous system due to the kidney disease. This finding suggests the importance of gait analysis in the early stages of renal disease in the diagnosis of changes in the nervous system due to kidney failure that affect gait. Early detection of these changes would potentially allow a prevention program tailored to this population to be developed.
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Affiliation(s)
- Damiano D Zemp
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Geriatric Service, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland
| | - Olivier Giannini
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland.,Service of Nephrology, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Pierluigi Quadri
- Geriatric Service, Ente Ospedaliero Cantonale, Ospedale Regionale della Beata Vergine, Mendrisio, Switzerland.,Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | | | - Mauro Tettamanti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCSS, Milan, Italy
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,OST - Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
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Tsuchiya K, Akihisa T. The Importance of Phosphate Control in Chronic Kidney Disease. Nutrients 2021; 13:nu13051670. [PMID: 34069053 PMCID: PMC8156430 DOI: 10.3390/nu13051670] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
A series of problems including osteopathy, abnormal serum data, and vascular calcification associated with chronic kidney disease (CKD) are now collectively called CKD-mineral bone disease (CKD-MBD). The pathophysiology of CKD-MBD is becoming clear with the emerging of αKlotho, originally identified as a progeria-causing protein, and bone-derived phosphaturic fibroblast growth factor 23 (FGF23) as associated factors. Meanwhile, compared with calcium and parathyroid hormone, which have long been linked with CKD-MBD, phosphate is now attracting more attention because of its association with complications and outcomes. Incidentally, as the pivotal roles of FGF23 and αKlotho in phosphate metabolism have been unveiled, how phosphate metabolism and hyperphosphatemia are involved in CKD-MBD and how they can be clinically treated have become of great interest. Thus, the aim of this review is reconsider CKD-MBD from the viewpoint of phosphorus, its involvement in the pathophysiology, causing complications, therapeutic approach based on the clinical evidence, and clarifying the importance of phosphorus management.
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Affiliation(s)
- Ken Tsuchiya
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- Correspondence:
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan;
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21
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Prevalence and Associated Factors of Frailty and Mortality in Patients with End-Stage Renal Disease Undergoing Hemodialysis: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073471. [PMID: 33801577 PMCID: PMC8037521 DOI: 10.3390/ijerph18073471] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
Hemodialysis is the most common type of treatment for end-stage renal disease (ESRD). Frailty is associated with poor outcomes such as higher mortality. ESRD patients have a higher prevalence of frailty. This systematic review and meta-analysis aimed to identify the prevalence and associated factors of frailty and examine whether it is a predictor of mortality among ESRD patients undergoing hemodialysis. Five electronic databases including PubMed, Embase, CINAHL, Web of Science, and Cochrane Library were searched for relevant studies up to 30 November 2020. A total of 752 articles were found, and seven studies with 2604 participants in total were included in the final analysis. The pooled prevalence of frailty in patients with ESRD undergoing hemodialysis was 46% (95% Confidence interval (CI) 34.2−58.3%). Advanced age, female sex, and the presence of diabetes mellitus increased the risk of frailty in ESRD patients undergoing hemodialysis. Our main finding showed that patients with frailty had a greater risk of all-cause mortality compared with those without (hazard ratio (HR): 2.02, 95% CI: 1.65−2.48). To improve ESRD patient outcomes, healthcare professionals need to assess the frailty of older ESRD patients, particularly by considering gender and comorbidities. Comprehensive frailty screening tools for ESRD patients on hemodialysis need to be developed.
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Mei F, Gao Q, Chen F, Zhao L, Shang Y, Hu K, Zhang W, Zhao B, Ma B. Frailty as a Predictor of Negative Health Outcomes in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2020; 22:535-543.e7. [PMID: 33218914 DOI: 10.1016/j.jamda.2020.09.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/12/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To perform a comprehensive evidence synthesis to summarize the impact of frailty on health outcomes in patients with chronic kidney disease (CKD). DESIGN Systematic reviews and meta-analysis. SETTING Electronic searches in PubMed, Embase, Web of Science, CNKI, VIP, CBM, and Wanfang Database were performed. The methodological quality was evaluated using the Newcastle Ottawa Scale (NOS). PARTICIPANTS Patients with chronic kidney disease (CKD). MEASUREMENTS Potential clinical outcomes due to frailty. RESULTS Eighteen cohort studies incorporating a total of 22,788 participants were included. The overall risk of bias was low. The median reported prevalence of frail and prefrail individuals with CKD was 41.8% (range 2.8-81.5%) and 43.9% (range 19.1-62.7%), respectively. Prefrailty and frailty related to mortality indicated an increased hazard ratio (HR), with a pooled HR of 1.68 [95% confidence interval (CI) 1.46-1.94; P < .001] and 1.48 (95% CI 1.21-1.81; P < .001), respectively. Prefrailty and frailty related to hospitalization with the pooled HR/risk ratio (RR) of 1.56 (95% CI 1.37-1.76; P < .001) and 1.21 (95% CI 0.79-1.85; P = .38), respectively. Similarly, the pooled HR demonstrated a strong correlation between frailty and falls in patients with CKD with HR 1.83 (95% CI 1.40-2.37; P < .001) and no statistical correlation between prefrailty and falls in these patients with pooled HR 1.19 (95% CI 0.44-3.22; P = .73), respectively. CONCLUSIONS AND IMPLICATIONS Frailty is predictive of negative outcomes in patients with CKD, including all-cause mortality, all-cause hospitalization, and falls. Therefore, frailty should be routinely assessed among patients with CKD to prevent poor prognosis, reduce fatality rate, and provide evidence to support future targeted interventions. However, because of the limited amount of information currently in the literature, additional prospective studies are needed to explore the role of prefrailty in predicting adverse outcomes for patients with CKD.
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Affiliation(s)
- Fan Mei
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qianqian Gao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Fei Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Li Zhao
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Yi Shang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Kaiyan Hu
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Weiyi Zhang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Bing Zhao
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Bin Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China; Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
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