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Katayıfçı N, Hüzmeli İ, İriş D, Turgut FH. Impairments of functional exercise capacity, muscle strength, balance and kinesiophobia in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2024; 25:19. [PMID: 38212675 PMCID: PMC10785456 DOI: 10.1186/s12882-023-03448-z] [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: 09/09/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Muscle weakness, balance, and functional capacity are affected in patients with chronic kidney disease (CKD) in dialysis. However, studies about kinesiophobia, peripheral and respiratory muscle strength, balance, exercise capacity, fatigue, and physical activity level in patients with CKD 3-4 are limited. The study aimed to compare the functional exercise capacity, peripheral and respiratory muscle strength, pulmonary function, balance, kinesiophobia, physical activity, fatigue, and dyspnea between patients with CKD 3-4 and controls. METHODS This cross-sectional study included 43 patients and 45 controls. Functional exercise capacity [6-Minute Walking Test (6MWT)], peripheral and respiratory muscle strength, pulmonary function, dyspnea, fatigue, physical activity, balance [Berg Balance Scale (BBS)], and kinesiophobia were evaluated. RESULTS Demographic characteristics were similar in patients [53(50-57) y, 26 M/17F] and controls [51(4.506-55) y, 33 M/12F] (p > 0.05). The 6MWT, respiratory and peripheral muscle strength, pulmonary function, physical activity, and BBS were significantly lower, and the level of dyspnea and kinesiophobia were higher in patients compared with controls (p < 0.05). CONCLUSIONS Patients had impaired functional exercise capacity, upper and lower extremity muscle strength, respiratory muscle strength, pulmonary function, and balance, increased perception of dyspnea and kinesiophobia, and reduced physical activity level compared with controls. Patients should be directed to cardiopulmonary rehabilitation programs.
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Affiliation(s)
- Nihan Katayıfçı
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay, Turkey.
| | - İrem Hüzmeli
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Döndü İriş
- Institute of Health Sciences, Department of Physiotherapy and Rehabilitation, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Faruk Hilmi Turgut
- Tayfur Ata Sokmen Faculty of Medicine, Department of Nephrology, Hatay Mustafa Kemal University, Hatay, Turkey
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Diwan V, Hoy WE, Wang Z, Zhang J, Cameron A, Venuthurupalli SK, Fassett RG, Chan S, Healy HG, Tan KS, Baer R, Mallett AJ, Gray N, Mantha M, Cherian R, Mutatiri C, Madhan K, Kan G, Mitchell G, Hossain S, Wu D, Han T, Kark A, Titus T, Ranganathan D, Bonner A, Govindarajulu S. Hospitalizations Among Adults With CKD in Public Renal Specialty Practices: A Retrospective Study From Queensland, Australia. Kidney Med 2023; 5:100700. [PMID: 37649728 PMCID: PMC10462882 DOI: 10.1016/j.xkme.2023.100700] [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: 09/01/2023] Open
Abstract
Rationale & Objective Little is known about hospital admissions in nondialysis patients with chronic kidney disease (CKD) before death or starting kidney replacement therapy (KRT). Study Design Retrospective observational cohort study. Setting & Participants Hospitalizations among 7,201 patients with CKD from 10 public renal clinics in Queensland (QLD), enrolled in the CKD.QLD registry starting in May 2011, were followed for 25,496.34 person-years until they started receiving KRT or died, or until June 30, 2018. Predictors Demographic and clinical characteristics of patients with CKD. Outcomes Hospital admissions. Analytical Approach We evaluated the association of demographic and clinical features with hospitalizations, length of hospital stay, and cost. Results Approximately 81.5% of the patients were admitted at least once, with 42,283 admissions, costing Australian dollars (AUD) 231 million. The average number of admissions per person-year was 1.7, and the cost was AUD 9,060, 10 times and 2 times their Australian averages, respectively. Single (1-day) admissions constituted 59.2% of all the hospital episodes, led by neoplasms (largely chemotherapy), anemia, CKD-related conditions and eye conditions (largely cataract extractions), but only 14.8% of the total costs. Approximately 41% of admissions were >1-day admissions, constituting 85.2% of the total costs, with cardiovascular conditions, respiratory conditions, CKD-related conditions, and injuries, fractures, or poisoning being the dominant causes. Readmission within 30 days of discharge constituted >42% of the admissions and 46.8% costs. Admissions not directly related to CKD constituted 90% of the admissions and costs. More than 40% of the admissions and costs were through the emergency department. Approximately 19% of the hospitalized patients and 27% of the admissions did not have kidney disease mentioned as either principal or associate causes. Limitations Variable follow-up times because of different dates of consent. Conclusions The hospital burden of patients with CKD is mainly driven by complex multiday admissions and readmissions involving comorbid conditions, which may not be directly related to their CKD. Strategies to prevent these complex admissions and readmissions should minimize hospital costs and outcomes. Plain-Language Summary We analyzed primary causes, types, and costs of hospitalizations among 7,201 patients with chronic kidney disease (CKD) from renal speciality clinics across Queensland, Australia, over an average follow-up of 3.54 years. The average annual cost per person was $9,060, and was the highest in those with more advanced CKD, higher age, and with diabetes. More than 85% of costs were driven by more complex hospitalizations with longer length of stay. Cardiovascular disease was the single largest contributor for hospitalizations, length of hospital stay, and total costs. Readmission within 30 days of discharge, particularly for the same disorder, and multiday admissions should be the main targets for mitigation of hospital costs in this population.
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Affiliation(s)
- Vishal Diwan
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy E. Hoy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Zaimin Wang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jianzhen Zhang
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Anne Cameron
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sree K. Venuthurupalli
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Brisbane, Renal Service, Ipswich Hospital, West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
| | - Robert G. Fassett
- Tasmanian Health Service Northwest, Hobart, Tasmania, Australia
- School of Human Movement and Nutrition Studies, the University of Queensland, Brisbane, Queensland, Australia
| | - Samuel Chan
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen G. Healy
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ken-Soon Tan
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
| | - Richard Baer
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Andrew J. Mallett
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Nicholas Gray
- Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Murty Mantha
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
| | - Roy Cherian
- Nephrology Service, North Mackay, Mackay, Queensland, Australia
| | - Clyson Mutatiri
- Renal Unit, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg, Queensland, Australia
| | - Krishan Madhan
- Renal Medicine, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
- Hervey Bay Clinical School, University of Queensland, Hervey Bay, Queensland, Australia
| | - George Kan
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
| | - Geoffrey Mitchell
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Danielle Wu
- Mackay Base Hospital, Mackay HHS, Mackay, Queensland, Australia
| | - Thin Han
- Rockhampton Hospital, Central Queensland HHS, Rockhampton, Queensland, Australia
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Adrian Kark
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Thomas Titus
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | | | - Ann Bonner
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University Gold Coast, Queensland, Australia
| | | | - NHMRC CKD.CRE and the CKD.QLD Collaborative
- NHMRC CKD.CRE and CKD.QLD, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Brisbane, Renal Service, Ipswich Hospital, West Moreton Hospital and Health Service, Ipswich, Queensland, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
- Department of Nephrology, Logan Hospital, Logan, Queensland, Australia
- Nephrology, Cairns Private Hospital, Cairns, Queensland, Australia
- College of Medicine & Dentistry, James Cook University, Townsville, Queensland, Australia
- Renal Unit, The Townsville Hospital, Townsville, Queensland, Australia
- Renal Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
- Nephrology Service, North Mackay, Mackay, Queensland, Australia
- Renal Unit, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg, Queensland, Australia
- Renal Medicine, Hervey Bay Hospital, Hervey Bay, Queensland, Australia
- Hervey Bay Clinical School, University of Queensland, Hervey Bay, Queensland, Australia
- Bundaberg Hospital, Bundaberg Central, Queensland, Australia
- Mackay Base Hospital, Mackay HHS, Mackay, Queensland, Australia
- Rockhampton Hospital, Central Queensland HHS, Rockhampton, Queensland, Australia
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University Gold Coast, Queensland, Australia
- St Andrew’s Hospital, Toowoomba, Queensland, Australia
- Tasmanian Health Service Northwest, Hobart, Tasmania, Australia
- School of Human Movement and Nutrition Studies, the University of Queensland, Brisbane, Queensland, Australia
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Zicarelli MT, Patella G, Bolignano D, Comi A, Cianfrone P, Comi N, Presta P, Fuiano G, Castagna A, Ruotolo G, Andreucci M, Coppolino G. Nephrosclerosis impacts time trajectory of renal function and outcomes in elderly individuals with chronic kidney disease. J Investig Med 2021; 69:1411-1416. [PMID: 34127513 DOI: 10.1136/jim-2021-001854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 12/22/2022]
Abstract
Despite hypertension ranks among the leading causes of chronic kidney disease (CKD), the impact of chronic hypertensive nephropathy, the so-called 'nephrosclerosis' (NS), on CKD progression is often unpredictable, particularly in elderly population. We have conducted a prospective, observational study to define renal function patterns and outcomes in elderly CKD individuals with or without NS. Three hundred four individuals with an already established CKD were categorized according to the etiology of CKD. NS was defined as the presence of CKD associated with long-term essential hypertension, hypertensive retinopathy, left ventricular hypertrophy and minimal proteinuria. Time trajectories in estimated glomerular filtration rate (eGFR) (CKD-Epi) were computed over a 4-year follow-up. In addition, we analyzed the occurrence of a composite outcome of doubling of serum creatinine levels, eGFR reduction ≥25% and/or the need of chronic renal replacement therapy. CKD was secondary to nephrosclerosis (CKD-NS) in 220 (72.3%). In the whole cohort, the average estimated annual GFR slope was 1.8 mL/min/1.73 m2 eGFR decline was slower in CKD-NS as compared with others (1.4 vs 3.4 mL/min/1.73 m2; p<0.001). The composite renal outcome during follow-up occurred less frequently among elderly with CKD-NS (16/204 vs 14/70; p=0.01, crude HR 0.43, 95% CI 0.22 to 0.85) and was associated at logistic analyses with the etiology of CKD, background cardiovascular disease, total and low density lipoproteins (LDL) cholesterol, and glycemia levels (p value was ranging from 0.01 to 0.05). Despite being highly prevalent in the elderly, NS is associated with a more favorable renal disease course as compared with other conditions.
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Affiliation(s)
- Maria Teresa Zicarelli
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Gemma Patella
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Davide Bolignano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Alessandro Comi
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Paola Cianfrone
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Nicolino Comi
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Pierangela Presta
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Giorgio Fuiano
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | | | - Giovanni Ruotolo
- Department of Medicine, Pugliese Ciaccio Hospital, Catanzaro, Calabria, Italy
| | - Michele Andreucci
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Calabria, Italy
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