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Hendra H, Sridharan S, Farrington K, Davenport A. Characteristics of Frailty in Haemodialysis Patients. Gerontol Geriatr Med 2022; 8:23337214221098889. [PMID: 35548325 PMCID: PMC9083032 DOI: 10.1177/23337214221098889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 01/29/2023] Open
Abstract
Background: Both frailty and cachexia increase mortality in haemodialysis (HD) patients. The clinical frailty score (CFS) is a seven-point scale and less complex than other cachexia and frailty assessments. We wished to determine the characteristics of frail HD patients using the CFS. Methods: Single centre cross-sectional study of HD patients completing physical activity questionnaires with bioimpedance measurements of body composition and hand grip strength (HGS). Results: We studied 172 HD patients. The CFS classified 54 (31.4%) as frail, who were older (70.4±12.2 vs 56.2 ± 16.1 years, p < 0.001), greater modified Charlson co-morbidity (3 (2–3) versus 1.5 (0–3), p < 0.001), and body fat (33 (25.4–40.2) versus 26.2 (15.8–34) %, p < 0.01), but lower total energy expenditure (1720 (1574–1818) versus 1870 (1670–2194) kcal/day, p < 0.01), lean muscle mass index (9.1 (7.7–10.1) versus 9.9 (8.9–10.8) kg/m2), and HGS (15.3 (10.3–21.9) versus 23.6 (16.7–34.4) kg), both p < 0.001. On multivariable logistic analysis, frailty was independently associated with lower active energy expenditure (odds ratio (OR) 0.98, 95% confidence limits (CL) 0.98–0.99, p = 0.001), diabetes (OR 5.09, CL 1.06–16.66) and HGS (OR 0.92, CL 0.86–0.98). Discussion: Frail HD patients reported less active energy expenditure, associated with reduced muscle mass and strength. Frail patients were more likely to have greater co-morbidity, particularly diabetes. Whether physical activity programmes can improve frailty remains to be determined.
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Affiliation(s)
- Heidy Hendra
- UCL Department of Nephrology, University College London, London NW, UK
| | | | - Ken Farrington
- University of Hertfordshire, Hatfield, UK
- Renal Unit, Lister Hospital, Corey’s Mill Lane, ST, UK
| | - Andrew Davenport
- UCL Department of Nephrology, University College London, London NW, UK
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McKeaveney C, Slee A, Adamson G, Davenport A, Farrington K, Fouque D, Kalantar-Zadeh K, Mallett J, Maxwell AP, Mullan R, Noble H, O'Donoghue D, Porter S, Seres DS, Shields J, Witham M, Reid J. Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study. Nephrol Dial Transplant 2021; 36:1919-1926. [PMID: 33150449 DOI: 10.1093/ndt/gfaa174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. OBJECTIVE The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. METHOD This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. RESULTS A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.6 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. CONCLUSION Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Adrian Slee
- Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
| | - Gary Adamson
- School of Psychology, Ulster University, Coleraine Campus, Londonderry, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East and North Hertfordshire University NHS Trust, Stevenage, UK
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, University Lyon, CARMEN, Pierre-Benite, France
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California 92868, USA
| | - John Mallett
- School of Psychology, Ulster University, Coleraine Campus, Londonderry, UK
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.,Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, BT9 7AB, Northern Ireland
| | - Robert Mullan
- Department of Nephrology, Antrim Area Hospital, Northern Health Social Care Trust, Antrim, BT41 2RL, Northern Ireland
| | - Helen Noble
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | | | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, UK
| | - David S Seres
- Department of Medicine, Columbia University Medical Centre / New York Presbyterian Hospital, New York, USA
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, BT9 7AB, Northern Ireland
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
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Tallman DA, Sahathevan S, Karupaiah T, Khosla P. Egg Intake in Chronic Kidney Disease. Nutrients 2018; 10:E1945. [PMID: 30544535 PMCID: PMC6315879 DOI: 10.3390/nu10121945] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
Abstract
Patients with chronic kidney disease (CKD) are often instructed to adhere to a renal-specific diet depending on the severity and stage of their kidney disease. The prescribed diet may limit certain nutrients, such as phosphorus and potassium, or encourage the consumption of others, such as high biological value (HBV) proteins. Eggs are an inexpensive, easily available and high-quality source of protein, as well as a rich source of leucine, an essential amino acid that plays a role in muscle protein synthesis. However, egg yolk is a concentrated source of both phosphorus and the trimethylamine N-oxide precursor, choline, both of which may have potentially harmful effects in CKD. The yolk is also an abundant source of cholesterol which has been extensively studied for its effects on lipoprotein cholesterol and the risk of cardiovascular disease. Efforts to reduce dietary cholesterol to manage dyslipidemia in dialysis patients (already following a renal diet) have not been shown to offer additional benefit. There is a paucity of data regarding the impact of egg consumption on lipid profiles of CKD patients. Additionally, egg consumption has not been associated with the risk of developing CKD based on epidemiological studies. The egg yolk also contains bioactive compounds, including lutein, zeaxanthin, and vitamin D, which may confer health benefits in CKD patients. Here we review research on egg intake and CKD, discuss both potential contraindications and favorable effects of egg consumption, and describe the need for further research examining egg intake and outcomes in the CKD and end-stage renal disease population.
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Affiliation(s)
- Dina A Tallman
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA.
| | - Sharmela Sahathevan
- Dietetics Program, Faculty of Health and Medical Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 5300, Malaysia.
| | - Tilakavati Karupaiah
- School of Biosciences, Faculty of Health Sciences, Taylor's University, Subang Jaya 47500, Malaysia.
| | - Pramod Khosla
- Department of Nutrition and Food Science, Wayne State University, Detroit, MI 48202, USA.
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