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Nitta K, Hanafusa N, Kawaguchi Y, Tsuchiya K. Physical function management for elderly dialysis patients: prevention and improvement of frailty and disability. RENAL REPLACEMENT THERAPY 2023. [DOI: 10.1186/s41100-023-00459-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AbstractFrailty has become an emerging public health problem in the aging society and is regarded as a state of vulnerability to developing increased dependency and/or mortality when exposed to a stressor. As the proportion of elderly dialysis patients is increasing worldwide, frailty has recently influenced on the clinical outcomes among those patients also caused great attention. The prevalence of frailty among dialysis patients has ranged from 3.0- to 10-fold higher than in community-dwelling elderly. Since frailty has been found to be associated with higher mortality, independent of clinical characteristics and comorbidity, interventions to improve frailty have the potential to contribute to better quality of life and lower mortality among dialysis patients. Moreover, clinical research should be focused on the possibility that early rehabilitation of dialysis patients might improve poor outcomes. Current clinical question should aim to take an appropriate strategy to address frailty, including identifying the optimal timing for intervention.
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Hydration status according to impedance vectors and its association with clinical and biochemical outcomes and mortality in patients with chronic kidney disease. NUTR HOSP 2022; 39:1037-1046. [DOI: 10.20960/nh.03970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Agreement between vector analysis and body composition measurements by four types of bioelectrical impedance technology in hemodialysis patients. NUTR HOSP 2022; 39:1047-1057. [DOI: 10.20960/nh.04005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Yip JYC. Peritoneal Dialysis Failure and its Impact on Holistic Kidney Care: A Case Report. SAGE Open Nurs 2021; 7:23779608211037496. [PMID: 34869856 PMCID: PMC8642045 DOI: 10.1177/23779608211037496] [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: 11/21/2020] [Revised: 06/03/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Peritonitis remains the primary cause of treatment failure among patients with
end-stage kidney disease on continuous ambulatory peritoneal dialysis. However, detailed
case analyses illustrating the application of current research in clinical practice
remain scant. This case report aimed to elucidate the roles of dialysis nurses in a
hospital setting in the management of a 62-year-old male patient with a history of
kidney failure secondary to amyloidosis. Case Presentation The patient was diagnosed with continuous ambulatory peritoneal dialysis-associated
peritonitis. Management and Outcomes Dialysis nurses applied evidence-based practices in the management of the patient’s
exit-site infection, imbalanced nutrition, and psychosocial concerns. The patient was
discharged after 7 days, with a comprehensive treatment regimen, including an
individualized peritoneal dialysis protocol adjusted to his daily schedules, education
on self-care techniques, and continual nutritional management to prevent recurrence and
improve his overall health. This case report shows that admissions for continuous
ambulatory peritoneal dialysis-associated peritonitis require evidence-based nursing
interventions specific to, and geared toward, each patient’s prioritized health
problems. Discussion Peritonitis cases are preventable with appropriate nursing interventions that can lower
the chance of treatment failure and long-term impact caused by an abrupt switch to
hemodialysis. To successfully manage patients with continuous ambulatory peritoneal
dialysis-associated peritonitis, dialysis nurses should appreciate the intricacies of
the analyses underpinning their professional practices in promoting the patient’s
self-care techniques.
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Affiliation(s)
- Jeffrey Yuk Chiu Yip
- School of Health Sciences, Caritas Institute of Higher Education, Hong Kong, China
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Umakanthan M, Li JW, Sud K, Duque G, Guilfoyle D, Cho K, Brown C, Boersma D, Gangadharan Komala M. Prevalence and Factors Associated with Sarcopenia in Patients on Maintenance Dialysis in Australia-A Single Centre, Cross-Sectional Study. Nutrients 2021; 13:nu13093284. [PMID: 34579163 PMCID: PMC8469859 DOI: 10.3390/nu13093284] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Sarcopenia is associated with significant morbidity and mortality in patients with chronic kidney disease. The prevalence of sarcopenia in the dialysis population varies from 4% to 63%. However, the prevalence and risk factors of sarcopenia in the Australian dialysis population remain uncertain. Aim: To study the prevalence of sarcopenia in patients on maintenance dialysis by using the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic criteria of sarcopenia and to identify associated risk factors. Methods: We evaluated adult patients on maintenance haemodialysis and peritoneal dialysis in this single-centre cross-sectional study in Australia. Patient’s clinical (age, gender, dialysis modality and diabetic status) and laboratory parameters (serum albumin, calcium, phosphate, 25-hydroxy-vitamin D and parathyroid hormone levels) were investigated. We employed bioimpedance spectroscopy, hand grip dynamometer and the timed up and go test (TUG) to evaluate muscle mass, strength and function, respectively. Results: We evaluated 39 dialysis patients with a median age of 69 years old. The prevalence of sarcopenia was 18%. Sarcopenia was associated with low serum albumin (p = 0.02) and low serum phosphate level (p = 0.04). Increasing age and female sex were potential risk factors for sarcopenia (p = 0.05 and 0.08, respectively). Low lean muscle mass, reduced hand grip strength and prolonged TUG were present in 23.1%, 41% and 40.5%, respectively, of the cohort. The hand grip test had good correlation with lean muscle evaluation and the TUG. Conclusions: Sarcopenia was prevalent in 18% of maintenance haemodialysis patients from an Australian single-centre cohort, with low serum albumin and phosphate as significant risk factors.
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Affiliation(s)
- Marille Umakanthan
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
| | - John Wing Li
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
- Nepean Clinical School, The University of Sydney, Sydney, NSW 2006, Australia; (G.D.); (C.B.)
| | - Gustavo Duque
- Nepean Clinical School, The University of Sydney, Sydney, NSW 2006, Australia; (G.D.); (C.B.)
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC 3021, Australia
| | - Daniel Guilfoyle
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
| | - Kenneth Cho
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
| | - Chris Brown
- Nepean Clinical School, The University of Sydney, Sydney, NSW 2006, Australia; (G.D.); (C.B.)
| | - Derek Boersma
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
| | - Muralikrishna Gangadharan Komala
- Department of Renal Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia; (M.U.); (J.W.L.); (K.S.); (D.G.); (K.C.); (D.B.)
- Nepean Clinical School, The University of Sydney, Sydney, NSW 2006, Australia; (G.D.); (C.B.)
- Correspondence: ; Tel.: +612-47341864; Fax: +612-47344215
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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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Nagy E, Mahmoud M, El-Kannishy G, Sayed-Ahmed N. Impact of malnutrition on health-related quality of life in patients on maintenance hemodialysis. Ther Apher Dial 2020; 25:467-474. [PMID: 32974922 DOI: 10.1111/1744-9987.13588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
Malnutrition is considered as one of the most important risk factors that adversely affect the quality of life (QOL) in maintenance hemodialysis (MHD) patients. Many clinically useful nutrition assessment techniques are now available, but the usefulness of such techniques in predicting QOL in MHD patients had not been sufficiently tested. The aim of this study was to explore the relation between different nutritional assessment methods, and QOL and identify nutritional parameter that can best predict physical and mental domains of QOL in MHD patients. This cross-sectional study involved 84 MHD patients. Nutritional status was assessed by using International Society of Renal Nutrition and Metabolism criteria for diagnosis of protein-energy wasting (PEW), malnutrition inflammation score (MIS), subjective global assessment (SGA), anthropometric measurements, bioelectrical impedance analysis, and biochemical tests. Quality of life was evaluated by using the Kidney Disease Quality of Life (36 KDQOL-36). Only mental health composite component of QOL (MHC) showed statistically significant differences between PEW and non-PEW groups. MHC was correlated with serum albumin, MIS, and SGA. Physical health composite component (PHC) was correlated with age, hemodialysis duration, socioeconomic status, comorbidity, educational level, serum creatinine and ferritin, MIS, and SGA. On multiple linear regression analysis, MIS was found to be the most significant predictor of PHC while none of the nutritional parameters can predict MHC. Malnutrition is not uncommon problem in MHD patients that is associated with poor QOL. There are multiple factors associated with PHC and only malnutrition afflicts MHC in those patients.
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Affiliation(s)
- Eman Nagy
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University, Mansoura, Egypt
| | - Mostafa Mahmoud
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University, Mansoura, Egypt
| | - Ghada El-Kannishy
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University, Mansoura, Egypt
| | - Nagy Sayed-Ahmed
- Mansoura Nephrology and Dialysis Unit (MNDU), Mansoura University, Mansoura, Egypt
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Iyengar A, Raj JM, Vasudevan A. Protein Energy Wasting in Children With Chronic Kidney Disease and End-Stage Kidney Disease: An Observational Study. J Ren Nutr 2020; 31:270-277. [PMID: 32958374 DOI: 10.1053/j.jrn.2020.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/27/2020] [Accepted: 08/02/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Protein energy wasting (PEW), a specific nutritional comorbidity associated with increased mortality, is underrecognized in children with chronic kidney disease (CKD). The aim of this study was to determine the burden and factors associated with PEW and assess the utility of parameters used to diagnose PEW in children with CKD and End stage kidney disease (ESKD). METHODS Children between 2 and 18 years of age with CKD stages 2-5 were recruited over 30 months. Parameters of PEW assessed included body mass index for height, mid-upper arm circumference, height for age, appetite, serum albumin, cholesterol, transferrin, and C-reactive protein. Based on number of criteria fulfilled in each subject, PEW was further stratified as mild, standard, and modified PEW. RESULTS One hundred twenty-three children (male:female 3:1, 73 in CKD stages 2-4, 50 with ESKD) were recruited. PEW was observed in 58% (47% in CKD stages 2-4 vs. 73% ESKD, P = .035). Longer duration and severity of disease was associated PEW. Reduced appetite (P = .001, P = .04), low mid-upper arm circumference (P = .000, P = .006), and low body mass index for height (P = .000, P = .007) were useful criteria to diagnose PEW in CKD stages 2-4 and ESKD, while most children did not meet biochemical criteria. Inflammation observed in 47% was higher in those with ESKD [CKD stages 2-4: 72 (39%) vs. ESKD: 29 (59%), P = .02] but was associated with PEW only in CKD stages 2-4. CONCLUSION PEW was highly prevalent in children with CKD and ESKD. Appetite and anthropometry measures were more useful than biochemical criteria for diagnosis of PEW. Whereas inflammation was common, it was associated with PEW only in CKD stages 2-4. Pediatric CKD and ESKD may need exclusive diagnostic criteria for PEW based on anthropometry, appetite, and inflammation.
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Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bangalore, Karnataka, India.
| | - John M Raj
- Department of Biostatistics, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St John's National Academy of Health Sciences, Bangalore, Karnataka, India
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Christensson A, Ash JA, DeLisle RK, Gaspar FW, Ostroff R, Grubb A, Lindström V, Bruun L, Williams SA. The Impact of the Glomerular Filtration Rate on the Human Plasma Proteome. Proteomics Clin Appl 2018; 12:e1700067. [DOI: 10.1002/prca.201700067] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/08/2017] [Indexed: 01/02/2023]
Affiliation(s)
| | | | | | | | | | - Anders Grubb
- Department of Clinical Chemistry; Skåne University Hospital; Lund Sweden
| | - Veronica Lindström
- Department of Clinical Chemistry; Skåne University Hospital; Lund Sweden
| | - Laila Bruun
- Department of Nephrology; Skåne University Hospital; Malmö Sweden
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Nitta K, Hanafusa N, Tsuchiya K. Frailty and mortality among dialysis patients. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0122-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Brook MS, Wilkinson DJ, Atherton PJ. Nutrient modulation in the management of disease-induced muscle wasting: evidence from human studies. Curr Opin Clin Nutr Metab Care 2017; 20:433-439. [PMID: 28832372 DOI: 10.1097/mco.0000000000000413] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW In addition to being essential for movement, skeletal muscles act as both a store and source of key macronutrients. As such, muscle is an important tissue for whole body homeostasis, undergoing muscle wasting in times of starvation, disease, and stress, for example, to provide energy substrates for other tissues. Yet, muscle wasting is also associated with disability, comorbidities, and mortality. As nutrition is so crucial to maintaining muscle homeostasis 'in health', it has been postulated that muscle wasting in cachexia syndromes may be alleviated by nutritional interventions. This review will highlight recent work in this area in relation to muscle kinetics, the acute metabolic (e.g. dietary protein), and longer-term effects of dietary interventions. RECENT FINDINGS Whole body and skeletal muscle protein synthesis invariably exhibit deranged kinetics (favouring catabolism) in wasting states; further, many of these conditions harbour blunted anabolic responses to protein nutrition compared with healthy controls. These derangements underlie muscle wasting. Recent trials of essential amino acid and protein-based nutrition have shown some potential for therapeutic benefit. SUMMARY Nutritional modulation, particularly of dietary amino acids, may have benefits to prevent or attenuate disease-induced muscle wasting. Nonetheless, there remains a lack of recent studies exploring these key concepts to make conclusive recommendations.
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Affiliation(s)
- Matthew S Brook
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Clinical, Metabolic and Molecular Physiology, National Institute for Health Research Biomedical Research Centre, University of Nottingham, Royal Derby Hospital, Derby, UK
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Hanafusa N, Nitta K, Tsuchiya K. The characteristics of the older dialysis population—heterogeneity and another type of altered risk factor patterns. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0110-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Hanafusa N, Nitta K, Okazaki M, Komatsu M, Shiohira S, Kawaguchi H, Tsuchiya K. Serum albumin level adjusted with C-reactive protein predicts hemodialysis patient survival. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-016-0085-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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