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Yang Y, Lv W, Zeng Y, Chen Y, Yuan H. Bioelectrical impedance phase angle combined with physical function predicts pre-frailty in maintenance hemodialysis patients: a prospective study. BMC Nephrol 2024; 25:243. [PMID: 39075445 DOI: 10.1186/s12882-024-03684-x] [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: 02/25/2024] [Accepted: 07/23/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND The prevalence of pre-frailty is notably high among maintenance hemodialysis (MHD) patients. Pre-frailty, an early and reversible condition between non-frailty and frailty, can lead to adverse outcomes such as increased unplanned hospital admissions and a higher risk of other chronic diseases. Early identification and intervention of pre-frailty in MHD patients are crucial. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of pre-frailty by using 50 kHz-Whole Body Phase Angle (PhA) measured by bioelectrical impedance analysis (BIA), hand grip strength (HGS), the Five-Times-Sit-to-Stand Test (FTSST), and laboratory parameters, with a specific focus on gender differences. METHODS This prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled, comprising 128 non-frail and 116 pre-frail individuals. Data were collected prospectively, including demographic information, physical measurements, and laboratory test results. All participants provided informed consent before enrollment. The FRAIL scale (FS) was used to assess pre-frailty in MHD patients. Grip strength was measured using an electronic grip strength tester, physical function was assessed using the Five-Times-Sit-to-Stand Test, and whole-body phase angle was measured using the InBody S10 device. RESULTS A total of 244 MHD patients with a mean age of 53.75 ± 0.90 years were enrolled, including 130 males with a mean age of 54.12 ± 1.26 years and 114 females with a mean age of 53.32 ± 1.29 years. ROC curve analysis showed that in male patients, the AUC of PhA for predicting pre-frailty was 0.919, with a sensitivity of 94.5% and specificity of 91.3%, and a cutoff value of 6.05°; in female patients, the AUC of PhA was 0.870, with a sensitivity of 70.5% and specificity of 90.6%, and a cutoff value of 5.25°. The AUC of FTSST for screening pre-frailty in male patients was 0.827, with a sensitivity of 62.3% and specificity of 96.2%, and a cutoff value of 12.95 s; in female patients, the AUC of FTSST was 0.784, with a sensitivity of 67.3% and specificity of 84.0%, and a cutoff value of 12.95 s. Additionally, in male patients, the combination of PhA and FTSST resulted in an AUC of 0.930, with a sensitivity of 96.4% and specificity of 81.3%; in female patients, the AUC was 0.911, with a sensitivity of 78.7% and specificity of 92.5%. CONCLUSION PhA measured by BIA, in combination with the Five-Times-Sit-to-Stand Test, serves as an effective screening tool and predictor of pre-frailty in MHD patients. The combination of PhA and FTSST shows enhanced diagnostic value in female patients, while PhA alone is sufficient for predicting pre-frailty in male patients. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021-09-13.
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Affiliation(s)
- Yujie Yang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Wenmei Lv
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Ying Zeng
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Yang Chen
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China
- School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Huaihong Yuan
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, NO.37, Guoxue Alley, Chengdu, Sichuan province, 610041, China.
- School of Nursing, Sichuan University, Chengdu, 610041, China.
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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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Shaaker H, Davenport A. Does Dietary Intake Differ in Kidney Failure Patients With Sarcopenia and Frailty Treated by Hemodialysis. Gerontol Geriatr Med 2024; 10:23337214241253433. [PMID: 38765918 PMCID: PMC11100388 DOI: 10.1177/23337214241253433] [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: 09/01/2023] [Revised: 12/16/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Background: Inadequate nutrition is common for both sarcopenia and frailty. We investigated whether hemodialysis patients with sarcopenia and frailty have reduced dietary intakes. Methods: Dietary intake, and physical activity were analyzed, along with body composition and relevant clinical data. Results: We studied 51 hemodialysis patients; 52.9% male, age 60 ± 15 years; 33.3% sarcopenic, and 72.5% frail. Dietary protein and calories were similar for sarcopenic and non-sarcopenic patients 0.68 (0.38-3.5) vs. 0.68 (0.18-2.9) g protein/kg/day and 19.2 (8.2-77.5) vs. 15.2 (6.2-38.5) kcal/kg/day. More sarcopenic patients had low physical activity (88.2% vs. 58.8%, X2 4.6, p = .03). Frail and non-frail patients had similar intakes 0.67 (0.28-3.5) versus 0.83 (0.18-1.6) g protein/kg/day and 15.5 (8.1-77.5) vs. 18.8 (6.2-45.4) kcal/kg/day. Sarcopenia was associated with age [Odds ratio (OR) 1.09, 95% confidence interval (CI) [1.02, 1.18], p = .017], body mass index [OR 0.84, 95% CI [0.71, 0.99], p = .042] and lack of exercise [OR 7.62, 95% CI [1.16, 50.29], p = .035]. Frailty was associated with female gender [OR 17.79, 95% CI [2.09, 151.59], p = .008], age [OR 1.13, 95% CI [1.04, 1.22], p = .006], and dialysis vintage [OR 1.55, 95% CI [1.06, 2.26], p = .024]. Conclusion: Hemodialysis patients with sarcopenia and frailty did not have lower dietary protein and calorie intake. Frailty was associated with age and sarcopenia with a sedentary lifestyle.
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Affiliation(s)
- Haalah Shaaker
- University College London, UK
- King Abdulaziz University, Jeddah, Saudi Arabia
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Kojima S, Usui N, Uehata A, Hisadome H, Inatsu A, Tsuchiya T, Mawatari T, Tsubaki A. Relationships between frailty and exercise capacity in patients undergoing hemodialysis: A cross-sectional study. Geriatr Gerontol Int 2023; 23:795-802. [PMID: 37743050 DOI: 10.1111/ggi.14681] [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: 03/07/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Abstract
AIM Hemodialysis (HD) patients have a high prevalence of frailty. The association between frailty and exercise capacity in HD patients has not been established. This study aimed to clarify the relationships between frailty and exercise capacity in HD patients. METHODS This two-center cross-sectional study included HD patients who performed cardiopulmonary exercise testing. Participants were divided by frailty phenotype into robust, pre-frail, and frail using the revised Japanese version of the Cardiovascular Health Study criteria. Peak oxygen uptake (peakVO2 ) measured by cardiopulmonary exercise testing was compared with each frailty phenotype. The association between peakVO2 and frailty phenotype was analyzed using multivariate linear regression analysis adjusted for age, sex, body mass index diabetes mellitus, cardiovascular disease, cancer, history of fracture, hemoglobin, left ventricle ejection fraction, and percentage of heart rate reserve. RESULTS The study included 136 patients (median age, 71.0 years; female, 23.5%), with 15.4%, 44.9%, and 39.7% with frailty phenotypes robust, pre-frail, and frail, respectively. PeakVO2 decreased with deterioration of the frailty phenotype (robust, median 15.1 [13.7-18.3] mL/min/kg; pre-frail, median 12.2 [10.5-14.4] mL/min/kg; frail, median 10.6 [9.2-12.5] mL/min/kg, P < 0.05). PeakVO2 decline was significantly associated with frail (B = -2.19, P = 0.004). Modeling individual frailty components showed a significant association between peakVO2 , usual gait speed (B = 2.38, P = 0.04), and low physical activity (B = -1.44, P = 0.004). CONCLUSION Frailty in HD patients was associated with a decline in exercise capacity. HD patients with frailty need to improve exercise capacity, gait speed, and physical activity. Geriatr Gerontol Int 2023; 23: 795-802.
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Affiliation(s)
- Sho Kojima
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Usui
- Department of Rehabilitation, Kisen Hospital, Tokyo, Japan
- Department of Nephrology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Akimi Uehata
- Division of Cardiology, Kisen Hospital, Tokyo, Japan
| | | | | | | | | | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
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Kawate Y, Hashimoto Y, Ushigome E, Kosaka S, Takahashi F, Sawamura A, Yumen Y, Hamaguchi M, Yamazaki M, Fukui M. Comparison of Diet, Sleep, and Stress During the Emergency Coronavirus Disease Curfew in Men and Women with Hemodialysis. J Ren Nutr 2023; 33:666-675. [PMID: 37302719 PMCID: PMC10256582 DOI: 10.1053/j.jrn.2023.06.002] [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: 11/02/2022] [Revised: 04/13/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE To investigate the effect of coronavirus disease 2019 (COVID-19) on diet, stress, and sleep in Japanese patients with hemodialysis. METHODS Data on nutritional intake, frequency of food intake by cuisine, dietary behavior, and frequency of food use before and during the declaration of the state of emergency due to COVID-19, were collected. RESULTS For the 81 participants (47 men), changes were observed in the following diet-related items: nutrition and nutrient content (one item for men, three for women), eating behavior, and frequency of food use (1 item for men, six for women), and the total number of items was two for men and nine for women. Nine out of 12 questions addressed stress and six out of eight questions addressed sleep, with a higher percentage of women adversely affected and no item with a higher percentage of men adversely affected. The mean score for stress was 25.3 ± 5.1 for men and 29.5 ± 5.0 for women, P < .001, and for sleep disturbance was 11.6 ± 3.0 for men and 14.4 ± 4.4 for women, P < .001. CONCLUSIONS In patients with hemodialysis, the effect of refraining from going out due to the spread of COVID-19 on diet, sleep, and stress was suggested to be more significant in women than in men.
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Affiliation(s)
- Yuka Kawate
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Nutrition, Kyoto Katsura Hospital, Kyoto, Japan; Kyoto working committee on foods for patients with dialysis and kidney diseases, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Osaka, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shiho Kosaka
- Kyoto working committee on foods for patients with dialysis and kidney diseases, Kyoto, Japan
| | - Fuyuko Takahashi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Nutrition, Saiseikai Suita Hospital, Osaka, Japan
| | - Atsuko Sawamura
- Kyoto working committee on foods for patients with dialysis and kidney diseases, Kyoto, Japan; Fundamental Nursing, Faculty of Nursing, Toho University, Tokyo, Japan
| | - Yukina Yumen
- Kyoto working committee on foods for patients with dialysis and kidney diseases, Kyoto, Japan; Kyoto College of Nutritional & Medical Sciences, Kyoto, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Diabetes Endocrinology & Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Kennard AL, Rainsford S, Glasgow NJ, Talaulikar GS. Use of frailty assessment instruments in nephrology populations: a scoping review. BMC Geriatr 2023; 23:449. [PMID: 37479978 PMCID: PMC10360289 DOI: 10.1186/s12877-023-04101-y] [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: 02/07/2023] [Accepted: 06/09/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Frailty is a clinical syndrome of accelerated aging associated with adverse outcomes. Frailty is prevalent among patients with chronic kidney disease but is infrequently assessed in clinical settings, due to lack of consensus regarding frailty definitions and diagnostic tools. This study aimed to review the practice of frailty assessment in nephrology populations and evaluate the context and timing of frailty assessment. METHODS The search included published reports of frailty assessment in patients with chronic kidney disease, undergoing dialysis or in receipt of a kidney transplant, published between January 2000 and November 2021. Medline, CINAHL, Embase, PsychINFO, PubMed and Cochrane Library databases were examined. A total of 164 articles were included for review. RESULTS We found that studies were most frequently set within developed nations. Overall, 161 studies were frailty assessments conducted as part of an observational study design, and 3 within an interventional study. Studies favoured assessment of participants with chronic kidney disease (CKD) and transplant candidates. A total of 40 different frailty metrics were used. The most frequently utilised tool was the Fried frailty phenotype. Frailty prevalence varied across populations and research settings from 2.8% among participants with CKD to 82% among patients undergoing haemodialysis. Studies of frailty in conservatively managed populations were infrequent (N = 4). We verified that frailty predicts higher rates of adverse patient outcomes. There is sufficient literature to justify future meta-analyses. CONCLUSIONS There is increasing recognition of frailty in nephrology populations and the value of assessment in informing prognostication and decision-making during transitions in care. The Fried frailty phenotype is the most frequently utilised assessment, reflecting the feasibility of incorporating objective measures of frailty and vulnerability into nephrology clinical assessment. Further research examining frailty in low and middle income countries as well as first nations people is required. Future work should focus on interventional strategies exploring frailty rehabilitation.
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Affiliation(s)
- Alice L Kennard
- Department of Renal Medicine, The Canberra Hospital, Canberra Health Services, Building 15, Yamba Drive, Garran, ACT 2605, Australia.
- Australian National University, Canberra, ACT, Australia.
| | | | | | - Girish S Talaulikar
- Department of Renal Medicine, The Canberra Hospital, Canberra Health Services, Building 15, Yamba Drive, Garran, ACT 2605, Australia
- Australian National University, Canberra, ACT, Australia
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Wang J, Huang LJ, Li B, Xu MC, Yang L, Deng X, Li X. Combined evaluation of Geriatric nutritional risk index and Neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients. PLoS One 2023; 18:e0287696. [PMID: 37384751 PMCID: PMC10310003 DOI: 10.1371/journal.pone.0287696] [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: 02/21/2023] [Accepted: 06/10/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Malnutrition, accompanied by an inflammatory profile, is a risk factor for poor prognosis in hemodialysis patients. The purpose of this study was to investigate the predictive value of NLR combined with GNRI for all-cause and cardiovascular mortality in hemodialysis patients. METHODS A total of 240 maintenance hemodialysis (MHD) patients in hemodialysis centers were enrolled in this retrospective study. The influencing factors of all-cause death in hemodialysis patients were analyzed by COX regression. The cut-off values of GNRI and NLR for predicting mortality in enrolled MHD patients were 89.01 and 4, respectively. Based on these cut-off values, the patients were divided into four groups: G1: high GNRI (≥ 89.01) + high NLR (≥ 4) group; G2: high GNRI (≥ 89.01) + low NLR (<4) group, G3: low GNRI (< 89.01) + high NLR (≥4) group; G4: low GNRI (< 89.01) + low NLR (<4). RESULTS During the follow-up period (average: 58 months), the all-cause mortality was 20.83%(50/240) and the cardiovascular mortality was 12.08%(29/240). Both NLR and GNRI were independent risk factors for the prognosis of MHD patients (P<0.05). Survival analysis showed that patients with low GNRI had a lower survival rate than those with high GNRI, whereas patients with high NLR had a lower survival rate than those with low NLR. Kaplan-Meier curve for all-cause mortality revealed that compared to G1, G2, and G4, G3 had the lowest survival rate, while G2 had the highest survival rate among all groups (P < 0.05). Kaplan-Meier curve for cardiovascular mortality showed that G3 had lower survival than G1, G2, and G4 (P < 0.001). CONCLUSIONS Our study demonstrates that bothGNRI and NLR are associated with all-cause mortality and cardiovascular mortality in MHD patients. Combining these two factorsmay contribute to a prognostic evaluation for MHD patients.
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Affiliation(s)
- Jun Wang
- Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
| | - Li-juan Huang
- Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
| | - Bei Li
- Department of Nephrology, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, 210012, Jiangsu Province, China
| | - Mei-chang Xu
- Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
| | - Lei Yang
- Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
| | - Xu Deng
- Department of Nephrology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
| | - Xin Li
- Department of Science & Education Division, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Nanjing, 210014, Jiangsu Province, China
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Ishida J, Kato A. Recent Advances in the Nutritional Screening, Assessment, and Treatment of Japanese Patients on Hemodialysis. J Clin Med 2023; 12:jcm12062113. [PMID: 36983116 PMCID: PMC10051275 DOI: 10.3390/jcm12062113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/19/2023] [Accepted: 03/04/2023] [Indexed: 03/30/2023] Open
Abstract
Patients on hemodialysis (HD) have a higher rate of protein-energy wasting (PEW) due to lower dietary intake of energy and protein (particularly on dialysis days) and greater loss of many nutrients in the dialysate effluent than other patients. The most well-known method of nutritional screening is the subjective global assessment. Moreover, the Global Leadership Initiative on MalnutIrition has developed the first internationally standardized method for diagnosing malnutrition; however, its use in patients on HD has not been established. In contrast, the nutritional risk index for Japanese patients on HD has recently been developed as a screening tool for malnutrition in patients on HD, based on the modified PEW criteria. These tools are beneficial for screening nutritional disorders, enabling registered dietitians to assess patients' dietary intake on dialysis and non-dialysis days and provide advice on dietary intake, especially immediately after dialysis cessation. Oral supplementation with enteral nutrients containing whey protein may also be administered when needed. In patients that experience adverse effects from oral supplementation, intradialytic parenteral nutrition (IDPN) should be combined with moderate dietary intake because IDPN alone cannot provide sufficient nutrition.
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Affiliation(s)
- Junko Ishida
- Department of Food and Nutritional Environment, College of Human Life and Environment, Kinjo Gakuin University, Nagoya 463-8521, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu 431-3192, Japan
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Takahashi R, Yabe H, Hibino T, Yamaguchi T, Morishita S, Kono K, Moriyama Y, Yamada T. Influence of Malnutrition on the Improvement of Physical Function by Intradialytic Resistance Exercise in Patients Undergoing Hemodialysis. J Ren Nutr 2023; 33:346-354. [PMID: 36179956 DOI: 10.1053/j.jrn.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/20/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Intradialytic exercise improves physical function. However, malnutrition may be an essential factor affecting the effectiveness of exercise to improve physical function. Few studies of the relationship between malnutrition and the effectiveness of intradialytic exercise to improve physical function exist. Therefore, this study investigated malnutrition at the beginning of intradialytic exercise and how it affects the subsequent improvement in physical function. METHODS Patients who performed intradialytic exercise for 12 months were enrolled in this study. A Geriatric Nutritional Risk Index of 91.2 was defined as malnutrition. Patients were assigned to 2 groups using propensity score matching to adjust for confounding factors. Physical function outcomes were handgrip strength, isometric knee extension strength, short physical performance battery, and 10-m walking speed; these were compared at baseline, 3 months, 6 months, and 12 months. The 2 groups were further divided into another 2 groups as per whether the nutritional status had improved after 12 months; therefore, a total of 4 groups were analyzed. RESULTS After matching, the data of 154 patients in each group were analyzed. During the intragroup comparison, isometric knee extension strength, short physical performance battery, and 10-m walking speed improved significantly in both groups after intradialytic exercise was started compared with before intradialytic exercise was started. However, there was no significant improvement in handgrip strength in the malnutrition group. There were no significant differences in any of the physical function measurements or changes from the baseline values among the 4 groups divided as per subsequent recovery of the nutritional status. CONCLUSION Malnutrition may not impact the effectiveness of intradialytic exercise to improve lower-leg physical function. Its effect on the improvement of handgrip strength requires further investigation.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Nagano H, Tomori K, Koiwa M, Kobayashi S, Takahashi M, Makabe H, Okada H, Kushiyama A. Identification of Prescribing Patterns in Hemodialysis Outpatients Taking Multiple Medications. PHARMACY 2023; 11:pharmacy11020043. [PMID: 36961021 PMCID: PMC10037568 DOI: 10.3390/pharmacy11020043] [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: 01/28/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
We investigated the relationship between multidrug administration and the characteristics, pathophysiology, and drug class in outpatients with hemodialysis. A retrospective cross-sectional study was conducted at Saitama Medical University Hospital in October 2018. Multidrug administration was defined as receiving either more than six drugs or more than the median number of drugs. The drugs used were represented by their anatomical classification codes in the Anatomical Therapeutic Chemistry Classification System (ATC classification). A latent class analysis (LCA) was used to identify clusters at risk of receiving multiple medications. A stepwise logistic regression analysis was performed to select ATC classifications prone to being involved in multidrug administration. As of October 2018, 98 outpatients with hemodialysis were enrolled in the study. In the LCA, when diabetes was the main primary disease, oral hypoglycemic agents available to dialysis patients were limited, but the number of drugs administered was large. Old age, poor nourishment, a long history of dialysis, and chronic nephritis were associated with multidrug administration among nondiabetic patients. In the second level of the ATC classification, the drugs frequently used were coded A02 (drugs for acid-related disorders), A07 (antidiarrheal agents, intestinal anti-inflammatory/anti-infective agents), B01 (antithrombotic agents), and N05 (psycholeptics). The prescribing patterns for either diabetic patients or nondiabetic elderly patients were identified in outpatients with hemodialysis taking multiple medications, and drugs for acid-related disorders, antidiarrheal agents, intestinal anti-inflammatory/anti-infective agents, antithrombotic agents, and psycholeptics are frequently used in those patients.
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Affiliation(s)
- Hiroyuki Nagano
- Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
- Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan
| | - Koji Tomori
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Mano Koiwa
- Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Shotaro Kobayashi
- Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan
- Department of Pharmacy, Sonoda Daiichi Hospital, 4-1-12 Takenotsuka, Adachi-ku, Tokyo 121-0813, Japan
| | - Masahiro Takahashi
- Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan
| | - Hideki Makabe
- Department of Pharmacy, Saitama Medical University Hospital, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Hirokazu Okada
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan
| | - Akifumi Kushiyama
- Department of Pharmacotherapy, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose-shi, Tokyo 204-8588, Japan
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Decreased Physical and Daily Living Activities in Patients with Peripheral Arterial Disease on Hemodialysis. J Clin Med 2022; 12:jcm12010135. [PMID: 36614936 PMCID: PMC9821591 DOI: 10.3390/jcm12010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Decreased physical activity and activities of daily living (ADL) in patients on hemodialysis (HD) are associated with a poor prognosis. Additionally, comorbid peripheral arterial disease is associated with further deterioration. We conducted a cross-sectional study of ADL difficulty and life-space assessment (LSA) in three groups of patients on hemodialysis according to their ankle-brachial index (ABI) values. The 164 patients were divided into ABI Low (ABI < 0.9), Normal (0.9 ≤ ABI < 1.3), and High (1.3 ≤ ABI) groups, and compared using analysis of covariance with LSA and ADL difficulty adjusted for age. The Kihon checklist (KCL) was used to assess the presence of frailty. The LSA was lower in the Low group than in the High group (F = 3.192, p = 0.044). Similarly, the ADL difficulty was significantly lower in the Low group than in the Normal group (F = 3.659, p = 0.028). In the Low group, the proportion of patients with frailty was 47.1% and KCL physical was significantly lower, indicating that patients on HD with a lower ABI had a higher prevalence of frailty and lower LSA and ADL difficulty. In conclusion, patients on HD with decreased ABI values most likely exhibit decline in physical activity and ADL due to frailty and claudication.
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Luo CM, Hsieh MY, Cheng CH, Chen CH, Liao MT, Chuang SY, Wu CC. Association of Frailty With Thrombosis of Hemodialysis Vascular Access: A Prospective Taiwanese Cohort Study. Am J Kidney Dis 2022; 80:353-363.e1. [PMID: 35257814 DOI: 10.1053/j.ajkd.2021.12.017] [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: 08/10/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023]
Abstract
RATIONALE & OBJECTIVE Frailty, a multidimensional construct, has been associated with poor outcomes in patients receiving maintenance dialysis. This study assessed the association of frailty with dialysis vascular access patency. STUDY DESIGN Multicenter prospective cohort study. SETTING & PARTICIPANTS 761 prevalent patients receiving hemodialysis at 9 centers in Taiwan as of January 2018. EXPOSURE Performance-based frailty was defined as 3 of the following: unintentional weight loss, weakness, exhaustion, low physical activity, and slow gait speed. Patients were categorized as prefrail if they had 1 or 2 of these characteristics. OUTCOME Rate of and time to dialysis access thrombosis. Data regarding vascular access events were collected for 30 months after enrollment through December 31, 2020. ANALYTICAL APPROACH Logistic regression analysis was used to estimate the association of clinical characteristics with frailty. Cox proportional hazards regression analysis was used to estimate the association of frailty with vascular access thrombosis adjusted for known clinical risk factors. RESULTS The patients' mean age was 66 years, 46% were female, 18% had synthetic graft accesses, and 82% arteriovenous fistulas. Overall, 31% were frail, 35% were prefrail, and 34% were not frail. The frailty phenotype was associated with age, female sex, low body mass index, diabetes mellitus, and prior stroke. During a median follow-up of 731 days, 161 patients (21%) had access thrombosis events (not frail, 14%; prefrail, 20%; frail, 30%; P < 0.001). Frail patients had a higher risk of vascular access thrombosis than nonfrail patients (HR, 2.31 [95% CI, 1.55-3.39], P < 0.001). After multivariable adjustment for age and comorbidities, frailty remained significantly associated with access thrombosis for both fistulas and grafts. LIMITATIONS Limited generalizability and potential residual confounding. CONCLUSIONS Frailty is associated with an increased risk of vascular access thrombosis. These findings highlight the risks of access failure experienced by frail patients receiving hemodialysis.
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Affiliation(s)
- Chien-Ming Luo
- Cardiovascular Division, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | - Mu-Yang Hsieh
- Cardiology Division, Department of Medicine, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | | | - Chiu-Hui Chen
- Hemodialysis Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu
| | - Min-Tsun Liao
- Cardiology Division, Department of Medicine, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Chih-Cheng Wu
- Quality Control Center, National Taiwan University Hospital, Hsin-Chu Hospital, Hsin-Chu; College of Medicine, National Taiwan University, Taipei; Institute of Biomedical Engineering, National Tsing-Hua University, Hsin-Chu; Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan.
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13
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Ido K, Miyazaki M, Nakayama M. Hemodialysis Record Sharing: Solution for Work Burden Reduction and Disaster Preparedness. JMIR Form Res 2022; 6:e32925. [PMID: 35867394 PMCID: PMC9356332 DOI: 10.2196/32925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background After the Great East Japan Earthquake in 2011, backup systems for clinical information were launched in Japan. The system in Miyagi Prefecture called the Miyagi Medical and Welfare Information Network (MMWIN) is used as a health information exchange network to share clinical information among various medical facilities for patients who have opted in. Hospitals and clinics specializing in chronic renal failure require patients’ data and records during hemodialysis to facilitate communication in daily clinical activity and preparedness for disasters. Objective This study aimed to facilitate the sharing of clinical data of patients undergoing hemodialysis among different hemodialysis facilities. Methods We introduced a document-sharing system to make hemodialysis reports available on the MMWIN. We also recruited hospitals and clinics to share the hemodialysis reports of their patients and promoted the development of a network between emergency and dialysis clinics. Results In addition to basic patient information as well as information on diagnosis, prescription, laboratory data, hospitalization, allergy, and image data from different facilities, specific information about hemodialysis is available, as well as a backup of indispensable information in preparation for disasters. As of June 1, 2021, 12 clinics and 10 hospitals of 68 dialysis facilities in Miyagi participated in the MMWIN. The number of patients who underwent hemodialysis in Miyagi increased by more than 40%. Conclusions Our backup system successfully developed a network of hemodialysis facilities. We have accumulated data that are beneficial to prevent the fragmentation of patient information and would be helpful in transferring patients efficiently during unpredictable disasters.
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Affiliation(s)
- Keisuke Ido
- Medical Information Center, Tohoku University Hospital, Sendai, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Wang J, Lee SY, Chao CT, Huang JW, Chien KL. The frailty risk trajectory associated with kidney and cardiovascular morbidities among patients with incident diabetes: A population-based study. Atherosclerosis 2022; 358:60-67. [DOI: 10.1016/j.atherosclerosis.2022.06.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022]
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Candemir B, Yıldırım F, Yaşar E, Erten Y, Göker B. Relationship between Health Literacy and Frailty in Older Adults with Chronic Kidney Disease. Exp Aging Res 2022; 49:201-213. [PMID: 35467490 DOI: 10.1080/0361073x.2022.2068326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with an increased risk of frailty, morbidity, and mortality in older adults. Limited health literacy (HL) is a condition that can cause frailty in CKD. Frailty leads to a decreased resistance to stress situations caused by activities of daily living and increased morbidity and mortality. The aim of this study was to investigate the relationship between HL and frailty in older adults with stage 4-5 CKD. METHODS A total of 109 patients with stage 4-5CKD were included. All patients underwent a comprehensive geriatric assessment. Health literacy was assessed by the Turkish version of the European Health Literacy Questionnaire. Frailty status was measured using the Fried Frailty Index. RESULTS The median age was 72 (68-80) years and 72 patients (66.1%) had lowHL. Forty-six patients (42.2%) were frail, and frailty was more common in the low HL group. CONCLUSION The present study demonstrated that low HL level was common in geriatric patients with stage 4-5 CKD and was associated with frailty, as well as a decrease in daily and instrumental life activities, decrease in acceptance of illness scale, and compliance with medical treatment.
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Affiliation(s)
- Burcu Candemir
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Funda Yıldırım
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emre Yaşar
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yasemin Erten
- Department of Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Berna Göker
- Department of Geriatrics, Gazi University Faculty of Medicine, Ankara, Turkey
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Gong W, Yao L, Zhong X, Qin D, Huang C, Yin L, Liu F. Prevalence and associated factors of frailty among Southern Chinese Han patients on haemodialysis: a multicentre, observational cross-sectional study. BMJ Open 2022; 12:e054177. [PMID: 35296479 PMCID: PMC8928315 DOI: 10.1136/bmjopen-2021-054177] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Frailty has been extensively studied in the general population. However, there is little information on frailty among patients undergoing haemodialysis (HD) in China. This study analysed the prevalence and associated factors of frailty among Southern Chinese Han patients on HD. DESIGN Observational cross-sectional study. SETTING Three HD centres in Southern China. PARTICIPANTS Three hundred patients who underwent regular HD between June 2019 and October 2019. MAIN OUTCOMES AND MEASURES Frailty was assessed using the Tilburg indicator of frailty (TFI) questionnaire, and the psychological status of the respondents was evaluated by the Self-Rating Depression Scale (SDS) and the Self-Rating Anxiety Scale (SAS). RESULTS Seventy-five per cent of participants were in the frailty group, and the TFI score of HD patients was 6.89±2.87, with 8.15±2.06 in the frailty group and 2.87±1.31 in the non-frailty group. Frailty patients had higher SDS and SAS scores, and were more likely to suffer depression and anxiety than non-frailty patients. Multivariate logistic regression analysis excluding depression and anxiety showed that age, Charlson Comorbidity Index (excluding end-stage renal disease), a nuclear family (compared with living alone), and albumin were independently associated with frailty (all p<0.05). In the model including depression and anxiety, age, diabetes mellitus, living as a couple (compared with living alone), a nuclear family (compared with living alone), an extended family (compared with living alone), low phosphorus, depression and anxiety were associated with frailty by multivariate logistic regression analysis (all p<0.05). CONCLUSIONS Approximately three-quarters of patients with HD in Southern China are frail, often accompanied with depression and anxiety. Age, diabetes mellitus, family structure, phosphorus, depression and anxiety were associated with frailty.
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Affiliation(s)
- Wenyu Gong
- Division of Nephrology, Department of Medicine, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Lirong Yao
- Division of Nephrology, Department of Medicine, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
- Division of Nephrology, Department of Medicine, Shangrao People's Hospital, Shangrao, Jiangxi, China
| | - Xiaoshi Zhong
- Division of Nephrology, Department of Medicine, Guangzhou Red Cross Hospital, Guangzhou, Guangdong, China
| | - Danping Qin
- Division of Nephrology, Department of Medicine, Guangzhou Red Cross Hospital, Guangzhou, Guangdong, China
| | - Chunrong Huang
- Department of Hemodialysis Center, Jinan University Affiliated Jihua Hospital, Guangzhou, Guangdong, China
| | - Lianghong Yin
- Division of Nephrology, Department of Medicine, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Fanna Liu
- Division of Nephrology, Department of Medicine, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
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Guo Y, Tian R, Ye P, Luo Y. Frailty in Older Patients Undergoing Hemodialysis and Its Association with All-Cause Mortality: A Prospective Cohort Study. Clin Interv Aging 2022; 17:265-275. [PMID: 35313671 PMCID: PMC8934156 DOI: 10.2147/cia.s357582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The study aimed to determine the prevalence and risk factors of frailty among a Chinese cohort of hemodialysis patients and to assess the degree to which frailty was associated with all-cause mortality. Participants and Methods We enrolled a group of older adults (≥60 years old) in a prospective cohort study of cognitive impairment in Chinese patients undergoing hemodialysis (registered in Clinical Trials.gov, ID: NCT03251573). We assessed the prevalence of frailty using Fried’s definition in the Cardiovascular Health Study, then we evaluated the associated risk factors of frailty using multivariate logistic regression analysis. Finally, we assessed the association of frailty and all-cause mortality with multivariable Cox proportional hazard regression analyses. Results The prevalence of frailty in these 204 enrolled hemodialysis patients was 72.1%. Patients with frailty were more inclined to have composite abnormal components that included poor physical functioning, exhaustion, low physical activity, and undernutrition. Multivariable logistic regression analysis suggested that increased age, female gender, history of diabetes, longer dialysis vintage, lower Kt/V, lower serum level of albumin concentrations, and increased serum iPTH concentrations were independently associated with frailty. Cox regression analysis indicated that frailty as a dichotomous construct was strongly associated with an increased risk of mortality (HR 6.092, 95% CI 1.886–19.677, P = 0.003) in unadjusted analyses. After adjusting (Model I = no adjusted; II = adjusted for age, gender; III = adjusted for age, gender, history of diabetes; IV = adjusted for all covariates associated at the p ≤ 0.10 level with death in unadjusted analyses, including age, history of diabetes, MoCA<26, single-pool Kt/V, and the levels of albumin and iPTH), the association was slightly affected but observed consistent as before. Conclusion Frailty is extremely common and is associated with serious clinical outcomes among older hemodialysis patients. Based on those clinical features of frailty, future studies should focus on exploring effective interventions aimed to prevent or attenuate frailty in the older hemodialysis population.
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Affiliation(s)
- Yidan Guo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, People’s Republic of China
| | - Ru Tian
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, People’s Republic of China
| | - Pengpeng Ye
- Division of Injury Prevention and Mental Health National Center for Chronic and Non-Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yang Luo
- Division of Nephrology, Beijing Shijitan Hospital, Capital Medical University, Bejing, People’s Republic of China
- Correspondence: Yang Luo, Email
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Study on the Clinical Implications of NLR and PLR for Diagnosing Frailty in Maintenance Hemodialysis Patients and Their Correlations with Patient Prognosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1267200. [PMID: 35070222 PMCID: PMC8769815 DOI: 10.1155/2022/1267200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/23/2021] [Indexed: 12/30/2022]
Abstract
Objective To explore the clinical implications of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for diagnosing frailty in patients with maintenance hemodialysis (MHD) and their correlations with patient prognosis. Methods A total of 185 patients with MHD admitted to the hemodialysis center of our hospital were selected, 72 of whom were diagnosed with frailty according to the Chinese version of Tilburg Frailty Indicator (TFI). The relevant data were collected, and the influencing factors of frailty in MHD patients were analyzed by one-way analysis of variance (ANOVA) and multivariate logistic regression. The value of NLR and PLR in diagnosing frailty in MHD patients was observed, and patients' all-cause mortality was compared during the 3-year follow-up. The influences of different levels of NLR and PLR on the survival of MHD patients were investigated. Results Multivariate regression analysis identified that serum albumin, dialysis adequacy, NLR, and PLR are independent risk factors for frailty in MHD patients (P < 0.05). The area under the receiver operating characteristic (ROC) curve of NLR and PLR in diagnosing frailty in MHD patients was 0.859 and 0.799, respectively. Compared with the nonfrailty group, the 3-year mortality was higher, and the 3-year survival rate assessed by survival analysis was lower in the frailty group (P < 0.05). Patients with high NLR and PLR levels showed a lower 3-year survival rate. Conclusions Dialysis adequacy, serum albumin, NLR, and PLR are independently associated with frailty in MHD patients. NLR and PLR are of a certain diagnostic value for frailty in MHD patients. MHD patients with frailty have an unfavorable prognosis, as of those with high NLR and PLR levels.
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Ozturk S, Cetin DG, Cetin M, Yilmaz MD, Ozler TE, Cebeci E, Karadag S, Feyizoglu H, Bahat G. Prevalence and Associates of Frailty Status in Different Stages of Chronic Kidney Disease: A Cross-Sectional Study. J Nutr Health Aging 2022; 26:889-895. [PMID: 36156681 DOI: 10.1007/s12603-022-1839-z] [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] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Frailty is a state of homeostenosis associated with adverse outcomes. Chronic kidney disease (CKD) increases considerably by aging and shares the common risk factors with frailty. We aimed to examine the prevalence and independent associates of frailty status in CKD patients. DESIGN In this single-centre, cross-sectional study, we used the five-item Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) scale to evaluate frailty. A binary logistic regression analysis model including the parameters found to have relationship with frailty in univariate analyses was used to detect independent associates of frailty status. Odds ratio (OR) and 95% confidence interval (CI) were given. PARTICIPANTS Study included 148 patients aged 18-80. Sixty (60) patients were end stage renal disease (ESRD) patients on maintenance hemodialysis (HD) (at least for 3 months) and 88 were stage 3-4 CKD patients. Thirty-seven (37) patients (42%) were eGFR G3a, 31 patients (35.3%) were eGFR G3b and 20 patients (22.7%) were eGFR G4 in stage 3-4 CKD patients. MEASUREMENTS Demographics, etiology of CKD, comorbidities, regular drugs, dialysis-related and laboratory data were recorded. FRAIL scale was scored as follows; 0=robust, 1-2=prefrail, and ≥3= frail. The frailty status was compared between frail+prefrail group vs robust (non-frail) group. RESULTS The prevalences of prefrailty and frailty were 68.3% and 3.3% in HD group and 53.4% and zero in stage 3-4 CKD group, respectively (p = 0.025). In the multivariate logistic regression analysis, being in HD group (OR=3.87, 95% CI= 1.06-14.19, p=0.04), older age (OR=1.09, 95% CI= 1.04-1.13) and female sex (OR=9.13, 95%CI= 2.82-29.46) were independent risk factors for frailty (p<0.001, for both). CONCLUSION Prefrailty and frailty are quite common among HD and CKD stage 3-4 patients. Being an HD patient is an independent risk factor for non-robust (frail or prefrail) status. Our findings point out a remarkably high prevalence of frailty severity (prefrailty/frailty) phenotype among patients with advanced CKD stages.
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Affiliation(s)
- S Ozturk
- Prof. Dr. Gulistan Bahat, Istanbul University, Istanbul Medical School, Department of Internal Medicine, Division of Geriatrics, Capa, 34093, Istanbul, Turkey, Telephone: + 90 212 414 20 00-31478; 33090, Fax:+ 90 212 414 22 48,+ 90 212 532 42 08, e-mail: , ORCID No: 0000-0001-5343-9795
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Chen CH, Hsieh YL, Chuang SY, Su FY, Wang KT, Luo CM, Meng SW, Wu CC. The Impact of Frailty on the Outcomes of Hemodialysis Vascular Access. ACTA CARDIOLOGICA SINICA 2022; 38:29-38. [PMID: 35068881 PMCID: PMC8743470 DOI: 10.6515/acs.202201_38(1).20210711a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Frailty has been associated with mortality and adverse cardiovascular outcomes in patients with hemodialysis (HD), however the relevance of frailty on the outcomes of HD vascular access remains unclear. METHODS We enrolled a cohort of patients with prevalent HD between August 2018 and November 2018. The presence of 5 frailty phenotypes was determined at enrollment, using the modified Fried's criteria. Data regarding vascular access events or mortality were linked to prospectively collected data up to 24 months after enrollment. RESULTS Of the 382 patients screened, 313 were recruited in the final analysis. The participants' mean age was 66 years, and 42.5% were female. Among all participants, 40.3% were determined to be frail and 29.4% pre-frail. The frail phenotype was associated with age, female gender, lower body mass index, unemployment, lower education level, and higher dialysis clearance. During the follow-up period (median, 24 months), 112 patients had vascular access events (non-frail, 27.4%; pre-frail, 35.9%; frail, 46.1%; p = 0.003) and 45 patients experienced thrombosis of the vascular access (non-frail, 4.2%; pre-frail, 9.8%; frail, 18.3%; p = 0.002). Cox regression analysis showed that frail patients had a 2.2-fold higher risk of experiencing vascular access events than non-frail patients [hazard ratio (HR): 2.205, 95% confidence interval (CI): 1.377-3.532, p = 0.001], but the association was not significant (HR: 1.634, 95% CI: 0.938-2.848, p = 0.082) after multivariate adjustment. CONCLUSIONS The frail phenotype is common in Taiwanese patients who undergo maintenance HD and is associated with adverse outcomes of dialysis vascular access.
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Affiliation(s)
| | - Yu-Ling Hsieh
- Department of Nursing, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Zhunan
| | | | | | - Chien-Ming Luo
- Department of Surgery, Division of Cardiovascular Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu
- College of Medicine, National Taiwan University, Taipei
| | | | - Chih-Cheng Wu
- College of Medicine, National Taiwan University, Taipei
- Quality Control Center, National Taiwan University Hospital, Hsin-Chu Branch
- Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
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Li Y, Zhang D, Ma Q, Diao Z, Liu S, Shi X. The Impact of Frailty on Prognosis in Elderly Hemodialysis Patients: A Prospective Cohort Study. Clin Interv Aging 2021; 16:1659-1667. [PMID: 34552324 PMCID: PMC8450604 DOI: 10.2147/cia.s329665] [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: 07/16/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To explore the impact of frailty on adverse outcomes in elderly hemodialysis (HD) patients. Patients and Methods An observational and prospective cohort study was conducted in elderly patients (≥60) with HD, with an average 12-month follow-up. Fried frailty phenotype (FFP) was used to define frailty. Negative binomial regression was used to estimate the impact of frailty on the incidence of emergency visits, hospitalizations, acute cardiovascular events, and falls within a year. Cox regression analysis was used to assess the influence of frailty on all-cause mortality in elderly HD patients. Results Our study enrolled 150 elderly HD patients, and the prevalence of frailty was 34.7%. After adjustment, frailty was independently associated with increased all-cause mortality [hazard ratio (HR)=4.10, 95% CI: 1.09-15.43, p=0.037] and emergency visits [incidence rate ratio (IRR)=2.78 95% CI: 1.70-4.60, p<0.001]. Gait speed was an independent risk factor for all-cause deaths (HR=5.56 95% CI: 1.41-22.00, p=0.014), emergency visits (IRR=2.52 95% CI: 1.48-4.33, p<0.001), and hospitalizations (IRR=2.24, 95% CI: 1.19-4.21, p=0.010) in elderly HD patients. Conclusion Frailty was an independent indicator of all-cause mortality and emergency visits in elderly patients with HD.
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Affiliation(s)
- Yuanyuan Li
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dai Zhang
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qing Ma
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zongli Diao
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Sha Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaotian Shi
- Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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22
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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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Zanotto T, Mercer TH, van der Linden ML, Koufaki P. Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study. BMC Geriatr 2021; 21:411. [PMID: 34215211 PMCID: PMC8252257 DOI: 10.1186/s12877-021-02356-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is associated with multiple adverse outcomes in stage-5 chronic kidney disease (CKD-5) and upwards of one third of people receiving haemodialysis (HD) are frail. While many frailty screening methods are available in both uremic and non-uremic populations, their implementation in clinical settings is often challenged by time and resource constraints. In this study, we explored the diagnostic accuracy of time-efficient screening tools in people receiving HD. METHODS A convenience sample of 76 people receiving HD [mean age = 61.1 years (SD = 14), 53.9% male] from three Renal Units were recruited for this cross-sectional study. Frailty was diagnosed by means of the Fried phenotype. Physical performance-based screening tools encompassed handgrip strength, 15-ft gait speed, timed up and go (TUG), and five-repetition sit to stand (STS-5) tests. In addition, participants completed the SF-36 Health Survey, the short-form international physical activity questionnaire and the Tinetti falls efficacy scale (FES) as further frailty-related measures. Outcome measures included the area under the curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV). The diagnostic performance of screening tools in assessing fall-risk was also investigated. RESULTS Overall, 36.8% of participants were classified as frail. All the examined instruments could significantly discriminate frailty status in the study population. Gait speed [AUC = 0.89 (95%CI: 0.81-0.98), sensitivity = 75%, specificity = 93%] and TUG [AUC = 0.90 (95%CI: 0.80-0.99), sensitivity = 89%, specificity = 85%] exhibited the highest diagnostic accuracy. There was a significant difference in gait speed AUC (20%, p = 0.013) between participants aged 65 years or older (n = 36) and those under 65 years of age (n = 40), with better discriminating performance in the younger sub-group. The Tinetti FES was the only instrument showing good diagnostic accuracy (AUCs≥0.80) for both frailty (sensitivity = 82%, specificity = 79%) and fall-risk (sensitivity = 82%, specificity = 71%) screening. CONCLUSIONS This cross-sectional study revealed that time- and cost-efficient walking performance measures can accurately be used for frailty-screening purposes in people receiving HD. While self-selected gait speed had an excellent performance in people under 65 years of age, TUG may be a more suitable screening method for elderly patients (≥65 years). The Tinetti FES may be a clinically useful test when physical testing is not achievable.
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Affiliation(s)
- Tobia Zanotto
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK. .,Present Address: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66103, USA.
| | - Thomas H Mercer
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
| | - Pelagia Koufaki
- Centre for Health, Activity and Rehabilitation Research, School of Health Sciences, Queen Margaret University, Edinburgh, EH21 6UU, UK
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Jamal A, Babazono A, Li Y, Fujita T, Yoshida S, Kim SA. Elucidating variations in outcomes among older end-stage renal disease patients on hemodialysis in Fukuoka Prefecture, Japan. PLoS One 2021; 16:e0252196. [PMID: 34033671 PMCID: PMC8148375 DOI: 10.1371/journal.pone.0252196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 05/11/2021] [Indexed: 12/02/2022] Open
Abstract
Variations in health care outcomes and services potentially indicate resource allocation inefficiency. Therefore, this study was conducted to examine variations in mortality and hospitalization cases among end-stage renal disease (ESRD) patients receiving hemodialysis (HD) care from medical facilities located in 13 secondary medical care areas (SMAs) of Fukuoka prefecture, Japan. The research was designed as a retrospective, cross-sectional study using insurance claims data. The subjects of the study were older patients (over 65 years old) insured by the Fukuoka prefecture’s Latter-Stage Elderly Healthcare Insurance. Using an electronic claims database, we identified patients with chronic kidney disease (CKD) who had received HD care from April 1, 2017 to March 31, 2018. The CKD status was identified using International Classification of Disease, 10th revision code, and HD maintenance status was ascertained using specific insurance procedure codes. A total of 5,243 patients met our inclusion criteria and their records were subsequently reviewed. About 73% (n = 3,809) of patients had admission records during the period studied. Thus, the data regarding hospital length of stay (LOS) and admission costs were analyzed separately. Significant differences in terms of increased risks in hospitalization were evident in a number of SMAs. An increase in mortality risk due to heart failure and malignancy was observed in two separate SMAs. Also, analyzed LOS, total hospitalization cost, and cost per day according to SMAs showed statistically significant variations. The findings highlight the magnitude of the burden of CKD and ESRD in the community. The high prevalence of ESRD, associated mortality, and hospitalized HD patients signal the need for clinicians to assume broader roles in measures against chronic kidney disease through involvement in community awareness programs. To improve patient outcomes, improvement of regional health care provision, the level of medical care, and the development of existing human resources are needed.
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Affiliation(s)
- Aziz Jamal
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia
- * E-mail:
| | - Akira Babazono
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshida
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Sung A. Kim
- Department of Health Care Administration & Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Uragami Y, Takikawa K, Kareki H, Kimura K, Yamamoto K, Iihara N. Effect of number of medications and use of potentially inappropriate medications on frailty among early-stage older outpatients. J Pharm Health Care Sci 2021; 7:15. [PMID: 33934718 PMCID: PMC8091752 DOI: 10.1186/s40780-021-00195-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Frailty is an urgent concern among an aging population worldwide. However, the relationship between frailty and number and types of medications has not been studied in detail among early-stage older patients, and it is unclear what prescriptions may have a role in preventing frailty. This study aimed to clarify the effects of number of medications and use of potentially inappropriate medications (PIMs) on frailty among early-stage older outpatients in Japan. Methods A cross-sectional study was undertaken. Frailty scores and medications of outpatients aged 65–74 years who regularly visited community pharmacies were investigated. Frailty scores were classified as 0 (non-frailty), 1–2 (pre-frailty), and ≥ 3 (frailty). The association between frailty and number of medications was analyzed by age and compared between PIM use and non-use groups. The proportion of patients who used PIMs was also analyzed by frailty score. Results Of 923 older outpatients, 49 (5.3%) and 318 (34.5%) patients had frailty and pre-frailty scores, respectively. The numbers of medications among patients with pre-frailty and frailty were significantly higher than among those with non-frailty (p < 0.001 for both). A similar increase was shown for PIM use groups aged 69–71 and 72–74 years, but not for the PIM use group aged 65–68 years and all groups without PIM use. An increasing linear trend was observed for the relationship between the proportion of patients who used any PIM, as well as some subcategories of PIMs (such as NSAIDs, benzodiazepines, loop diuretics and antithrombotic drugs) and frailty score. Conclusions Unnecessary medication use among early-stage older outpatients, especially patients aged ≥69 years who use PIMs and many medications, seems to be associated with frailty, but further research is needed to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s40780-021-00195-x.
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Affiliation(s)
- Yuya Uragami
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan.
| | - Kazuhiro Takikawa
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Hajime Kareki
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Koji Kimura
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Kazuyuki Yamamoto
- Star Pharmacy Co., Ltd, 4113-1 Onohara Onohara-cho, Kagawa, 769-1611, Kanonji City, Japan
| | - Naomi Iihara
- Kagawa School of Pharmaceutical Sciences, Tokushima Bunri University, 1314-1 Shido, Sanuki City, Kagawa, 769-2193, Japan
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26
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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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27
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Fu W, Zhang A, Ma L, Jia L, Chhetri JK, Chan P. Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China. Int J Med Sci 2021; 18:3309-3317. [PMID: 34400900 PMCID: PMC8364462 DOI: 10.7150/ijms.51569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 07/13/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients. Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status. Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD. Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.
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Affiliation(s)
- Wenjing Fu
- Department of Nephrology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Aihua Zhang
- Department of Nephrology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
| | - Linpei Jia
- Department of Nephrology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jagadish K Chhetri
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Piu Chan
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,Department of Geriatrics, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China.,National Clinical Research Center for Geriatric Disorders, Beijing, China
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28
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Miyazaki S, Iino N, Koda R, Narita I, Kaneko Y. Brain‐derived neurotrophic factor is associated with sarcopenia and frailty in
Japanese
hemodialysis patients. Geriatr Gerontol Int 2020; 21:27-33. [DOI: 10.1111/ggi.14089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Satoru Miyazaki
- Department of Nephrology Uonuma Kikan Hospital Niigata Japan
- Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Noriaki Iino
- Department of Nephrology Uonuma Kikan Hospital Niigata Japan
| | - Ryo Koda
- Department of Nephrology Uonuma Kikan Hospital Niigata Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
| | - Yoshikatsu Kaneko
- Division of Clinical Nephrology and Rheumatology Niigata University Graduate School of Medical and Dental Sciences Niigata Japan
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Kosaka S, Ohara Y, Naito S, Iimori S, Kado H, Hatta T, Yanishi M, Uchida S, Tanaka M. Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2020; 21:357. [PMID: 32819288 PMCID: PMC7441609 DOI: 10.1186/s12882-020-02019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3–5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47–0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.
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Affiliation(s)
- Shiho Kosaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroshi Kado
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Tsuguru Hatta
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Masaaki Yanishi
- Kansai Medical University, 2-3-1 Shinmachi, Hirakata-city, Osaka, 573-1191, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Makoto Tanaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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30
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Vanden Wyngaert K, Celie B, Calders P, Eloot S, Holvoet E, Van Biesen W, Van Craenenbroeck AH. Markers of protein-energy wasting and physical performance in haemodialysis patients: A cross-sectional study. PLoS One 2020; 15:e0236816. [PMID: 32730305 PMCID: PMC7392314 DOI: 10.1371/journal.pone.0236816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Bert Celie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
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31
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Carswell C, Reid J, Walsh I, McAneney H, Lee JB, Noble H. Complex arts-based interventions for patients receiving haemodialysis: A realist review. Arts Health 2020; 13:107-133. [PMID: 32233723 DOI: 10.1080/17533015.2020.1744173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Many patients with end-stage kidney disease require haemodialysis, a treatment that requires attending hospital three times a week for four hours each visit. This treatment impacts profoundly on mental health. Arts-based interventions for patients receiving haemodialysis could address the impact of this treatment; however, there is no consensus on methods of implementation and mechanisms underlying these interventions in specific clinical contexts. Using a realist approach, relevant articles were synthesised to inform theory relating to the mechanism and implementation of complex arts-based interventions for haemodialysis patients. The theoretical framework includes two implementation phases, firstly delivery of person-centred art activities during haemodialysis and secondly, display of completed artwork. This intervention triggers mechanisms including flow and social capital. Implementation is hindered by constraints of the haemodialysis unit and patients' lack of confidence in their artistic skills. These issues can be addressed through aflexible approach to implementation and support from healthcare professionals.
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Affiliation(s)
- Claire Carswell
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast UK
| | - Jenny Baxley Lee
- UF Health Shands Arts in Medicine, University of Florida, Gainesville, Florida, USA
| | - Helen Noble
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
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Kosoku A, Uchida J, Iwai T, Shimada H, Kabei K, Nishide S, Maeda K, Kabata D, Shintani A, Nakatani T. Frailty is associated with dialysis duration before transplantation in kidney transplant recipients: A Japanese single-center cross-sectional study. Int J Urol 2020; 27:408-414. [PMID: 32145708 DOI: 10.1111/iju.14208] [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: 11/27/2019] [Accepted: 01/29/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the prevalence of frailty, and the relationship of frailty based on the Kihon Checklist criteria with dialysis duration before transplantation and time after transplantation in kidney transplant recipients. METHODS This study was a single-center, cross-sectional investigation carried out on kidney transplant recipients. To examine the association between the total Kihon Checklist score with time after transplant and dialysis duration before transplant, the multivariable proportional odds logistic regression model was used with adjustment for age, sex, body mass index, estimated glomerular filtration rate and serum albumin levels. RESULTS Out of 205 kidney transplant recipients enrolled in this study, frail, prefrail and robust recipients accounted for 11.2%, 26.8% and 62.0%, respectively. Dialysis duration before transplantation was associated with frailty, but time after transplant was not associated with frailty. CONCLUSIONS The prevalence of frailty in kidney transplant recipients is approximately 11%, and it is associated with the duration of pretransplant dialysis. These findings suggest that a shorter dialysis duration might be beneficial for preventing frailty in kidney transplant recipients.
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Affiliation(s)
- Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Iwai
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisao Shimada
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Kabei
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shunji Nishide
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Maeda
- Department of Nursing, Osaka City University Hospital, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Sugimoto K, Rakugi H, Kojima T, Ishii S, Akishita M, Tamura Y, Araki A, Kozaki K, Senda K, Fukuoka H, Satake S, Arai H. Chapter 4 Frailty and specific diseases. Geriatr Gerontol Int 2020; 20 Suppl 1:25-37. [PMID: 32050299 DOI: 10.1111/ggi.13833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiromi Rakugi
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Koichi Kozaki
- Department of Geriatric Medicine, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kazuyoshi Senda
- Department of Clinical Research Promotion, Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hideki Fukuoka
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shosuke Satake
- Department of Frailty Research, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
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Garcia-Canton C, Rodenas A, Lopez-Aperador C, Rivero Y, Anton G, Monzon T, Diaz N, Vega N, Loro JF, Santana A, Esparza N. Frailty in hemodialysis and prediction of poor short-term outcome: mortality, hospitalization and visits to hospital emergency services. Ren Fail 2019; 41:567-575. [PMID: 31234684 PMCID: PMC6598473 DOI: 10.1080/0886022x.2019.1628061] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Frailty is an aging-associated state of increased vulnerability, which raises the risk of adverse outcomes. Chronic kidney disease is associated with higher prevalence of frailty. Our aim was to estimate frailty prevalence in a hemodialysis population and its influence on short-term outcomes. Design: Observational prospective longitudinal study of 277 prevalent hemodialysis patients. Frailty was estimated through the Edmonton Frail Scale (EFS). Demographic and clinical data, comorbidity index, and laboratory parameters were recorded. A 29-month follow-up was conducted on mortality, including hospitalization, and visits to hospital emergency services in the first 12 months of this period. Results: According to the EFS, 82 patients (29.6%) were frail, 53 (19.1%) were vulnerable, and 142 (51.3%) were non-frail. During follow-up, 58.5% frail patients, 30.2% vulnerable, and 16.2% non-frail ones died (p < .005). In the analysis of survival using an adjusted Cox model, a higher hazard of mortality was observed in frail than in non-frail patients (HR 2.34; 95% CI 1.39–3.95; p = .001). During follow-up the hospitalization rate was 852 episodes/1000 patient-years for frail patients, 784 episodes/1000 patient-years for vulnerable patients, and 417 episodes/1000 patient-years for non-frail patients (p = .0005). The incidence ratio of visits to emergency services was 3216, 1735, and 1545 visits/1000 patient-years for each group (p < .001). Conclusions: Hemodialysis patients present high frailty prevalence. Frailty is associated with poor short-term outcomes and higher rates of mortality, visits to hospital emergency services, and hospitalization.
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Affiliation(s)
- Cesar Garcia-Canton
- a Department of Nephrology , Insular University Hospital of Gran Canaria , Gran Canaria , Spain.,b Faculty of Health Sciences , University of Las Palmas de Gran Canaria , Gran Canaria , Spain
| | - Ana Rodenas
- a Department of Nephrology , Insular University Hospital of Gran Canaria , Gran Canaria , Spain
| | - Celia Lopez-Aperador
- b Faculty of Health Sciences , University of Las Palmas de Gran Canaria , Gran Canaria , Spain
| | - Yaiza Rivero
- a Department of Nephrology , Insular University Hospital of Gran Canaria , Gran Canaria , Spain
| | - Gloria Anton
- c Avericum Dialysis Center , Gran Canaria , Spain
| | - Tania Monzon
- c Avericum Dialysis Center , Gran Canaria , Spain
| | - Noa Diaz
- a Department of Nephrology , Insular University Hospital of Gran Canaria , Gran Canaria , Spain
| | - Nicanor Vega
- d Department of Nephrology , University Hospital of Gran Canaria Dr Negrin , Las Palmas , Spain
| | - Juan F Loro
- b Faculty of Health Sciences , University of Las Palmas de Gran Canaria , Gran Canaria , Spain
| | - Angelo Santana
- e Faculty of Mathematics , University of Las Palmas de Gran Canaria , Gran Canaria , Spain
| | - Noemi Esparza
- a Department of Nephrology , Insular University Hospital of Gran Canaria , Gran Canaria , Spain
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Umebayashi R, Uchida HA, Wada J. Abdominal aortic aneurysm in aged population. Aging (Albany NY) 2019; 10:3650-3651. [PMID: 30523221 PMCID: PMC6326692 DOI: 10.18632/aging.101702] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/21/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Ryoko Umebayashi
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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36
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The prevalence of frailty in patients on hemodialysis: a systematic review and meta-analysis. Int Urol Nephrol 2019; 52:115-120. [PMID: 31642001 DOI: 10.1007/s11255-019-02310-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/03/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Coexistence of frailty and hemodialysis is related to higher risk of hospitalization, falls and mortality. Given the potential reversibility of frailty, reaching the epidemiology of frailty in hemodialysis is of great importance. However, estimates of the prevalence of frailty in patients on hemodialysis vary widely. We tried to synthesize the existing body of literature on the prevalence of frailty in patients on hemodialysis. METHODS We searched Pubmed, Embase, Web of Science and Cochrane for studies of the prevalence in patients on hemodialysis. The prevalence of frailty was synthesized across eligible studies using a random-effects model. We explored potential origin of heterogeneity in the estimates by meta-regression analysis. RESULTS Prevalence range from 6.0 to 82.0% and the pooled prevalence of frailty in patients on dialysis was 34.3% (95% confidence interval (CI) 24.5-44.1%; z = 6.87; p = 0.00). The pooled estimates of prevalence for patients aged < 55, 55-65, and ≥ 65 were 56.0% (95% CI 28.9-83.2%; z = 4.04; p = 0.00), 32.3% (95% CI 22.9-41.7%; z = 6.74; p = 0.00), and 20.3% (95% CI 7.9-32.8%; z = 3.2; p = 0.00), respectively. There were no significant relationships between frailty in hemodialysis and factors such as years of publication, sample size (continuous), sample size(> 500 vs ≤ 500), diagnostic method (the Fried Frailty vs other), country (Europe & USA vs Asia) and duration of hemodialysis. CONCLUSIONS Frailty influences almost three in ten patients on hemodialysis. Understanding the underlying pathophysiology mechanisms and weakening the impacts of frailty in patients on hemodialysis are called on to action in the future work.
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37
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Chao CT, Lee YH, Li CM, Han DS, Huang JW, Huang KC. Advanced Age and Chronic Kidney Disease Modify the Association Between Metabolic Syndrome and Frailty Among Community-Dwelling Elderly. Rejuvenation Res 2019; 23:333-340. [PMID: 31423906 DOI: 10.1089/rej.2019.2202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metabolic syndrome (MetS) predisposes older adults to the development of frailty. However, previous studies have not explored factors that may influence the association between MetS and the risk of frailty in this population. Community-dwelling older adults (≥65 years of age) were prospectively identified and enrolled between 2013 and 2016. MetS and frailty were defined based on the American Association of Clinical Endocrinologists and Study of Osteoporotic Fractures criteria, respectively. Multiple logistic regression with frailty/prefrailty as the dependent variable was used to examine the relationship between MetS and frailty/prefrailty, supplemented by subgroup analyses of the influence of aging and chronic kidney disease (CKD). Among 2862 elderly (73.4 ± 6.7 years), 17.5% and 17.3%, respectively, had MetS and frailty/prefrailty, among whom 74 (2.6%) and 420 (14.7%) had frailty and prefrailty. The presence of MetS (odds ratio [OR] 2.53, p < 0.001), higher age (OR 1.05, p < 0.001), and CKD (OR 1.42, p = 0.006) were associated with a significantly higher risk of frailty/prefrailty. Furthermore, among those ≥80 years of age, the association between MetS and frailty/prefrailty disappeared (p = 0.329). Among those with CKD, the presence of MetS was significantly associated with a progressively higher risk of frailty/prefrailty (for stage 3 or higher and for stage 3b or higher, OR 6.4 and 12.4, p < 0.001 and = 0.009, respectively). In conclusion, aging and CKD modified the association between MetS and frailty. These findings may assist in devising case-specific care plans for elderly with MetS by refocusing our attention on those at high risk of developing frailty/prefrailty.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Chia-Ming Li
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Ching Huang
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
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38
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Ishikawa H, Hibino T, Moriyama Y. Chronic Kidney Disease is Associated with Physical Impairment. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2019; 2:1000013. [PMID: 33884114 PMCID: PMC8008711 DOI: 10.2340/20030711-1000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Background Physical impairment or frailty due to sarcopaenia is common in patients with chronic kidney disease and those receiving dialysis. This study examined the association between muscle weakness and kidney function in Japanese patients with chronic kidney disease. Methods A total of 23 stable outpatients were enrolled in the study. Several indices were used to assess muscle function; hand grip strength, isometric knee extension strength, Timed Up and Go test (TUG), and the short physical performance battery. The relationships between these indices and estimated glomerular filtration rate (eGFR) as a measure of kidney function were analysed statistically. Results Patients' characteristics were as follows: mean age 73.9 years (standard deviation (SD) 13); 12 males, 11 females; body mass index (BMI) 22.5 kg/m2 (SD 3.2); serum creatinine (sCr) 4.6 mg/ dl (SD 3.7); estimated glomerular filtration rate (eGFR) 19.1 ml/min (SD 16). Their physical performance indices were: hand grip strength 20.8 kg (SD 7.9); isometric knee extension strength 19.1 kgf/kg (SD 10.6); TUG 14.9 s (SD 6.0); and short physical performance battery score 7.0 (SD 4.3). Multiple regression analysis adjusted for age revealed significant associations between isometric knee extension strength/body weight and eGFR (F [2,19] = 8.38, p = 0.002) and TUG and eGFR (F=4.98 [2,18], p = 0.02). Conclusion Deterioration in muscle function or maintenance of posture is associated with chronic kidney disease.
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Affiliation(s)
- Hideaki Ishikawa
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan.,Department of Nephrology, Kaikoukai Josai Hospital, Nagoya, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Japan
| | - Yoshifumi Moriyama
- Department of Health Fitness Programmer, Nagoya Kyoritsu Hospital, Nagoya, Japan
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Yano J, Kaida Y, Nakayama Y, Ito S, Kurokawa Y, Nakamura N, Hazama T, Maeda T, Hashida R, Tashiro K, Inokuchi T, Matsuse H, Fukami K. Carnitine deficiency is associated with decreased exercise activity in hemodialysis patients. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0197-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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40
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Yi C, Lin J, Cao P, Chen J, Zhou T, Yang R, Lu S, Yu X, Yang X. Prevalence and Prognosis of Coexisting Frailty and Cognitive Impairment in Patients on Continuous Ambulatory Peritoneal Dialysis. Sci Rep 2018; 8:17305. [PMID: 30470776 PMCID: PMC6251896 DOI: 10.1038/s41598-018-35548-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 11/07/2018] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to investigate the prevalence of coexisting frailty and cognitive impairment and its association with clinical outcomes in patients on continuous ambulatory peritoneal dialysis (CAPD). Patients on CAPD started to enroll from 2014 to 2016 and ended follow-up by 2017. Frailty was assessed by clinical frailty scale (CFS), and cognitive function was assessed by Montreal Cognitive Assessment (MoCA). Totally 784 CAPD patients were recruited, with median duration of PD 30.7 (8.9~54.3) months. The mean age was 48.8 ± 14.6 years, 320 (40.8%) patients were female and 130 (16.6%) had diabetic nephropathy. Patients with cognitive impairment were more than those with frailty (55.5% vs. 27.6%). Coexisting frailty and cognitive impairment was present in 23.9% patients. Pathway analysis showed that CFS score was negatively associated with MoCA score (β = −0.69, P < 0.001). Coexisting frailty and cognitive impairment was associated with decreased patient survival rate (Log-rank = 84.33, P < 0.001) and increased peritonitis rate (0.22 vs. 0.11, 0.15 and 0.12 episodes per patient year, respectively; all P < 0.001). It was concluded that there was a relatively high prevalence of coexisting frailty and cognitive impairment among patients on CAPD. Frailty was positively associated with cognitive impairment. Coexisting frailty and cognitive impairment increased the risk of adverse outcomes.
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Affiliation(s)
- Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Peiyi Cao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jingjing Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Ting Zhou
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Rui Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Shuchao Lu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University and Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.
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Onishi Y, Uchida HA, Takeuchi H, Kakio Y, Sugiyama H, Wada J, Shimada N, Tokumasu H, Fukushima M, Asano K. Impaired mental health status in patients with chronic kidney disease is associated with estimated glomerular filtration rate decline. Nephrology (Carlton) 2018; 24:926-932. [PMID: 30334305 DOI: 10.1111/nep.13515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
Abstract
AIM Deteriorated health-related quality of life (HRQOL) is associated with increased risk for death in both chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients; however, the impact of HRQOL on CKD progression is not well investigated. METHODS We aimed to evaluate the association between HRQOL and CKD progression in Japanese patients with CKD. One hundred and three outpatients who visited the department of nephrology at our hospital (mean estimated glomerular filtration rate (eGFR); 32.1 ± 11.2 mL/min per 1.73 m2 ) between April 2007 and March 2012 were enrolled in this study. The primary outcome was 30% decline of eGFR or ESRD. We assessed HRQOL of all participants at baseline, including the physical component summary (PCS), the mental component summary (MCS) and the role/social component summary (RCS), using SF-36. Based on the baseline score of PCS, MCS and RCS, we divided all subjects into two groups by median. RESULTS We studied 66 men (64.1%) and 37 women aged 61.7 ± 10.0 years old. During approximately 2.5 years of follow-up period, 59 patients (57.3%) reached 30% eGFR decline or ESRD. Cox regression analyses demonstrated that lower MCS score was significantly associated with CKD progression (hazard ratio (HR) = 1.83, 95% CI = 1.04-3.21, P = 0.035), but that lower PCS score and RCS score were not (HR = 0.70, 95% CI = 0.39-1.25, P = 0.223; HR = 0.95, 95% CI = 0.54-1.67, P = 0.854, respectively). CONCLUSION We found that impaired mental health was associated with CKD progression. The evaluation of the mental health should be performed in the patients with CKD.
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Affiliation(s)
- Yasuhiro Onishi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Nephrology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriaki Shimada
- Department of Nephrology, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Masaki Fukushima
- Department of Nephrology, Shigei Medical Research Hospital, Okayama, Japan
| | - Kenichiro Asano
- Department of Nephrology, Kurashiki Central Hospital, Kurashiki, Japan
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Kakio Y, Uchida HA, Takeuchi H, Okuyama Y, Okuyama M, Umebayashi R, Wada K, Sugiyama H, Sugimoto K, Rakugi H, Kasahara S, Wada J. Diabetic nephropathy is associated with frailty in patients with chronic hemodialysis. Geriatr Gerontol Int 2018; 18:1597-1602. [DOI: 10.1111/ggi.13534] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/31/2018] [Accepted: 08/13/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
- Department of Chronic Kidney Disease and Cardiovascular DiseaseOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
- Department of Internal MedicineInnoshima General Hospital Hiroshima Japan
| | - Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Michihiro Okuyama
- Department of Cardiovascular SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Kentaro Wada
- Division of Nephrology and Dialysis, Department of Internal MedicineNippon Kokan Fukuyama Hospital Hiroshima Japan
| | - Hitoshi Sugiyama
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
- Department of Human Resource Development of Dialysis Therapy for Kidney DiseaseOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Ken Sugimoto
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Hiromi Rakugi
- Department of Geriatric and General MedicineOsaka University Graduate School of Medicine Osaka Japan
| | - Shingo Kasahara
- Department of Cardiovascular SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and MetabolismOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
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