Associations between frailty trajectories and cardiovascular, renal, and mortality outcomes in chronic kidney disease

Journal of Cachexia Sarcopenia and Muscle, Год журнала: 2022, Номер 13(5), С. 2426 - 2435

Опубликована: Июль 19, 2022

Abstract Background Frailty is characterized by the loss of biological reserves and vulnerability to adverse outcomes. In individuals with chronic kidney disease (CKD), numerous pathophysiological factors may be responsible for frailty development including inflammation, physical inactivity, reduced energy intake, metabolic acidosis. Given that both CKD incur a significant healthcare burden, it important understand relationship in real‐world routine clinical practice, how simple assessment methods (e.g. indexes) useful. We investigated risk impact status on mortality end‐stage (ESKD). Methods A retrospective cohort study using primary care records from Clinical Practice Research Datalink linked Hospital Episode Statistics UK Office National was undertaken 819 893 participants aged ≥40 years, which 140 674 had CKD. defined an electronic index, generated electronically records. Cox proportional hazard flexible parametric survival models were used investigate developing effect all‐cause cardiovascular mortality, ESKD. Results The mean age those 77.5 (SD 9.7) years [61.0 12.1) no‐CKD group]; 62.0% group female (compared 53.3% group). estimated glomerular filtration rate 46.1 9.9) mL/min/1.73 m 2 . majority (75.3%) frail [vs. 45.4% without (no‐CKD)]. Over 3 (median), 69.5% developed frailty. Compared no‐CKD, increased rates mild (hazard ratio: 1.02; 95% confidence interval: 1.01–1.04), moderate (1.30; 1.26–1.34), severe (1.50; 1.37–1.65) Mild (1.22; 1.19–1.24), (1.60; 1.56–1.63), (2.16; 2.11–2.22) associated cardiovascular‐related (mild 1.35; 1.31–1.39; 1.96; 1.90–2.02; 2.91; 2.81–3.02). All stages significantly ESKD rates. Conclusions highly prevalent outcomes people CKD, Preventative interventions should initiated mitigate use health records, can predict aid prioritization management

Язык: Английский

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Factors influencing fatigue among patients undergoing hemodialysis: a multi-center cross-sectional study

Libyan Journal of Medicine, Год журнала: 2024, Номер 19(1)

Опубликована: Янв. 9, 2024

Fatigue has been reported to be the most common symptom experienced by patients receiving hemodialysis (HD) therapy. can lead a reduction in their ability engage both routine and self-care activities, which negatively affect self-confidence quality of life. This study aimed determine level fatigue factors that affecting its among uHD. Methods: A cross-sectional design was utilized explore maintenance HD using Mul-tidimensional Assessment (MAF) scale. Data were collected from four dialysis centers two Saudi Arabia cities, Hail Al-Qassim, between January 2022 October 2022. Results: The questionnaire completed 236 patients. Older patients, male retired pa-tients significantly higher levels (p < 0.001). In contrast, marital status, educational level, financial status did not = 0.193, 0.285, 0.126, respectively). Patients who had seven or more dependents than those lower have 0.004). addition, regular exercise regimen an 0.011). Multiple linear regression demonstrated employment (student), comorbidity condition (one chronic disease), duration, satisfaction with time, time found scores (R2 0.302, p ˂ Conclusion: findings this gives broader understanding influencing will help develop strategies focused interventions reduce HD.

Язык: Английский

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Bioelectrical impedance analysis-derived phase angle as a determinant of protein-energy wasting and frailty in maintenance hemodialysis patients: retrospective cohort study

BMC Nephrology, Год журнала: 2020, Номер 21(1)

Опубликована: Окт. 19, 2020

Abstract Background Phase angle (PA), measured by bioelectrical impedance analysis (BIA) has been studied as indicator of nutritional status or muscle function in hemodialysis (HD) patients. It remains unclear if the phase is associated protein-energy wasting (PEW) frailty, which are common complication The aim this study to determine whether BIA-derived PA a marker PEW frailty HD Methods This retrospective observational included 116 adult patients (35% female, 64 ± 12 years age) single dialysis center. Patients were classified according quartiles into four groups; 1) first quartile: < 3.7°, 2) second 3.7–4.1°, 3) third 4.2–4.9°and 4) forth ≥ 5.0°. International Society Renal Nutrition and Metabolism (ISRNM) criteria Japanese version Cardiovascular Health Study (J-CHS) used identify frailty. Results lower group was with greater risk vs. 24% 21% 3%; p = 0.032), (59% 40% 0.001). In multivariate logistic regression analysis, quartile at significantly both compared fourth after adjusting for other confounding factors. Conclusions Lower

Язык: Английский

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Klinische Bedeutung der Erfassung von Frailty

Zeitschrift für Gerontologie und Geriatrie, Год журнала: 2021, Номер 54(3), С. 285 - 296

Опубликована: Март 29, 2021

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Healthy aging and chronic kidney disease

Kidney Research and Clinical Practice, Год журнала: 2022, Номер 41(6), С. 644 - 656

Опубликована: Окт. 25, 2022

The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, chronic kidney disease (CKD) will increase significantly. With advances in medical treatment public health, human lifespan continues to outpace health span a way that last decade life generally spent poor health. In 2015, World Health Organization defined healthy 'the process developing maintaining functional ability enables wellbeing older age.' CKD increasingly being recognized model accelerated associated with physical performance decline, cognitive falls fractures, quality life, loss appetite, inflammation. Frailty dementia are final pathways key determinants disability mortality independent underlying disease. CKD, dementia, frailty share triangular relationship synergistic actions have common risk factors wherein accelerates through mechanisms uremic toxicity, metabolic acidosis derangements, anorexia malnutrition, dialysis-related hemodynamic instability, sleep disturbance. glomerular filtration decline well dialysis induction more than doubles risk. Anorexia one major causes protein-energy which also prevalent warrants screening. Healthcare systems across need system place for prevention amongst high-risk adults, focusing on screening prognostic patients frailty, impairment providing necessary person-centered interventions reverse may contribute outcomes.

Язык: Английский

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Malnutrition Patterns in Children with Chronic Kidney Disease

Life, Год журнала: 2023, Номер 13(3), С. 713 - 713

Опубликована: Март 6, 2023

Malnutrition is frequent in children with chronic kidney disease (CKD). Apart from undernutrition and protein energy wasting (PEW), overnutrition prevalence rising, resulting fat mass accumulation. Sedentary behavior unbalanced diet are the most important causal factors. Both underweight obesity linked to adverse outcomes regarding renal function, cardiometabolic risk mortality rate. Muscle cornerstone finding of PEW, preceding loss may lead fatigue, musculoskeletal decline frailty. In addition, clinical data emphasize growing occurrence muscle strength deficits patients accumulation, attributed CKD-related processes, reduced physical activity possibly obesity-induced inflammatory diseases, leading sarcopenic obesity. Moreover, CKD susceptible abdominal obesity, high body distribution into visceral abdomen compartment. associated increased risk. This review analyzes pathogenetic mechanisms, current trends malnutrition patterns pediatric CKD. it underlines importance composition assessment for nutritional evaluation summarizes advantages limitations currently available techniques. Furthermore, highlights benefits growth hormone therapy on management.

Язык: Английский

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Physical Frailty and Functional Status in Patients With Advanced Chronic Kidney Disease: A Systematic Review

Canadian Journal of Kidney Health and Disease, Год журнала: 2023, Номер 10

Опубликована: Янв. 1, 2023

Background: With an aging population and growing number of patients with chronic kidney disease (CKD), integrating the latest risk factors when deciding on a treatment plan can result in better patient care. Frailty remains prevalent syndrome CKD resulting adverse health outcomes. However, measures frailty functional status remain excluded from clinical decision making. Objective: To examine degree to which different are associated mortality, hospitalization, other outcomes advanced CKD. Design: Systematic review. Setting: Observation studies including cohort study, case-control or cross-sectional study examining There were no restrictions type setting country origin. Patients: Adults CKD, both types dialysis patients. Measurements: Data demographic information (e.g., sample size, follow-up time, age, country), assessments their domains, cardiovascular events, function, composite extracted. Methods: A search was conducted using databases Medline, Embase, Cochrane Central Register for Controlled Trials. Studies included inception March 17, 2021. The eligibility screened by 2 independent reviewers. presented instrument outcome. Point estimates 95% confidence intervals fully adjusted statistical model reported calculated raw data. Results: total 117 unique instruments found among 140 studies. median size 319 (interquartile range, 161-893). Most focused incident populations, only 15% non-dialysis lower increased such as mortality hospitalization. 5 individual domains also be poor Limitations: Meta-analysis could not performed due significant heterogeneity between methods used measure status. Many had issues methodological rigor. Selection bias validity data collection ascertained some Conclusion: should integrated help guide care making comprehensive assessment Registration (PROSPERO): CRD42016045251

Язык: Английский

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Intrinsic capacity and frailty in older adults with end-stage kidney disease undergoing pre-kidney transplant comprehensive geriatric assessment

The journal of nutrition health & aging, Год журнала: 2024, Номер 28(6), С. 100236 - 100236

Опубликована: Апрель 20, 2024

Frailty has been extensively studied in end-stage kidney disease (ESKD) and transplant (KT) patients. The identification of frailty is useful to predict adverse outcomes among ESKD KT recent concept intrinsic capacity (IC) appears as a good easy-to-understand tool screen for monitor older adults with ESKD. This study aims assess the relationships between IC awaiting KT. Cross-sectional SETTING AND PARTICIPANTS: 236 patients from day-care geriatric unit undergoing pre-KT assessment 2017 2022 were included main sample, 151 an independent multicentric replication sample. was evaluated using physical phenotype (PFP) measures World Health Organization's screening (step 1) diagnostic 2) tools five domains (vitality, locomotion, audition, cognition, psychology). Multivariate regressions run PFP domains, adjusted age, sex, comorbidities. Analyses replicated another multicenter cohort including confirm results. Impairments psychology, vitality according WHO associated (odds ratio 9.62 [95% CI 4.09-24.99], 3.19 1.11-8.88], 3.11 1.32-7.29], respectively). When measured linearly z-scores, all except hearing inversely frailty. In cohort, results overall similar, greater association psychology domain highlights relationship We assume that may be assessed monitored patients, prevent future frailty, post-KT outcomes.

Язык: Английский

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Subjective and objectives measures of frailty among adults with advanced chronic kidney disease: a cross‐sectional analysis of clinician misclassification

Internal Medicine Journal, Год журнала: 2025, Номер unknown

Опубликована: Янв. 8, 2025

Abstract Background Frailty is a recognisable clinical measure of impaired physiological reserve and vulnerability to adverse outcomes that validated among patients with kidney disease. Practice patterns reveal inconsistent use objective frailty measures by nephrologists, clinicians prioritising subjective impressions, possibly risking misclassification discrimination. Aims The aim this study was examine correlations between in cohort attending routine nephrologist review. Methods Eighty‐nine participants scheduled review their primary treating ( n = 6) were included cross‐sectional analysis. Measured based on Fried phenotype clinician impression assessed for congruence using Pearson's correlation analysis ĸ statistic. Ordinal logistic regression examined patient demographics associated perceived frailty. Misclassification explored descriptive statistics contingency table Results prefrailty prevalent both means assessment minimal measured r 0.50, P 0.00, 0.25, =&amp;#x02009;0.00). Subjective misclassified half participants, influenced surrogate including female sex, comorbidity reliance walking aid. Clinicians equally likely over‐classify as under‐recognise established frailty, no evidence systemic bias. clinican had positive predictive value 19.1% negative 56.2%. Conclusions Nephrologists' impressions overlook or misclassify offers incomplete prognostic potentially misses opportunities early intervention.

Язык: Английский

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Dialysis in the Elderly: A Practical Guide for the Clinician

International Journal of Nephrology, Год журнала: 2025, Номер 2025(1)

Опубликована: Янв. 1, 2025

The increasing prevalence of elderly patients with end‐stage kidney disease (ESKD) poses unique challenges in nephrology. These often present multiple comorbidities, cognitive impairments, and frailty, which significantly impact treatment options outcomes. Conservative management (CKM) offers a viable alternative to dialysis for many by focusing on symptom enhancing quality life rather than merely prolonging life. However, clinicians face difficulties approaching deciding between CKM dialysis. In addition, advocating involves selecting the appropriate modality vascular access. Nutritional management, overlooked, is critical due high protein‐energy wasting sarcopenia among patients. Similar initiation dialysis, there are dilemmas determining when withdraw from This practical review aims guide through complex challenging process managing elderly, emphasizing holistic, patient‐centered approach that prioritizes A multidisciplinary strategy, integrating clinical expertise patient autonomy, essential address needs this vulnerable population.

Язык: Английский

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