Associations between frailty, physical performance, and renal biomarkers in older people with advanced chronic kidney disease

Abstract Purpose Impaired physical performance and frailty are common in older people with advanced chronic kidney disease but it is unclear which metabolic derangements contribute to these impairments. We, therefore, examined associations between renal biochemical markers and both physical performance and frailty in older people with advanced chronic kidney disease. Methods Secondary analysis of data from the BiCARB trial, which enrolled non-dialysing patients aged 60 and over, with chronic kidney disease stage 4/5, with serum bicarbonate < 22 mmol/L. Participants undertook the Short Physical Performance Battery, maximum grip strength and six-minute walk test at baseline, 3, 6, 12 and 24 months. Renal biochemistry (serum creatinine, cystatin C, phosphate, and bicarbonate), haemoglobin, 25-hydroxyvitamin D and NT-pro-B-type natriuretic peptide were measured at baseline. Associations between baseline renal biochemistry and physical performance, and between baseline biochemistry and the monthly rate of change in physical performance were assessed. Results We analysed data from 300 participants (mean age 74 years; 86 [29%] women). 148 (49%) were pre-frail, 86 (29%) were frail. In multivariable cross-sectional baseline analyses, only age and BMI were significantly associated with baseline short physical performance battery; age, sex, body mass index, NT-pro-BNP and 25-hydroxyvitamin D were significantly associated with baseline six-minute walk distance. No significant associations were found between biochemical markers and change in physical performance over time, except between baseline 25-hydroxyvitamin D concentration and change in six-minute walk distance. Conclusions Biochemical markers associated with chronic kidney disease did not consistently associate with baseline physical performance or the rate of change of physical performance measures. Trial Registration: ISRCTN09486651

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47 What are the Associations Between Renal Biochemistry and Physical Performance in Older Patients with Advanced Chronic Kidney Disease? Findings From the Bicarb Trial Cohort

Age and Ageing ◽

10.1093/ageing/afab030.08 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

M D Witham ◽

E J Lamb ◽

D Sumukadas ◽

M M Band ◽

R L Soiza ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Older People ◽

Grip Strength ◽

Physical Performance ◽

Cystatin C ◽

Walk Distance ◽

Advanced Chronic Kidney Disease ◽

Minute Walk Distance ◽

Minute Walk

Abstract Background Impaired physical performance is common in older people with advanced chronic kidney disease. It is unclear which metabolic derangements contribute to this impairment. This analysis examined cross-sectional associations between renal biochemical indices and physical performance in older people with advanced chronic kidney disease. Methods We analysed data from the BiCARB multicentre trial, which enrolled patients aged 60 and over, with chronic kidney disease stage 4 or 5, not on dialysis, and with serum bicarbonate <22 mmol/L. Participants undertook baseline Short Physical Performance Battery (SPPB), grip strength and six minute walk test. Renal biochemistry (serum creatinine, cystatin C, phosphate, bicarbonate), haemoglobin, and NT-pro-B-type natriuretic peptide (NTproBNP) were measured at baseline. Associations were tested using Spearman’s rho and generalised linear modelling using forced entry was used for multivariable regression analysis. Results The analysis included 300 participants (mean age 74 years; 86 [29%] women). Mean baseline SPPB was 8.1 points (SD 2.3); mean six-minute walk distance was 311 m (SD 132). Age (r = −0.27, p < 0.001) and BNP (r = −0.27, p < 0.001) were most strongly associated with the SPPB. Age (r = −0.33, p < 0.001), haemoglobin (r = 0.24, p < 0.001), cystatin C (r = −0.21, p < 0.001) and NTproBNP (r = −0.32, p < 0.001) were most strongly associated with six-minute walk distance. For grip strength, age (r = −0.35, p < 0.001), cystatin C (r = −0.24, p < 0.001), and NTproBNP (r = −0.31, p < 0.001) were most strongly associated in men, with similar but weaker associations for women. Creatinine and bicarbonate concentrations were not significantly associated with any physical performance measures. Factors in multivariable regression independently associated with six-minute walk distance were age, sex, BMI, cystatin C, phosphate and NTproBNP; with SPPB were age and BMI; and with grip strength were age, sex and cystatin C. Conclusions Some biochemical markers related to kidney function are modestly associated with physical performance in older people with advanced chronic kidney disease; patterns differ between different performance measures.

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Serum 25-hydroxyvitamin D as a predictor of hospitalization-free survival in predialysis and dialysis patients with chronic kidney disease: a single-center prospective observational analysis

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2015.12.004 ◽

2016 ◽

Vol 35 (1) ◽

pp. 22-28 ◽

Cited By ~ 8

Author(s):

Eun-Jung Ko ◽

Bo Hye Kim ◽

Hye Yun Jeong ◽

Sung Un Soe ◽

Dong Ho Yang ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Single Center ◽

Dialysis Patients ◽

Free Survival ◽

Observational Analysis ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D

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Cholecalciferol v. ergocalciferol for 25-hydroxyvitamin D (25(OH)D) repletion in chronic kidney disease: a randomised clinical trial

British Journal Of Nutrition ◽

10.1017/s000711451600427x ◽

2016 ◽

Vol 116 (12) ◽

pp. 2074-2081 ◽

Cited By ~ 10

Author(s):

James B. Wetmore ◽

Cassandra Kimber ◽

Jonathan D. Mahnken ◽

Jason R. Stubbs

Keyword(s):

Clinical Trial ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Mineral Metabolism ◽

Substantial Reduction ◽

Randomised Clinical Trial ◽

Optimal Method ◽

Hydroxyvitamin D ◽

Significant Difference ◽

25 Hydroxyvitamin D

AbstractPatients with chronic kidney disease (CKD) demonstrate complex mineral metabolism derangements and a high prevalence of vitamin D deficiency. However, the optimal method of 25-hydroxyvitamin D (25(OH)D) repletion is unknown, and trials analysing the comparative efficacy of cholecalciferol and ergocalciferol in this population are lacking. We conducted a randomised clinical trial of cholecalciferol 1250μg (50 000 IU) weekly v. ergocalciferol 1250μg (50 000 IU) weekly for 12 weeks in forty-four non-dialysis-dependent patients with stage 3–5 CKD. The primary outcome was change in total 25(OH)D from baseline to week 12 (immediately after therapy). Secondary analyses included the change in 1,25-dihydroxyvitamin D (1,25(OH)2D), parathyroid hormone (PTH), D2 and D3 sub-fractions of 25(OH)D and 1,25(OH)2D and total 25(OH)D from baseline to week 18 (6 weeks after therapy). Cholecalciferol therapy yielded a greater change in total 25(OH)D (45·0 (sd 16·5) ng/ml) v. ergocalciferol (30·7 (sd 15·3) ng/ml) from baseline to week 12 (P<0·01); this observation partially resulted from a substantial reduction in the 25(OH)D3 sub-fraction with ergocalciferol. However, following cessation of therapy, no statistical difference was observed for total 25(OH)D change from baseline to week 18 between cholecalciferol and ergocalciferol groups (22·4 (sd 12·7) v. 17·6 (sd 8·9) ng/ml, respectively; P=0·17). We observed no significant difference between these therapies with regard to changes in serum PTH or 1,25(OH)2D. Therapy with cholecalciferol, compared with ergocalciferol, is more effective at raising serum 25(OH)D in non-dialysis-dependent CKD patients while active therapy is ongoing. However, levels of 25(OH)D declined substantially in both arms following cessation of therapy, suggesting the need for maintenance therapy to sustain levels.

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