P1543FACTORS ASSOCIATED WITH CHANGE IN FUNCTIONAL STATUS IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Keigo Imamura ◽  
Yuta Suzuki ◽  
Shohei Yamamoto ◽  
Manae Harada ◽  
Haruka Ito ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Functional Status ◽  
Gait Speed ◽  
Odds Ratio ◽  
Handgrip Strength ◽  
Risk Index ◽  
Treatment Strategies ◽  
Katz Index ◽  
Nutritional Risk Index ◽  
Usual Gait Speed

Abstract Background and Aims Hemodialysis (HD) patients have poor functional capacity. Expert clinical practice guidelines strongly recommend an assessment of functional status (FS) and treatment strategies in chronic kidney disease patients. A previous study demonstrated a high level of disability in daily activities in most HD patients, and a dose-response association was seen between poor FS at baseline and adverse clinical outcomes in HD patients. Moreover, a recent study reported that patients with a decline in FS over a 1-year period are at an elevated risk of mortality. Therefore, identifying factors that predict a decline in FS is important for developing treatment strategies. The purpose of this study was to investigate the factors that predict this decline in HD patients. Method A total of 146 outpatients (mean age of 66.1±11.0 years; 48% were female) undergoing maintenance HD thrice a week at an HD center were included. FS was assessed based on the ability to perform activities of daily living (ADLs) and instrumental ADLs (IADLs) as self-reported on the Katz Index of Independence and the Lawton-Brody IADL scale, respectively The Katz Index of Independence examines five tasks of ADLs, and the Lawton-Brody IADL scale examines eight tasks of IADLs. Both have been validated in the general population. We then calculated the FS score by combining the scores of the Katz Index of Independence and Lawton-Brody IADL scale in accordance with the algorithm developed in a previous study, and the assessments were conducted at baseline and after 1 year. We classified patients into two groups based on having or not having at least a 1-point decline in the FS score. Background factors such as age, sex, body mass index, comorbidities score, hemodialysis time, primary kidney disease, hemoglobin level, and geriatric nutritional risk index were collected at baseline. In addition, for physical function, the usual gait speed and handgrip strength and for body composition, the skeletal muscle mass by bioelectrical impedance analysis were analyzed at baseline. To investigate factors predicting a decline in FS 1 year later, logistic regression analysis was used. Results Over the study period, 29.5% of the patients showed a decline in the FS score. Patients who showed a decline were older (71.2 years vs. 64.0 years), had weaker handgrip strength (22.9 kg vs. 24.8 kg), and exhibited slower usual gait speed (1.06 m/s vs. 1.22 m/s) than those who did not show decline at baseline. To predict a decline in FS 1 year later, age (odds ratio: 1.07, 95% confidence interval [CI]:1.02-1.13, p=0.003) and usual gait speed (odds ratio: 0.17, 95% CI: 0.03-0.96, p=0.04) were determined as significant factors. Conclusion Gait speed was a predictor of a decline in FS after 1 year. These findings underscore the significance of gait speed assessment in addition to monitoring the patient's FS. Moreover, intervention in maintaining gait speed may be essential in preventing the FS from deteriorating over time.

scholarly journals Association of Serum Phosphate with Low Handgrip Strength in Patients with Advanced Chronic Kidney Disease

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3605
Author(s):  
Ping-Huang Tsai ◽  
Hsiu-Chien Yang ◽  
Chin Lin ◽  
Chih-Chien Sung ◽  
Pauling Chu ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Gait Speed ◽  
Handgrip Strength ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Serum Phosphate ◽  
Advanced Chronic Kidney Disease ◽  
Progressive Decline ◽  
Appendicular Skeletal Muscle

Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels between advanced CKD patients with (n = 51) and those without sarcopenia indicators (n = 83). Low appendicular skeletal muscle mass index (ASMI), low handgrip strength, and low gait speed were defined per the standards of the Asian Working Group for Sarcopenia. Mean serum Pi level was significantly higher in advanced CKD patients with sarcopenia indicators than those without sarcopenia indicators (3.88 ± 0.86 vs. 3.54 ± 0.73 mg/dL; p = 0.016). Univariate analysis indicated that serum Pi was negatively correlated with ASMI, handgrip strength, and gait speed. Multivariable analysis revealed that serum Pi was significantly associated with handgrip strength (standardized β = −0.168; p = 0.022) and this association persisted even after adjustments for potential confounders. The optimal serum Pi cutoff for predicting low handgrip strength was 3.65 mg/dL, with a sensitivity of 82.1% and specificity of 56.6%. In summary, low handgrip strength is common in advanced CKD patients and serum Pi level is negatively associated with handgrip strength.

scholarly journals Utility of Geriatric Nutritional Risk Index in Patients with Chronic Kidney Disease: A Mini-Review

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3688
Author(s):  
Naoki Nakagawa ◽  
Keisuke Maruyama ◽  
Naoyuki Hasebe
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Risk Index ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Left Ventricular ◽  
Nutritional Risk ◽  
Geriatric Nutritional Risk Index ◽  
Nutritional Risk Index

Chronic kidney disease (CKD) is one of the most significant risk factors for cardiovasculardisese. Malnutrition has been recognized as a significant risk factor for cardiovascular disease in patients with CKD, including those on chronic dialysis. Current studies showed higher all-cause and cardiovascular mortality rates in patients with CKD and malnutrition. Geriatric nutritional risk index (GNRI), a simple and validated nutritional screening measure for both elderly people and patients on dialysis, is based only on three objective parameters: body weight, height, and serum albumin level. Recently, we demonstrated that the cutoff GNRI for predicting all-cause and cardiovascular mortality was 96 in patients on hemodialysis. Moreover, together with left ventricular hypertrophy and low estimated glomerular filtration rate, the utility of GNRI as a significant determinant of cardiovascular events was demonstrated in non-dialysis-dependent patients with CKD. In the present review, we summarize available evidence regarding the relationship of GNRI with all-cause and cardiovascular mortality in patients with CKD including those on dialysis.

scholarly journals Association between Geriatric Nutrition Risk Index and The Presence of Sarcopenia in People with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3729
Author(s):  
Fuyuko Takahashi ◽  
Yoshitaka Hashimoto ◽  
Ayumi Kaji ◽  
Ryosuke Sakai ◽  
Yuka Kawate ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Skeletal Muscle Mass ◽  
Adjusted Odds Ratio ◽  
Handgrip Strength ◽  
Risk Index ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Skeletal Muscle Mass Index

The aim of this cross-sectional study was to examine the association between the geriatric nutritional risk index (GNRI) and the prevalence of sarcopenia in people with type 2 diabetes (T2DM). Having both low handgrip strength (<28 kg for men and <18 kg for women) and low skeletal muscle mass index (<7.0 kg/m2 for men and <5.7 kg/m2 for women) was diagnosed as sarcopenia. GNRI was estimated by the formula as below: GNRI = (1.489 × serum albumin level [g/L]) + (41.7 × [current body weight (kg)/ideal body weight (kg)]). Participants were dichotomized on the basis of their GNRI scores (GNRI < 98, low; or GNRI ≥ 98, high). Among 526 people (301 men and 225 women) with T2DM, the proportions of participants with sarcopenia and low GNRI were 12.7% (n = 67/526) and 5.1% (n = 27/526), respectively. The proportion of sarcopenia in participants with low-GNRI was higher than that with high GNRI (44.4% [n = 12/27] vs. 11.0% [n = 55/499], p < 0.001). The GNRI showed positive correlations with handgrip strength (r = 0.232, p < 0.001) and skeletal muscle mass index (r = 0.514, p < 0.001). Moreover, low GNRI was related to the prevalence of sarcopenia (adjusted odds ratio, 4.88 [95% confidence interval: 1.88–12.7], p = 0.001). The GNRI, as a continuous variable, was also related to the prevalence of sarcopenia (adjusted odds ratio, 0.89 [95% confidence interval: 0.86–0.93], p < 0.001). The present study revealed that low GNRI was related to the prevalence of sarcopenia.

scholarly journals Association of Albuminuria and Estimated Glomerular Filtration Rate with Functional Performance Measures in Older Adults with Chronic Kidney Disease

2017 ◽  
Vol 45 (2) ◽  
pp. 172-179 ◽  
Author(s):  
Dawn F. Wolfgram ◽  
Katelyn Garcia ◽  
Greg Evans ◽  
Sara Zamanian ◽  
Rocky Tang ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Functional Status ◽  
Glomerular Filtration ◽  
Functional Impairment ◽  
Gait Speed ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate

Background: Chronic kidney disease (CKD) is increasingly common and disproportionately affects older adults. The contribution of kidney disease to the functional impairment noted in the elderly CKD population is unclear. Methods: This is a cross-sectional analysis of a hypertensive cohort of people aged ≥75 years from the Systolic Blood Pressure Intervention Trial. We evaluated estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) as predictors of 3 measures of functional status: EuroQol-5 Dimensional (EQ-5D) score, Falls Efficacy Scale (FES) score, and gait speed. Linear regression models were used to evaluate the associations between our independent variables and outcome measures. Results: Our analysis included 2,620 participants, mean age of 79.9 (4.0) years. Unadjusted models showed that lower eGFR level and higher UACR level were associated with lower EQ-5D (p < 0.001 for both) and slower gait speed (p < 0.001 for both) and worse scores on FES (p = 0.032 and p = 0.039). In the fully adjusted models, higher levels of UACR remained significantly associated with lower EQ-5D scores and slower gait speed (p = 0.011 and p = 0.002, respectively). In contrast, level of eGFR was not associated with any functional outcome measures when accounting for covariates. Conclusions: In individuals aged ≥75 years, albuminuria and eGFR were associated with impairments in physical performance and self-reported functional status; however, only the association with albuminuria remained after adjusting for relevant demographics and comorbidities. Evaluation of albuminuria may provide an additional tool for identifying older individuals at risk for functional impairment.

scholarly journals AN EVALUATION OF NUTRITIONAL INDEXES FOR TO PREDICTION THE HOSPITALIZATION DURATION IN ELDERLY CHRONIC KIDNEY DISEASE PATIENTS

2016 ◽  
pp. 1-4
Author(s):  
B. Buyukaydin ◽  
A.T. Isik ◽  
P. Soysal ◽  
M. Alay ◽  
R. Kazancioglu
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Assessment ◽  
Short Form ◽  
Risk Index ◽  
Mini Nutritional Assessment ◽  
Nutritional Risk ◽  
Control Group ◽  
Dialysis Patients ◽  
Nutritional Risk Index

Objective: Chronic kidney disease and malnutrition are serious and frequently encountered co-morbidities among older patients. We evaluated nutritional status of older pre-dialysis patients and the effect of malnutrition on length of stay (LOS) in hospital. Materials and Methods: 65 years and over 33 hospitalized pre-dialysis patients with glomerular filtration rate between 10-30ml/min/1.73m2 were included. There is no control group. For all patients, biochemical analysis was performed. The malnutrition risk was evaluated with Mini Nutritional Assessment Short-Form (MNA-SF) and Geriatric Nutritional Risk Index (GNRI) and LOS in hospital was recorded. Results: Mean GNRI was 98.4±12.9 and the mean MNA-SF was 8±3.15. For all patients, mean LOS was 10.58±9 days. According to MNA-SF, malnourished patients’ LOS was longer and a difference was observed between MNA-SF and GNRI in terms of LOS prediction (p=0.005, p=0.230). Conclusion: For older pre-dialysis patients, MNA-SF is probably a more sensitive index in terms of LOS in hospital prediction.

scholarly journals Gonadotropins at Advanced Age - Perhaps They Are Not So Bad? Correlations Between Gonadotropins and Sarcopenia Indicators in Older Adults

2021 ◽  
Vol 12 ◽  
Author(s):  
Agnieszka Guligowska ◽  
Zuzanna Chrzastek ◽  
Marek Pawlikowski ◽  
Malgorzata Pigłowska ◽  
Hanna Pisarek ◽  
...  
Keyword(s):  
Gait Speed ◽  
Handgrip Strength ◽  
Functional Decline ◽  
Treatment Strategies ◽  
Community Dwelling ◽  
Blood Levels ◽  
Timed Up And Go ◽  
Female Community ◽  
Age Related ◽  
European Working

Many hormones fluctuate during the aging process. It has been suggested that gonadotropins, which increase with age, contribute to the occurrence of many diseases and syndromes in older life, such as cardiovascular diseases, obesity, frailty syndrome and osteoporosis. This study aims to assess the relationship between circulating gonadotropins and other hormones potentially contributing to age-related functional decline and sarcopenia indicators in 39 male and 61 female community-dwelling seniors, mean age 80 years. According to the definition developed by the second European Working Group on Sarcopenia in Older People (EWGSOP2), the following indicators of the sarcopenia were assessed: bioimpedance-measured body composition, gait speed, handgrip strength, timed up and go test (TUG), chair stand test, Short Physical Performance Battery (SPPB). Blood levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, testosterone, dehydroepiandrosterone sulphate (DHEAS) and cortisol were also measured. In the men, FSH and partially LH correlated positively with muscle mass percentage, gait speed, handgrip strength and SPPB, and negatively with percent body fat. Additionally, testosterone and DHEAS correlated negatively with the percentage of fat mass in men. Whereas in the women, FSH and LH were mainly negatively associated with body mass and adipose tissue measures. Cortisol did not show any relationship with the examined indicators. The study shows that the indicators of sarcopenia are strongly associated with levels of gonadotropins, sex hormones and DHEAS, especially in older men. The obtained results, after being confirmed in a larger group, may modify prevention and treatment strategies of sarcopenia.

Is a composite score of physical performance measures more useful than usual gait speed alone in assessing functional status?

2012 ◽  
Vol 55 (2) ◽  
pp. 392-398 ◽  
Author(s):  
Satoshi Seino ◽  
Mi-ji Kim ◽  
Noriko Yabushita ◽  
Miyuki Nemoto ◽  
Songee Jung ◽  
...  
Keyword(s):  
Functional Status ◽  
Physical Performance ◽  
Performance Measures ◽  
Gait Speed ◽  
Composite Score ◽  
Usual Gait Speed

scholarly journals Nutritional risk, functional status and mortality in newly institutionalised elderly

2013 ◽  
Vol 110 (10) ◽  
pp. 1903-1909 ◽  
Author(s):  
Emanuele Cereda ◽  
Carlo Pedrolli ◽  
Annunciata Zagami ◽  
Alfredo Vanotti ◽  
Silvano Piffer ◽  
...  
Keyword(s):  
Functional Status ◽  
Long Term Care ◽  
Risk Index ◽  
Nutritional Risk ◽  
Muscle Area ◽  
Term Care ◽  
High Hazard Ratio ◽  
Nutritional Risk Index ◽  
Close Relationship

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI < 92) and low (GNRI 92–98) nutritional risk were 36·1 and 30·6 %, respectively. At multivariable linear regression, functional status was independently associated with age (P= 0·045), arm muscle area (P= 0·048), the number of co-morbidities (P= 0·027) and mainly with the GNRI (P< 0·001). During a median follow-up of 4·7 years (25th–75th percentile 3·7–6·2), 230 (66·5 %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95 % CI 1·32, 2·63; P< 0·001) and low nutritional risk (HR 1·52, 95 % CI 1·08, 2·14; P= 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI < 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95 % CI 1·28, 2·91; P< 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly.

scholarly journals Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maryam Marzban ◽  
Iraj Nabipour ◽  
Akram Farhadi ◽  
Afshin Ostovar ◽  
Bagher Larijani ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Physical Performance ◽  
Gait Speed ◽  
Elderly Population ◽  
Handgrip Strength ◽  
Cross Sectional ◽  
Elderly Health ◽  
Category Fluency ◽  
Usual Gait Speed ◽  
Fluency Test

Abstract Background and objectives The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population. Methods Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses. Results Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05). Conclusion There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

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