scholarly journals P1565THE COMBINATION OF MALNUTRITION-INFLAMMATION AND LIMITATIONS IN FUNCTIONAL STATUS IS ASSOCIATED WITH A HIGH RISK OF MORTALITY IN HEMODIALYSIS PATIENTS: RESULTS FROM THE DIALYSIS OUTCOMES AND PRACTICE PATTERNS STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Eiichiro Kanda ◽  
Marcelo Lopes ◽  
Angelo Karaboyas ◽  
Brian Bieber ◽  
Kazuhiko Tsuruya ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Proportional Hazards ◽  
Practice Patterns ◽  
Reference Group ◽  
Strong Predictor ◽  
High Serum ◽  
Cox Proportional Hazards ◽  
Dialysis Outcomes

Abstract Background and Aims The malnutrition-inflammation-complex (MIC) is a risk factor for mortality and lower quality of life in haemodialysis (HD) patients. The identification of MIC and its risk factors, which include the limited ability to perform functional status (FS), is key to improve the patient experience on HD. Our study investigates the association of MIC and FS combinations with mortality in HD patients. Method We analysed data from a cohort of 5465 HD patients from Australia, France, Germany, Italy, Japan, New Zealand, Spain, Sweden, and United Kingdom, enrolled in the Dialysis Outcomes and Practice Patterns Study phases 4 (2009-2011) and 5 (2012-2015). MIC syndrome was defined as low serum albumin (<3.8 g/dL) and high serum C-reactive protein (>3mg/L in Japan; >10 mg/L elsewhere). Poor functional status was defined as the sum of scores from the self-reported limitations in the Katz Index of Independence in Activities of Daily Living (score ranges from 0 to 5) and the Lawton-Brody Instrumental Activities of Daily Living Scale (score ranges from 0 to 8) less than 11. We investigated the association between combinations of MIC (+/-) and FS (low/high) with death, using Cox proportional hazards models adjusted for possible confounders including patient demographics, comorbidity history, catheter use, serum creatinine, phosphorus levels, WBC count, haemoglobin level, and time on dialysis therapy. Results The prevalence of different combinations were: MIC-/High FS 57%, MIC-/Low FS 24%, MIC+/High FS 9%, and MIC+/Low FS 10%. Patients with MIC-/high FS were younger, better nourished, and had lower prevalence of comorbidities. Compared to this reference group, the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.56 (1.24-1.98) for MIC-/ low FS, 1.75 (1.32-2.32) for MIC+/ high FS, and 2.97 (2.31-3.82) for MIC+/ low FS groups. The adjusted HRs for infection-related mortality were 1.57 (0.91, 2.71) for MIC-/low FS, 1.67 (0.84, 3.31) for MIC+/High FS, and 5.45 (3.15, 9.45) for MIC+/low FS groups. Conclusion The combination of MIC and low FS is a strong predictor of mortality, and infectious mortality in particular, in HD patients. Identification of patients with MIC and FS status may plausibly help to direct interventions to improve patients’ experiences and lessen adverse clinical outcomes in the HD setting.

scholarly journals The combination of malnutrition-inflammation and functional status limitations is associated with mortality in hemodialysis patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eiichiro Kanda ◽  
Marcelo Barreto Lopes ◽  
Kazuhiko Tsuruya ◽  
Hideki Hirakata ◽  
Kunitoshi Iseki ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Functional Status ◽  
Daily Living ◽  
Reference Group ◽  
Strong Predictor ◽  
Reactive Protein ◽  
Hazard Ratios ◽  
Katz Index ◽  
Related Mortality

AbstractThe identification of malnutrition-inflammation-complex (MIC) and functional status (FS) is key to improving patient experience on hemodialysis (HD). We investigate the association of MIC and FS combinations with mortality in HD patients. We analyzed data from 5630 HD patients from 9 countries in DOPPS phases 4–5 (2009–2015) with a median follow-up of 23 [IQR 11, 31] months. MIC was defined as serum albumin < 3.8 g/dL and serum C-reactive protein > 3 mg/L in Japan and > 10 mg/L elsewhere. FS score was defined as the sum of scores from the Katz Index of Independence in Activities of Daily Living and the Lawton-Brody Instrumental Activities of Daily Living Scale. We investigated the association between combinations of MIC (+/−) and FS (low [< 11]/high [≥ 11]) with death. Compared to the reference group (MIC−/high FS), the adjusted hazard ratios [HR (95% CI)] for all-cause mortality were 1.82 (1.49, 2.21) for MIC−/low FS, 1.57 (1.30, 1.89) for MIC+/high FS, and 3.44 (2.80, 4.23) for MIC+/low FS groups. Similar associations were observed with CVD-related and infection-related mortality. The combination of MIC and low FS is a strong predictor of mortality in HD patients. Identification of MIC and poor FS may direct interventions to lessen adverse clinical outcomes in the HD setting.

scholarly journals Discrimination and Risk of Incident Disability in Older African Americans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 260-260
Author(s):  
Melissa Lamar ◽  
Sue Leurgans ◽  
Aron Buchman ◽  
Lisa Barnes ◽  
Brittney Lange-Maia
Keyword(s):  
African Americans ◽  
Activities Of Daily Living ◽  
Sex Education ◽  
Daily Living ◽  
Proportional Hazards ◽  
Vascular Diseases ◽  
Cox Proportional Hazards ◽  
Iadl Disability ◽  
Adl Disability ◽  
Everyday Discrimination

Abstract Discrimination is linked to poor health outcomes, but most studies examine young or midlife populations. We assessed associations between discrimination and disability in African Americans. The Detroit Areas Study Everyday Discrimination Scale quantified experiences of interpersonal mistreatment. Separate Cox-proportional hazards models tested the associations between baseline discrimination and incident mobility, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) disability, adjusting for age, sex, education, BMI, smoking, depressive symptoms, and vascular diseases. At baseline, 441, 674, and 469, participants were initially free of mobility, ADL, and IADL disability, respectively, and 257, 185, and 269 new cases of mobility, ADL, and IADL disability were observed over approximately 8.5 years. Discrimination was associated with higher risk of ADL disability (hazard ratio: 1.03 per 1-point higher discrimination score, 95% confidence interval: 1.00-1.06) but no other disability type. Everyday discrimination is associated with risk of ADL disability.

scholarly journals Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults

2019 ◽  
Vol 75 (6) ◽  
pp. 1176-1183 ◽  
Author(s):  
Aron S Buchman ◽  
Robert J Dawe ◽  
Sue E Leurgans ◽  
Thomas A Curran ◽  
Timothy Truty ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adverse Health Outcomes ◽  
Backward Elimination ◽  
Cox Proportional Hazards Models

Abstract Background Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes. Methods A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome. Results During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes. Conclusions When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.

scholarly journals INCIDENT DIFFICULTY IN INSTRUMENTAL ACTIVITIES OF DAILY LIVING: WHICH COMES FIRST?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S522-S522
Author(s):  
Danielle L Feger ◽  
George W Rebok ◽  
Sherry Willis ◽  
Alden L Gross
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Independent Living ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Phone Call ◽  
Proportional Hazards Regression ◽  
Instrumental Activities ◽  
Household Cleaning

Abstract Background: Instrumental activities of daily living (IADLs) are necessary for successful independent living. Older adults may develop difficulty completing IADLs as they become physically and/or cognitively frail. The relative ordering in which IADLs deteriorate, and the importance of this ordering, is not well understood. Methods: Participants from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study who reported no difficulty with IADLs at baseline were included. Individuals were followed up to 10 years for incidence of self-reported difficulty in 19 specific IADLs. The outcome of interest was time to any incident difficulty. We used Cox proportional hazards regression to estimate the hazard ratio (HR) of incident IADL difficulty for each IADL. Results: Of N=1,273 participants who contributed 6,144 person-years to the analysis, 887 developed difficulty with at least 1 IADL during the study period. The tasks in which participants reported difficulty earliest included giving self-injections (HR=5.69, [4.77, 6.79]), balancing checkbooks (HR=5.56, [4.32-7.16]), remembering often called numbers without having to look them up (HR=5.47, [4.55-6.59]), and household chores (HR=4.18, [3.43-5.11]). The last tasks to become difficult included keeping household expenses balanced (HR=0.07, [0.04-0.14]) and hanging up at the end of a phone call (HR=0.23, [0.09-0.56]). Conclusion: Independent older adults reported earlier difficulty with balancing checkbooks, remembering often called phone numbers, and doing household cleaning. Recognizing these early difficult tasks may facilitate early planning for family members and adoption of compensatory strategies.

scholarly journals The association between longer haemodialysis treatment times and hospitalization and mortality after the two-day break in individuals receiving three times a week haemodialysis

2019 ◽  
Vol 34 (9) ◽  
pp. 1577-1584 ◽  
Author(s):  
James Fotheringham ◽  
Ayesha Sajjad ◽  
Vianda S Stel ◽  
Keith McCullough ◽  
Angelo Karaboyas ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Practice Patterns ◽  
Fluid Overload ◽  
Cox Proportional Hazards ◽  
Hospital Death ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality ◽  
Dialysis Outcomes ◽  
Event Rates ◽  
Haemodialysis Treatment

Abstract Background On the first haemodialysis (HD) day after the 2-day break in three times a week (3×W) in-centre HD, mortality and hospitalization are higher. If longer HD sessions prescribed 3×W is associated with a reduction in these events is unknown. Methods HD session length in 19 557 prevalent European in-centre 3×W HD patients participating in the Dialysis Outcomes and Practice Patterns Study (1998–2011) were categorized into &lt;200, 200–225, 226–250 or &gt;250 min. Standardized event rates on the first (HD1) versus the second (HD2) HD day after the 2-day break, with supporting Cox proportional hazards models adjusted for patient and dialysis characteristics, were generated for all-cause mortality, all-cause hospitalization, out-of-hospital death and fluid overload hospitalization. Results By comparing HD1 with HD2, increased rates of all endpoints were observed (all P &lt; 0.002). As HD session lengthened across the four groups, all-cause mortality per 100 patient-years on the HD1 (23.0, 20.4, 16.4 and 14.6) and HD2 (26.1, 13.3, 13.4 and 12.1) reduced. Similar improvements were observed for out-of-hospital death but were less marked for hospitalization endpoints. However, even patients dialysing &gt;250 min were at significantly greater risk on HD1 when compared with their HD2 for out-of-hospital death [hazard ratio (HR) = 2.1, 95% CI 1.0–4.3], all-cause hospitalization (HR = 1.3, 95% CI 1.2–1.4) and fluid overload hospitalization (HR = 3.2, 95% CI 1.8–6.0). Conclusions Despite the association between reduced mortality across all dialysis days in patients performing longer sessions, elevated risk on the first dialysis day relative to the second persists even in patients dialysing 4.5 h 3×W.

scholarly journals Sarcoscore: A Novel Approach for Assessing Sarcopenia and Functional Disability in Older Adults

2020 ◽  
Vol 9 (3) ◽  
pp. 692
Author(s):  
Yosuke Osuka ◽  
Hunkyung Kim ◽  
Hisashi Kawai ◽  
Yu Taniguchi ◽  
Yuri Yokoyama ◽  
...  
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Disability ◽  
Proportional Hazards ◽  
Handgrip Strength ◽  
Principal Component ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Cross Sectional ◽  
Skeletal Muscle Index

Sarcopenia is associated with instrumental activities of daily living (IADL) and basic activities of daily living (BADL) disabilities. We developed an index for assessing sarcopenia degree (sarcoscore) and compared it to the Asian Working Group for Sarcopenia (AWGS) criteria. Principal component analyses of walking speed, handgrip strength, and skeletal muscle index were performed to develop a sarcoscore using 3088 Japanese population-based cross-sectional data. During the nine-year follow-up, 278 of 2571 and 88 of 2341 participants developed IADL and BADL disabilities, respectively. Adjusted Cox proportional hazards regression models showed that the sarcoscore criteria, defined as proportional to the sarcopenia prevalence diagnosed by the AWGS criteria, had higher hazard ratios (HRs) and 95% confidence interval (CI) for disability onset than the AWGS criteria (IADL disability: 2.19 (1.64–2.93) vs. 1.79 (1.32–2.43), BADL disability: 4.28 (2.63–6.96) vs. 3.22 (1.97–5.27)). The adjusted HRs for IADL and BADL disabilities were reduced by 4% and 8% per point increase in the sarcoscore, respectively. The sarcoscore assessed the degree of sarcopenia and had a satisfactory performance for predicting functional disabilities in older Japanese adults, suggesting its usefulness as a complementary composite marker for clinical diagnosis.

Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults

2013 ◽  
Vol 16 (3) ◽  
pp. 344-352 ◽  
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Eileen M. Sullivan-Marx ◽  
Charlene Compher
Keyword(s):  
Weight Loss ◽  
Cardiac Surgery ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Grip Strength ◽  
Daily Living ◽  
Community Dwelling ◽  
Chair Stand ◽  
Prospective Longitudinal ◽  
Over Time

Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.

Social isolation, loneliness and functional disability in Chinese older women and men: a longitudinal study

2020 ◽  
Author(s):  
Lizhi Guo ◽  
Li An ◽  
Fengping Luo ◽  
Bin Yu
Keyword(s):  
Longitudinal Study ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Social Isolation ◽  
Daily Living ◽  
Functional Disability ◽  
Iadl Disability ◽  
Older Populations ◽  
New Onset

Abstract Objective This study investigated whether loneliness or social isolation is associated with the onset of functional disability over 4 years among Chinese older populations. Setting and Subjects This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Analyses were conducted with data from two waves (2011 and 2015) and were restricted to those respondents aged 50 and older and free of functional disability at baseline [n = 5,154, mean age (SD) = 60.72 (7.51); male, 52.3%]. Method Social isolation, loneliness and covariates were measured at baseline. Follow-up measures of new-onset ADL and IADL disability were obtained 4 years later. We stratified the sample by gender, and then used binary logistic regressions to evaluate the associations between baseline isolation, loneliness and new-onset ADL and IADL disability. Results For women, baseline social isolation was significantly associated with new-onset ADL (OR = 1.18, 95% CI = 1.07–1.30) and IADL (OR = 1.11, 95% CI = 1.01–1.21) disability; no significant association between loneliness and ADL or IADL disability was found. For men, neither social isolation nor loneliness was found to be significantly associated with ADL or IADL disability. Conclusion This longitudinal study found that social isolation, rather than loneliness, was significantly associated with functional disability over 4 years among women (but not men) in China. These findings expand our knowledge about the association between social relationships and functional status among non-Western populations.

Overall survival (OS) and metastasis-free survival (MFS) by depth of prostate-specific antigen (PSA) decline in the phase III PROSPER trial of men with nonmetastatic castration-resistant prostate cancer (nmCRPC) treated with enzalutamide (ENZA).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 94-94
Author(s):  
Maha H. A. Hussain ◽  
Cora N. Sternberg ◽  
Eleni Efstathiou ◽  
Karim Fizazi ◽  
Qi Shen ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Reference Group ◽  
Specific Antigen ◽  
Cox Proportional Hazards ◽  
Phase Iii ◽  
Castration Resistant Prostate Cancer ◽  
Analysis Model ◽  
Increased Risk ◽  
Psa Nadir ◽  
Post Hoc

94 Background: The PROSPER trial demonstrated prolonged MFS and OS for men with nmCRPC and rapidly rising PSA treated with ENZA vs placebo, both in combination with androgen deprivation therapy (ADT). The final survival analysis of PROSPER (Sternberg et al. NEJM 2020) recently reported a median OS of 67.0 months (95% CI, 64.0 to not reached) with ENZA and 56.3 months (95% CI, 54.4 to 63.0) with placebo (hazard ratio [HR] for death, 0.73; 95% CI, 0.61 to 0.89; P = .001). Post hoc analyses of PROSPER evaluating PSA dynamics have demonstrated longer MFS with greater PSA decline (Hussain et al. ESMO Sept 19-21, 2020. Poster 685P) and increased risk of metastases in patients with even modest PSA progression vs those without (Saad et al. Eur Urol 2020). Here we further explored the relationship between PSA dynamics and outcomes in PROSPER using uniquely defined PSA subgroups of decline. Methods: Eligible men in PROSPER had nmCRPC, a PSA level ≥ 2 ng/mL at baseline, and a PSA doubling time ≤ 10 months. Men continued ADT, were randomized 2:1 to ENZA 160 mg once daily vs placebo, and had PSA evaluation at week 17 and every 16 weeks thereafter. This post hoc analysis evaluated OS and MFS for 4 mutually exclusive subgroups defined by PSA nadir using men with PSA reduction < 50% as the reference group. The HR is based on an unstratified Cox proportional hazards analysis model. Results: 1401 men were enrolled in PROSPER; 933 were treated with ENZA and PSA data were available for 905. Measured at nadir, 38% of these men achieved PSA reduction ≥ 90% (actual nadir < 0.2 ng/mL), and another 27% achieved PSA reduction ≥ 90% (actual nadir ≥ 0.2 ng/mL). Among men in the placebo arm of PROSPER only 3/457 reported PSA reduction ≥ 90%. Median OS and MFS increased with increasing depth of PSA decline (Table). Conclusions: In men with nmCRPC and rapidly rising PSA treated with ADT plus ENZA, there was a close relationship between the degree of PSA decline and survival outcomes. Defining PSA by both percent decline and actual decline below 0.2 ng/mL revealed a previously under-appreciated relationship between these PSA metrics and highlights the importance of PSA nadir as an intermediate biomarker in nmCRPC. Clinical trial information: NCT02003924. [Table: see text]

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