Instrumented and Standard Measures of Physical Performance in Adults With Chronic Kidney Disease

Abstract Background Chronic kidney disease (CKD) is characterized by adverse changes in body composition, which are associated with poor clinical outcome and physical functioning. Whilst size is the key for muscle functioning, changes in muscle quality specifically increase in intramuscular fat infiltration (myosteatosis) and fibrosis (myofibrosis) may be important. We investigated the role of muscle quality and size on physical performance in non-dialysis CKD patients. Methods Ultrasound (US) images of the rectus femoris (RF) were obtained. Muscle quality was assessed using echo intensity (EI), and qualitatively using Heckmatt’s visual rating scale. Muscle size was obtained from RF cross-sectional area (RF-CSA). Physical function was measured by the sit-to-stand-60s (STS-60) test, incremental (ISWT) and endurance shuttle walk tests, lower limb and handgrip strength, exercise capacity (VO2peak) and gait speed. Results A total of 61 patients (58.5 ± 14.9 years, 46% female, estimated glomerular filtration rate 31.1 ± 20.2 mL/min/1.73 m2) were recruited. Lower EI (i.e. higher muscle quality) was significantly associated with better physical performance [STS-60 (r = 0.363) and ISWT (r = 0.320)], and greater VO2peak (r = 0.439). The qualitative rating was closely associated with EI values, and significant differences in function were seen between the ratings. RF-CSA was a better predictor of performance than muscle quality. Conclusions In CKD, increased US-derived EI was negatively correlated with physical performance; however, muscle size remains the largest predictor of physical function. Therefore, in addition to the loss of muscle size, muscle quality should be considered an important factor that may contribute to deficits in mobility and function in CKD. Interventions such as exercise could improve both of these factors.

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Sarcopenia in chronic kidney disease – A brief review

Portuguese Journal of Nephrology & Hypertension ◽

10.32932/pjnh.2021.07.129 ◽

2021 ◽

Vol 35 (2) ◽

Author(s):

Beatriz Donato ◽

◽

Catarina Teixeira ◽

Sónia Velho ◽

Edgar Almeida ◽

...

Keyword(s):

Skeletal Muscle ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Muscle Mass ◽

Physical Performance ◽

Functional Independence ◽

Muscle Dysfunction ◽

Skeletal Muscle Dysfunction ◽

Age Related ◽

The Impact

Sarcopenia is a progressive age -related loss of muscle mass associated with a decline in muscle function and physical performance. Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. Indeed, with the progression of chronic kidney disease, skeletal muscle dysfunction contributes to mobility limitation, loss of functional independence, and vulnerability to disease complications. There is a lack of robust data on the negative effect of the impact of kidney disease on skeletal muscle dysfunction, as well as on screening and treatment strategies that can be used in clinical practice to prevent functional decline and disability. Therefore, sarcopenia may be an underestimated condition with major implications for people with chronic kidney disease, even before the start of dialysis, which makes research into this topic necessary. The purpose of this review is to expand on some fundamental topics of sarcopenia, with an emphasis on the setting of chronic kidney disease patients.

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Impaired skeletal muscle mitochondrial bioenergetics and physical performance in chronic kidney disease

JCI Insight ◽

10.1172/jci.insight.133289 ◽

2020 ◽

Vol 5 (5) ◽

Cited By ~ 4

Author(s):

Bryan Kestenbaum ◽

Jorge Gamboa ◽

Sophia Liu ◽

Amir S. Ali ◽

Eric Shankland ◽

...

Keyword(s):

Skeletal Muscle ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Performance ◽

Mitochondrial Bioenergetics

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Physical Performance and Frailty in Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000355568 ◽

2013 ◽

Vol 38 (4) ◽

pp. 307-315 ◽

Cited By ~ 79

Author(s):

Peter P. Reese ◽

Anne R. Cappola ◽

Justine Shults ◽

Raymond R. Townsend ◽

Crystal A. Gadegbeku ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Physical Performance

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104 Oral Sodium Bicarbonate Therapy for Older Patients with Chronic Kidney Disease and Low-Grade Acidosis: The BiCARB Randomised Controlled Trial

Age and Ageing ◽

10.1093/ageing/afz196.06 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i34-i36

Author(s):

M D Witham ◽

M Band ◽

H Chong ◽

P T Donnan ◽

G Hampson ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Sodium Bicarbonate ◽

Physical Performance ◽

Primary Outcome ◽

Health Economic Analysis ◽

Significant Treatment ◽

Oral Sodium

Abstract Background Oral sodium bicarbonate is often used to treat metabolic acidosis in older people with advanced chronic kidney disease, but evidence is lacking on whether this provides a net gain in health or quality of life. Methods We conducted a multicentre, parallel group, double-blind, placebo-controlled randomised trial. Adults aged 60 years and over with category 4 or 5 chronic kidney disease, not on dialysis, with serum bicarbonate concentrations <22 mmol/L were recruited from 27 UK centres. Participants were randomised 1:1 to oral sodium bicarbonate or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery at 12 months, adjusted for baseline. Other key outcome measures included generic and disease-specific health-related quality of life, anthropometry, physical performance, renal function, adverse events including commencement of renal replacement therapy, and health economic analysis. Results We randomised 300 participants, mean age 74 years; 86 (29%) were female. Mean baseline estimated GFR was 19 ml/min/1.73m2. Study medication adherence was 73% in both groups. No significant treatment effect was evident for the primary outcome of the between-group difference in the Short Physical Performance Battery at 12 months (-0.4 points; 95% CI -0.9 to 0.1, p=0.15). No significant treatment benefit was seen for any of the secondary outcomes. Adverse events were more frequent in the bicarbonate arm (457 versus 400). Time to commencing renal replacement therapy was similar in both groups (HR 1.22, 95% CI 0.74 to 2.02, p=0.43). Health economic analysis showed lower quality of life and higher costs in the bicarbonate arm at one year (£1234 vs £807); placebo dominated bicarbonate under all sensitivity analyses for incremental cost-effectiveness. Conclusions Oral sodium bicarbonate did not improve a wide range of health measures in this trial, and is unlikely to be cost-effective for use in the UK NHS in this patient group.

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Aerobic training during hemodialysis improves body composition, muscle function, physical performance, and quality of life in chronic kidney disease patients

Journal of Physical Therapy Science ◽

10.1589/jpts.27.1445 ◽

2015 ◽

Vol 27 (5) ◽

pp. 1445-1449 ◽

Cited By ~ 20

Author(s):

Young-Hyeon Bae ◽

Suk Min Lee ◽

Jong Il Jo

Keyword(s):

Quality Of Life ◽

Chronic Kidney Disease ◽

Body Composition ◽

Kidney Disease ◽

Physical Performance ◽

Muscle Function ◽

Aerobic Training

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

European Geriatric Medicine ◽

10.1007/s41999-021-00478-4 ◽

2021 ◽

Author(s):

George Smith ◽

Alison Avenell ◽

Margaret M. Band ◽

Geeta Hampson ◽

Edmund J. Lamb ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Older People ◽

Physical Performance ◽

Biochemical Markers ◽

Rate Of Change ◽

Advanced Chronic Kidney Disease ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Minute Walk

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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Physical performance and chronic kidney disease development in elderly adults: results from a nationwide cohort study

Aging ◽

10.18632/aging.103741 ◽

2020 ◽

Vol 12 (17) ◽

pp. 17393-17417 ◽

Cited By ~ 1

Author(s):

Young Su Joo ◽

Jong Hyun Jhee ◽

Hyung-Woo Kim ◽

Seung Hyeok Han ◽

Tae-Hyun Yoo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Physical Performance ◽

Disease Development ◽

Elderly Adults

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P0961PHYSICAL REHABILITATION OF PATIENTS WITH CHRONIC KIDNEY DISEASE OF PRE -DIALYSIS STAGES

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0961 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Durdona Saipova

Keyword(s):

Chronic Kidney Disease ◽

Oxygen Consumption ◽

Kidney Disease ◽

Physical Performance ◽

Physical Training ◽

Stress Test ◽

Laboratory Data ◽

Public Health Problem ◽

Rehabilitation Program ◽

Maximum Oxygen Consumption

Abstract Background and Aims Chronic kidney disease is a global public health problem. Poor physical condition and skeletal muscle depletion are associated with the combined effects of uremic acidosis, protein-energy deficiency and inflammatory depletion, which leads to further exacerbation of a sedentary lifestyle. The aim of the determination of physical performance and the effectiveness of physical training during the 12-week program in patients with CKD of pre-dialysis stages. Method We examined 130 patients with CKD 2-4 stages. Clinical parameters (BP, BMI, mid-thigh circumference, mid-shoulder circumference, mid-calf circumference), laboratory data (serum creatinine, serum cholesterol, serum albumin, serum phosphorus, serum calcium) were evaluated in all patients according to the formula CKD-EPI 2011. Physical performance was determined by the results of cardiopulmonary stress test. In accordance with the initial data of the patients, a 12-week physical rehabilitation program was individually selected, which included morning exercises, physiotherapy exercises and dosed walking . The data obtained were subjected to statistical processing. Results The average age of patients was 54.8 years. Of these, 52 women (40%) and 78 (60%) men. The estimated glomerular filtration rate varied from 30 to 60 ml / min / 1.73 m2, which corresponded to the indicators of the pre-dialysis stages of CKD. After a 12-week rehabilitation program, the maximal oxygen consumption (V O2peak) increased in 70% of regularly engaged patients by 1.2 times (22.31 ml / min / kg and 27.05 ml / min / kg, respectively), and in 30% of those who did not pass the course Exercise therapy, the indicator of maximum oxygen consumption after 12 weeks was 21.7 ml / min / kg (with an initial 23.7 ml / min / kg) The average blood pressure decreased slightly (from 111 ± 5 initially to 106 ± 5 mm Hg after 12 weeks, p<0.05) When measuring anthropometric parameters, it was found that the circle the mid-thigh increased from 46.5 ± 6.0 cm to 0.6 cm, the circumference of the middle of the shoulder increased from 31.1 ± 4.0 cm to 0.4 cm. The circumference of the middle part of the lower leg was initially 356.7 ± 3.8 cm, and after 12 weeks of training it increased 0.3 cm. In 9 patients, these parameters did not change after a 12-week program. Conclusion Regular physical training led to an increase in the maximum oxygen consumption by 1.2 times. It was noted that regular training contributes to a slight increase in muscle mass in patients with CKD. The importance of regularity of physical therapy classes was also revealed.

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