Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

Abstract Background Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance.Methods We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.Results The prevalence of low gait speed and handgrip strength was 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes.Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.

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Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

10.21203/rs.2.21802/v2 ◽

2020 ◽

Author(s):

Yu Ho Lee ◽

Jin Sug Kim ◽

Su Woong Jung ◽

Hyeon Seok Hwang ◽

Ju-Young Moon ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Outcomes ◽

Physical Performance ◽

Gait Speed ◽

Cardiovascular Events ◽

Handgrip Strength ◽

Hemodialysis Patients ◽

Albumin Level ◽

Maintenance Hemodialysis ◽

All Cause Mortality

Abstract Background Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance. Methods We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia. Results The prevalence of low gait speed and handgrip strength was 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes. Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.

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P1490AGAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF ALL-CAUSE MORTALITY AND CARDIOVASCULAR EVENTS IN HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1490a ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yu Ho Lee ◽

Hyeyun Jeong ◽

Dong Ho Yang ◽

So-Young Lee ◽

Jin Sug Kim ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Outcomes ◽

Physical Performance ◽

Gait Speed ◽

Cardiovascular Events ◽

Handgrip Strength ◽

Patient Characteristics ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

All Cause Mortality

Abstract Background and Aims Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods to assess physical performance. Method We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationship with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia. Results The prevalence of low gait speed and handgrip strength were 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with had different determinant factors (older age, the presence of diabetes, and lower serum albumin for low gait speed, and lower body mass index, and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risk of all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and that their combination improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator for poor patient outcomes compared with handgrip strength.

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Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

10.21203/rs.2.21802/v1 ◽

2020 ◽

Author(s):

Yu Ho Lee ◽

Jin Sug Kim ◽

Su Woong Jung ◽

Hyeon Seok Hwang ◽

Ju-Young Moon ◽

...

Keyword(s):

Serum Albumin ◽

Clinical Outcomes ◽

Physical Performance ◽

Gait Speed ◽

Cardiovascular Events ◽

Handgrip Strength ◽

Patient Characteristics ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

All Cause Mortality

Abstract Background Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods to assess physical performance.Methods We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationship with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.Results The prevalence of low gait speed and handgrip strength were 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with had different determinant factors (older age, the presence of diabetes, and lower serum albumin for low gait speed, and lower body mass index, and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risk of all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024).Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and that their combination improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator for poor patient outcomes compared with handgrip strength.

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Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patients

BMC Nephrology ◽

10.1186/s12882-020-01831-8 ◽

2020 ◽

Vol 21 (1) ◽

Cited By ~ 2

Author(s):

Yu Ho Lee ◽

Jin Sug Kim ◽

Su-Woong Jung ◽

Hyeon Seok Hwang ◽

Ju-Young Moon ◽

...

Keyword(s):

Gait Speed ◽

Cardiovascular Events ◽

Handgrip Strength ◽

Hemodialysis Patients ◽

All Cause Mortality

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P1515IMPACT OF POLYPHARMACY ON ALL-CAUSE MORTALITY, ALL-CAUSE HOSPITALIZATION AND CARDIOVASCULAR EVENTS IN INITIAL JAPANESE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1515 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tatsunori Toida ◽

Reiko Toida ◽

Shou Ebihara ◽

Shigehiro Uezono ◽

Hiroyuki Komatsu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Chronic Renal Disease ◽

Risk Index ◽

Hemodialysis Patients ◽

Drug Prescriptions ◽

Increased Risk ◽

All Cause Mortality

Abstract Background and Aims Polypharmacy (PP) is common in end-stage chronic renal disease patients, largely because of the existence of multiple comorbid conditions. PP has the potential for harm and benefits, and the association between PP and mortality and morbidity in hemodialysis patients currently remains unclear. We examined the association of PP and the risk of clinical outcomes, such as all-cause mortality, all-cause hospitalization and cardiovascular events, in initial hemodialysis patients at admission and discharge. Method Study design: Cohort study. Setting: Participants: One hundred and fifty-two initial hemodialysis patients (female vs. male, 88 vs. 64; mean age, 70.3 years) were enrolled between February 2015 and March 2018 at the Nobeoka Prefectural Hospital and Chiyoda Hospital. Predictor: Patients were divided into 2 groups according to PP (6 or more drug prescriptions, or less) during admission and discharge for the initiation of hemodialysis. Outcomes: All-cause mortality, all-cause hospitalization and cardiovascular events (hospitalization due to stroke, ischemic heart disease or peripheral artery disease) during the mean 2.8-year follow-up. Measurements: Hazard ratios (HRs) were estimated using Cox’s model for the relationships between PP and the clinical outcomes, and adjusted for potential confounders, including age, sex, body mass index, systolic and diastolic blood pressure, Charlson comorbidity risk index, hemoglobin, serum levels of albumin, albumin-corrected Ca, phosphate, parathyroid hormone, C-reactive protein and NT-proBNP; and use of erythropoietin stimulating agents. The group with 5 or less drug prescriptions was set as reference. Results Among the patients in this cohort study, the number of prescribed drugs per patient averaged 7.4 at admission and 6.9 at discharge for initial hemodialysis. One hundred (65.8%) and 94 patients (61.8%) had PP at admission and discharge, respectively. During follow-up, 20 patients died, 71 patients were hospitalized and 25 patients had cardiovascular events. PP at admission is significantly associated with cardiovascular events (HR 8.50, 95%CI 1.45-49.68). Furthermore, PP at discharge is significantly associated with all-cause hospitalization and cardiovascular events (HR 1.95, 95%CI 1.01-3.70; HR 53.16, 95%CI 2.70-104.62, respectively). However, PP is not significantly associated with all-cause mortality at admission or discharge. Conclusion Among Japanese patients starting hemodialysis, PP may be associated with clinical outcomes. However, it remains unclear whether PP is the direct cause of the outcomes or is simply a marker for increased risk of outcomes.

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The Pandora’s Box of Frailty Assessments: Which Is the Best for Clinical Purposes in TAVI Patients? A Critical Review

Journal of Clinical Medicine ◽

10.3390/jcm10194506 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4506

Author(s):

Omar Baritello ◽

Annett Salzwedel ◽

Simon H. Sündermann ◽

Josef Niebauer ◽

Heinz Völler

Keyword(s):

Serum Albumin ◽

Gait Speed ◽

Albumin Level ◽

Lower Serum ◽

Transcatheter Aortic Valve ◽

Frailty Assessment ◽

Composite Indices ◽

Hazard Ratios ◽

All Cause Mortality ◽

Valve Implantation

Frailty assessment is recommended before elective transcatheter aortic valve implantation (TAVI) to determine post-interventional prognosis. Several studies have investigated frailty in TAVI-patients using numerous assessments; however, it remains unclear which is the most appropriate tool for clinical practice. Therefore, we evaluate which frailty assessment is mainly used and meaningful for ≤30-day and ≥1-year prognosis in TAVI patients. Randomized controlled or observational studies (prospective/retrospective) investigating all-cause mortality in older (≥70 years) TAVI patients were identified (PubMed; May 2020). In total, 79 studies investigating frailty with 49 different assessments were included. As single markers of frailty, mostly gait speed (23 studies) and serum albumin (16 studies) were used. Higher risk of 1-year mortality was predicted by slower gait speed (highest Hazard Ratios (HR): 14.71; 95% confidence interval (CI) 6.50–33.30) and lower serum albumin level (highest HR: 3.12; 95% CI 1.80–5.42). Composite indices (five items; seven studies) were associated with 30-day (highest Odds Ratio (OR): 15.30; 95% CI 2.71–86.10) and 1-year mortality (highest OR: 2.75; 95% CI 1.55–4.87). In conclusion, single markers of frailty, in particular gait speed, were widely used to predict 1-year mortality. Composite indices were appropriate, as well as a comprehensive assessment of frailty.

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Office-Based Physical Assessment in Patients Aged 75 Years and Older with Cardiovascular Disease

Gerontology ◽

10.1159/000493527 ◽

2019 ◽

Vol 65 (2) ◽

pp. 128-135 ◽

Cited By ~ 1

Author(s):

Ryota Matsuzawa ◽

Kentaro Kamiya ◽

Nobuaki Hamazaki ◽

Kohei Nozaki ◽

Shinya Tanaka ◽

...

Keyword(s):

Cardiovascular Disease ◽

Older Adults ◽

Physical Performance ◽

Mortality Risk ◽

Gait Speed ◽

Handgrip Strength ◽

Walk Distance ◽

Physical Assessment ◽

All Cause Mortality ◽

Usual Gait Speed

Background: The detection of impaired physical performance in older adults with cardiovascular disease is essential for clinical management and therapeutic decision-making. There is a requirement for an assessment tool that can be used conveniently, rapidly, and securely in clinical practice for screening decreased physical performance. Objective: The present study was performed to evaluate the association of office-based physical assessments with decreased physical performance and to compare the prognostic capability of these assessments in older adults with cardiovascular disease. Methods: A total of 1,040 patients aged 75 years and older with cardiovascular disease were included in this analysis. One-leg standing time (OLST) and handgrip strength were measured as office-based physical assessment tools, and short physical performance battery (SPPB), 6-min walk distance, and usual gait speed were also measured at hospital discharge as measurements of physical performance. All-cause mortality was assessed by death registry at the hospital. We examined the association of office-based measures with physical performance and all-cause mortality. Results: The areas under the curve of OLST for SPPB < 10, 6-min walk distance < 300 m, and usual gait speed < 1.0 m/s were 0.87 (95% CI 0.83–0.91), 0.83 (95% CI 0.80–0.86), and 0.81 (95% CI 0.78–0.85), respectively. The discrimination abilities of OLST for decreased physical performance were significantly higher than those of handgrip strength. After adjusting for the effects of patient characteristics, the hazard ratio for all-cause mortality in the < 3 s group for OLST was 1.68 (95% CI 1.06–2.67, p = 0.03). Handgrip strength, however, was not significantly associated with mortality risk in these participants. Conclusion: Short OLST, in particular < 3 s, is associated with decreased physical performance and elevated mortality risk in elderly patients with cardiovascular disease. OLST can be conveniently measured in the clinician’s office as a screening tool for impaired physical performance.

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Impact of serum albumin level and variability on short-term cardiovascular-related and all-cause mortality in patients on maintenance hemodialysis

Medicine ◽

10.1097/md.0000000000027666 ◽

2021 ◽

Vol 100 (43) ◽

pp. e27666

Author(s):

Chun Chen ◽

Jing Zhang ◽

Zemei Zhou ◽

Jiguo Liu ◽

Chunyin Li ◽

...

Keyword(s):

Serum Albumin ◽

Serum Albumin Level ◽

Albumin Level ◽

Maintenance Hemodialysis ◽

Short Term ◽

All Cause Mortality

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P0948ASSOCIATION OF PHASE ANGLE WITH NUTRITION, MORTALITY, MAJOR ADVERSE CARDIOVASCULAR EVENTS AND SARCOPENIA IN MAINTENANCE HEMODIALYSIS PATIENTS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0948 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Eunjin Bae ◽

Tae Won Lee ◽

Ha Nee Jang ◽

Hyun Seop Cho ◽

Hyun-Jung Kim ◽

...

Keyword(s):

Nutritional Status ◽

Phase Angle ◽

Cardiovascular Events ◽

Hemodialysis Patients ◽

Major Adverse Cardiovascular Events ◽

Maintenance Hemodialysis ◽

Lower Phase ◽

All Cause Mortality ◽

History Of ◽

Maintenance Hemodialysis Patients

Abstract Background and Aims Nutrition has been consistently important in end stage renal disease patients. However, it is difficult to obtain adequate nutritional status while avoiding fluid overload, hyperphosphatemia and hyperkalemia in hemodialysis patients. In addition, there is no golden standard for diagnosing protein energy wasting (PEW) in maintenance hemodialysis patients. We studied the clinical significance of phase angle using bioelectrical impedance analysis (BIA), one of the PEW diagnostic tools, to predict various clinical outcomes in maintenance hemodialysis patients. Method We retrospectively enrolled patients who received hemodialysis for more than 3 months from 2016 to March 2019, excluding patients had active cancer, or died within 30 days, had no BIA data. We evaluated the factors related phase angle and the role of phase angle as predictors of all-cause mortality and major adverse cardiovascular events (MACE), sarcopenia. Results Of 191 patients, 63.4% were men, mean age was 64.2 ± 12.4 years, mean body mass index (BMI) was 23.8 ± 6.9 kg/m2, and the most common underlying disease were hypertension and diabetes mellitus. Lower phase angle group (phase angle ≤4°) patients had older age, higher portion of women, malnourished, and history of coronary artery disease (CAD) than higher phase angle group (phase angle >4°) patients. Phase was significantly related with nutritional parameters. During a median follow up of 16.7 months, 14.1% (n=27) patients experienced a MACE, 11.0% (n=21) patients died. In multivariate Cox analyses, lower phase angle, higher CRP level and history of CAD were significantly related with all-cause mortality even after adjustment for covariates. However, phase angle was not significantly associated with MACE and sarcopenia. Conclusion In maintenance hemodialysis patients, phase angle was significantly related to mortality as well as nutritional status, but MACE and sarcopenia were not. Clinicians should be careful to find and treat correctable factors with low phase angle and high CRP level in maintenance hemodialysis patients.

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