scholarly journals The FRAILMar Study Protocol: Frailty in Patients With Advanced Chronic Kidney Disease Awaiting Kidney Transplantation. A Randomized Clinical Trial of Multimodal Prehabilitation

2021 ◽  
Vol 8 ◽  
Author(s):  
María José Pérez-Sáez ◽  
Andrea Morgado-Pérez ◽  
Anna Faura ◽  
Elena Muñoz-Redondo ◽  
Miguel Gárriz ◽  
...  

Introduction: Frailty is very frequent among patients with chronic kidney disease (CKD) who are awaiting deceased donor kidney transplantation (KT), and transplant outcomes are worsened in those frail recipients. Frailty and poor fitness powerfully predict mortality, kidney graft survival, and healthcare utilization after KT. Intervention is essential to improve survival and quality of life for frail CKD patients, regardless of their age. Studies of post-transplant physical therapy intervention have been met with limited success, in large part due to high dropout rates. A pre-transplant clinical framework for multimodal prehabilitation interventions including physical therapy, nutritional measures, and psychological support scheduled during the KT waiting list period may improve patient retention and compliance, better mitigate the effects of frailty and poor fitness after KT, and improve main outcomes in frail CKD patients.Main Objective: To study the effectiveness, feasibility, and safety of multimodal prehabilitation (exercise, nutritional plans, psychological advice) in KT candidates.Methods: Randomized controlled clinical trial in 38 frail and 76 non-frail KT candidates. The prehabilitation program will consist of physical exercise (24 sessions, 8 weeks), nutritional supplementation, and psychological advice. The primary endpoint will be a composite achievement of clinical and functional main outcomes in frail and non-frail KT candidates at 90 days post-transplantation. Secondary outcomes include changes in exercise capacity, physical activity, gait speed, respiratory and peripheral muscle strength, muscle size, body composition, performance in activities of daily living (basic and instrumental), anxiety and depression symptoms, and health-related quality of life. Feasibility of the intervention will be also analyzed.Expected Results: Multimodal prehabilitation is a feasible and effective intervention to decrease bad outcomes at 90 days post-KT by 25 and 12.5% in frail and non-frail patients, respectively.Clinical Trial Registration:clinicaltrials.gov (NCT04701398), date: 2021, January 8th (Protocol version: Frailmar_vers2).

2018 ◽  
Vol 26 (4) ◽  
pp. 493-499 ◽  
Author(s):  
Makhmadsho K. Gulov ◽  
Saidkhodzha M. Abdulloev ◽  
Khamdam K. Rofiev

Aim to study the quality of life (QOL) of patients with chronic kidney disease (CKD) in the Republic of Tajikistan. Materials and Methods. The study was conducted in 2016-2018 and included 319 patients, with CKD (of them 58.9% men, with CKD I-IV stages – 121, receiving long term hemodialysis – 109, after kidney transplantation – 89) and 103 relatively healthy individuals (control group, men – 53.4%). The main causes of CKD were glomerulonephritis, diabetes mellitus, and pyelonephritis. QOL was evaluated by the SF-36. Results. Impairment of the quality of life in patients with CKD was demonstrated in most parameters, both in comparison with the control group and with progression of CKD. In the terminal stage of CKD the quality of life evaluated by some parameters (bodily pain, general health, physical health, social functioning) was lower in patients dependent on program hemodialysis than in patients after kidney transplantation. The parameters of mental and psychological health did not show any differences between these groups which is explained by the authors as due to lack of psychological support after surgical intervention, to necessity of using immunosuppressive therapy and to the economical constituent of treatment. Conclusions. Evaluation of the quality of life should be an obligatory component of the analysis of the quality and effectiveness of management of patients with chronic kidney disease including those at the terminal stage. In the work, impairment of the quality of life and of its separate parameters in progression of chronic kidney disease was objectively demonstrated. At the terminal stage, the quality of life evaluated by some most important parameters was lower in patients receiving program hemodialysis that in patients after transplantation of kidney.


2018 ◽  
Vol 5 (2) ◽  
pp. 56-63
Author(s):  
Abdul Wakhid ◽  
Estri Linda Wijayanti ◽  
Liyanovitasari Liyanovitasari

Background: Self efficacy can optimize the quality of life of clients who undergo the healing process due to chronic diseases. Individuals with higher self-efficacy move their personal and social resources proactively to maintain and improve the quality and length of their lives so that they experience a better quality of life. Objectives: the purpose of this study was to find the correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency. Metode: This type of research was descriptive correlation with cross sectional approach. The samples in this study more 76 people with total sampling technique. The data collection tool for self efficacy was measured by General Self-Efficacy scale, for quality of life with WHOQoL-BREF. Statistical test used Kolmogorov-smirnov. Result: The result showed that self efficacy in patients with chronic kidney disease was mostly in moderate category (53,9%), quality of life in patients with chronic kidney disease was mostly in good category (68,4%). There was a correlation between self efficacy and quality of life of patients with chronic kidney disease who undergo hemodialysis at RSUD Semarang Regency, the result obtained p-value of 0.000 <α (0,05). Suggestion: Patients with chronic kidney disease can maintain good quality of life by helping to generate positive self-esteem and high self efficacy.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yan Shen ◽  
◽  
Jinwei Wang ◽  
Jing Yuan ◽  
Li Yang ◽  
...  

Abstract Background Anemia is one of the common complications in patients with chronic kidney disease (CKD). However, there is no systematic investigation on the prevalence of anemia in CKD patients and its relationship with the quality of life in China. Methods The data for this study comes from baseline data from the Chinese Chronic Kidney Disease Cohort Study (C-STRIDE), which recruited predialysis CKD patients in China. The kidney disease quality of life summary (KDQOL-TM) was used to assess health-related quality of life (HRQoL). Use linear regression model to estimate the relationship between hemoglobin level and quality of life. Results A total of 2921 patients were included in this study. The adjusted prevalence of hemoglobin (Hb) less than 100 g/L was 10.3% (95% confidence interval [CI]: 9.9,11.4%), and showed an increased trend through reduced eGFR levels from 4.0% (95%CI:2.3,5.9%) in the 45-60 ml/min/1.73m2 group to 23.4% (95%CI:20.5,26.2%) in the 15–29 ml/min/1.73m2 group. The prevalence of anti-anemia treatment was 34.0% (95%CI: 28.7,39.3%) and it is shown by reducing eGFR levels from 15.8% (95%CI:0,36.7%) in the 45-60 ml/min/1.73m2 group to 38.2% (95%CI: 30.7,45.2%) in the 15–29 ml/min/1.73m2 group. All five dimensions of the KDQOL scores in patients with CKD decreased as hemoglobin declined. After multivariable adjustments,the degrees of decrease became somewhat blunted. For example, compared with hemoglobin of ≥130 g/L, regression coefficients in the hemoglobin of < 100 g/L were − 0.047(95%CI: − 0.049,-0.045) for Symptoms and Problems(S), − 0.047(95%CI: − 0.049,-0.044) for Effects of the Kidney Disease(E), − 0.207(95%CI: − 0.212,-0.203) for Burden of the Kidney Disease(B), − 0.112(95%CI: − 0.115,-0.109) for SF-12 Physical Functioning (PCS), − 0.295(95%CI: − 0.299, -0.292) for SF-12 Mental Functioning (MCS), respectively. Conclusions In our cross-sectional analysis of patients with CKD in China, prevalence of both anemia and anti-anemia treatment increased with decreased eGFR. In addition, anemia was associated with reduced HRQoL.


2018 ◽  
Vol 104 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Anna Francis ◽  
Madeleine S Didsbury ◽  
Anita van Zwieten ◽  
Kerry Chen ◽  
Laura J James ◽  
...  

ObjectiveThe aim was to compare quality of life (QoL) among children and adolescents with different stages of chronic kidney disease (CKD) and determine factors associated with changes in QoL.DesignCross-sectional.SettingThe Kids with CKD study involved five of eight paediatric nephrology units in Australia and New Zealand.PatientsThere were 375 children and adolescents (aged 6–18 years) with CKD, on dialysis or transplanted, recruited between 2013 and 2016.Main outcome measuresOverall and domain-specific QoL were measured using the Health Utilities Index 3 score, with a scale from −0.36 (worse than dead) to 1 (perfect health). QoL scores were compared between CKD stages using the Mann-Whitney U test. Factors associated with changes in QoL were assessed using multivariable linear and ordinal logistic regression.ResultsQoL for those with CKD stages 1–2 (n=106, median 0.88, IQR 0.63–0.96) was higher than those on dialysis (n=43, median 0.67, IQR 0.39–0.91, p<0.001), and similar to those with kidney transplants (n=135, median 0.83, IQR 0.59–0.97, p=0.4) or CKD stages 3–5 (n=91, 0.85, IQR 0.60–0.98). Reductions were most frequent in the domains of cognition (50%), pain (42%) and emotion (40%). The risk factors associated with decrements in overall QoL were being on dialysis (decrement of 0.13, 95% CI 0.02 to 0.25, p=0.02), lower family income (decrement of 0.10, 95% CI 0.03 to 0.15, p=0.002) and short stature (decrement of 0.09, 95% CI 0.01 to 0.16, p=0.02).ConclusionsThe overall QoL and domains such as pain and emotion are substantially worse in children on dialysis compared with earlier stage CKD and those with kidney transplants.


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