elderly hemodialysis patients
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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261459
Author(s):  
M. Luz Sánchez-Tocino ◽  
Blanca Miranda-Serrano ◽  
Carolina Gracia-Iguacel ◽  
Ana María de-Alba-Peñaranda ◽  
Sebastian Mas-Fontao ◽  
...  

Background In 2019, EWGSOP2 proposed 4 steps to diagnose and assess sarcopenia. We aimed to quantify the prevalence of sarcopenia according to the EWGSOP2 diagnostic algorithm and to assess its applicability in elderly patients on hemodialysis. Methods Prospective study of 60 outpatients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4-step EWGSOP2: Find: Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F); Assess: grip strength by dynamometry (GSD) and sit to stand to sit 5 (STS5); Confirm: appendicular skeletal muscle mass (ASM) by bioimpedance; Severity: gait speed (GS), Timed-Up and Go (TUG), and Short Physical Performance Battery (SPPB). Results The sequential four steps resulted in a prevalence of confirmed or severe sarcopenia of 20%. Most (97%) patients fulfilled at least one criterion for probable sarcopenia. The sensitivity of SARC-F for confirmed sarcopenia was low (46%). Skipping the SARC-F step increased the prevalence of confirmed and severe sarcopenia to 40% and 37%, respectively. However, 78% of all patients had evidence of dynapenia consistent with severe sarcopenia. Muscle mass (ASM) was normal in 60% of patients, while only 25% had normal muscle strength values (GSD). Conclusions According to the 4-step EWGSOP2, the prevalence of confirmed or severe sarcopenia was low in elderly hemodialysis patients. The diagnosis of confirmed sarcopenia underestimated the prevalence of dynapenia consistent with severe sarcopenia. Future studies should address whether a 2-step EWGSOP2 assessment (Assess-Severity) is simpler to apply and may provide better prognostic information than 4-step EWGSOP2 in elderly persons on hemodialysis.


2022 ◽  
Vol 8 (4) ◽  
pp. 179
Author(s):  
Langgeng Perdhana ◽  
Shofa Chasani ◽  
Yudo Murti Mupangati ◽  
Siti Nuraini

Pendahuluan. Depresi merupakan gangguan mental yang banyak ditemukan baik pada kelompok lansia maupun pada pasien yang menjalani hemodialisis. Depresi berdampak buruk terhadap kualitas hidup pasien. Penelitian yang menghubungkan depresi sebagai faktor prediktor kematian dalam enam bulan pada lansia yang menjalani hemodialisis belum pernah dilakukan di Indonesia. Penelitian ini bertujuan untuk mengetahui peran gejala depresi sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Metode. Penelitian dengan desain kohort prospektif dilakukan pada Februari – Agustus 2020 di Unit Hemodialisis Rumah Sakit Roemani Muhammadiyah Semarang. Adapun kriteria inklusi meliputi lansia (usia ≥60 tahun), menjalani hemodialisis ≥3 bulan, frekuensi hemodialisis 2 kali seminggu, bersedia mengikuti penelitian, dapat berkomunikasi dengan baik, dan tidak terdapat riwayat gangguan mental sebelumnya yang meliputi riwayat gangguan psikotik, dan gangguan mental akibat penggunaan zat. Sedangkan pasien dengan data tidak lengkap, pindah ke unit hemodialisis lain, HBsAg +, kadar Hemoglobin <7 mg/dl, skor RAPUH >2, dan memiliki stressor lain yang tidak terkait dengan hemodialisis atau Penyakit Ginjal Kronis (PGK) seperti faktor sosial, keluarga, dan pekerjaan dieksklusi dari penelitian ini. Depresi dinilai menggunakan kuesioner Beck Depression Inventory-II yang telah diterjemahkan ke dalam Bahasa Indonesia. Adapun pengisian kuesioner dilakukan oleh responden dengan panduan oleh peneliti dalam proses pengisiannya. Data yang terkumpul kemudian dianalisis menggunakan Kaplan Meier dan Cox Regression menggunakan SPSS 18.0.Hasil. Dari total 32 responden, mayoritas adalah laki-laki yaitu sebanyak 26 responden (81,3%). Rerata usia responden adalah 67,2 (simpang baku [SB] 7) tahun. Sebanyak 6 (18,7%) responden mengalami depresi dan 26 (81,3%) responden tidak mengalami depresi. Hasil analisis Cox Regression menunjukkan bahwa depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis (p=0.012), dan hazard ratio=10,149.Simpulan. Depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Kata Kunci: Depresi, geriatri, mortalitas, penyakit ginjal kronik, penyakit ginjal tahap akhirDepressive symptoms as a Predictor Factor of All-Cause Mortality within Six Months in Elderly Hemodialysis PatientsIntroduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency twice a week, willing to participate in this study, able to communicate well, and has no history of mental disorders include a history of psychotic disorders and mental disorders due to substance use. Meanwhile, patients whose data were incomplete, transferred to another hemodialysis unit, HBsAg +, hemoglobin level <7 mg/dl. FRAILTY score >2, and had other stressors not related to hemodialysis or chronic kidney disease (CKD) such as social, family, and work factors were excluded from this study. Depression was assessed using the Beck Depression Inventory-II questionnaire. The collected data was then analyzed using Kaplan Meier and Cox Regression.Results. Of 32 respondents, most of them were male (81.3%). The mean age was 67.2 (SD 7) years. There were 6 (18.7%) respondents categorized into a depression group and 26 (81.3%) respondents into a non-depression group. Cox Regression analysis showed that depression was a predicting factor of all-cause mortality within six months in elderly hemodialysis patients (p value=0.012, and Hazard ratio=10.149). Conclusion. Depression is a predictor factor of all-cause mortality within six months in elderly hemodialysis patients. 


2021 ◽  
Vol 8 ◽  
Author(s):  
Hyung Woo Kim ◽  
Jong Hyun Jhee ◽  
Young Su Joo ◽  
Ki Hwa Yang ◽  
Jin Ju Jung ◽  
...  

Objective: Dementia is prevalent among elderly patients undergoing hemodialysis. However, the association between dialysis adequacy and the risk of dementia is uncertain.Methods: A total of 10,567 patients aged &gt;65 years undergoing maintenance hemodialysis who participated in a national hemodialysis quality assessment program were analyzed. The patients were classified into quartile groups based on single-pool Kt/V levels. The associations between single-pool Kt/V and the development of dementia, Alzheimer's disease (AD), and vascular dementia (VD) were examined.Results: The mean age of the patients was 72.9 years, and 43.4% were female. The mean baseline single-pool Kt/V level was 1.6 ± 0.3. During a median follow-up of 45.6 (45.6–69.9) months, there were 27.6, 23.9, and 2.8 events/1,000 person-years of overall dementia, AD, and VD, respectively. The incidences of overall dementia, AD, and VD were lowest in the highest single-pool Kt/V quartile group. Compared with the lowest single-pool Kt/V quartile, the risks of incident overall dementia and AD were significantly lower in the highest quartile [sub-distribution hazard ratio (sHR): 0.69, 95% confidence interval (CI): 0.58–0.82 for overall dementia; sHR: 0.69, 95% CI: 0.57–0.84 for AD]. Inverse relationships were found between the risks of developing overall dementia and AD, and single-pool Kt/V. However, no significant relationship was observed between single-pool Kt/V levels and VD development.Conclusions: Increased dialysis clearance was associated with a lower risk of developing dementia in elderly hemodialysis patients.


2021 ◽  
Vol Volume 16 ◽  
pp. 1659-1667
Author(s):  
Yuanyuan Li ◽  
Dai Zhang ◽  
Qing Ma ◽  
Zongli Diao ◽  
Sha Liu ◽  
...  

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2377
Author(s):  
Masaaki Inaba ◽  
Senji Okuno ◽  
Yoshiteru Ohno

In the current aging society of Japan, malnutrition and resultant sarcopenia have been widely identified as important symptomatic indicators of ill health and can cause impairments of longevity and quality of life in older individuals. Elderly individuals are recommended to have sufficient calorie and protein intake so as to enjoy a satisfactory quality of life, including maintaining activities of daily living in order to avoid emaciation and sarcopenia. The prevalence of emaciation and sarcopenia in elderly hemodialysis (HD) patients in Japan is higher than in non-HD elderly subjects due to the presence of malnutrition and sarcopenia associated with chronic kidney disease (CKD). Furthermore, comorbidities, such as diabetes and osteoporosis, induce malnutrition and sarcopenia in HD patients. This review presents findings regarding the mechanisms of the development of these early symptomatic conditions and their significance for impaired QOL and increased mortality in elderly HD patients.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maria Luz Sánchez-Tocino ◽  
Blanca Miranda ◽  
Sebastián Mas ◽  
Ana Maria De Alba-Peñaranda ◽  
Antonio Lopez-Gonzalez ◽  
...  

Abstract Background and Aims Sarcopenia, defined as the loss of muscle mass and strength, is common in patients with chronic kidney disease. The variability of the prevalence of sarcopenia depends in part on the diagnostic criteria applied. In 2019, the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) proposed four steps to diagnose and assess sarcopenia. The concept of sarcopenia is encompassed within the broader concept of frailty. The aim of this study was to analyse the incidence of sarcopenia in very elderly patients on haemodialysis following the criteria recently established by the European Working Group on Sarcopenia in Older People EWGSOP2. Additionally, to assess the usefulness of the diagnostic algorithm in the very elderly haemodialysis population, and its association with functionally scales related to sarcopenia, such as dependency, frailty, and nutrition. Method In a prospective study of 60 patients on chronic hemodialysis aged 75- to 95-years, sarcopenia was assessed according to the 4 EWGSOP2 steps: Find-Assess-Confirm-Severity, using Strength, Assistance walking, Rise from a chair, Climb stairs, and Falls (SARC-F) to find, grip strength by dynamometry (GFD) and sit to stand to sit 5 (STS5) test to assess, appendicular skeletal muscle mass by bioimpedance to confirm and gait speed, the Timed-Up and Go (TUG) test, and the Short Physical Performance Battery (SPPB) for severity. Functionality scales of malnutrition inflammation (MIS), comorbility of Charlson, dependence of Barthel, fragility by FRAIL index2 and Physical Activity Scale for the Elderly (PASE) were conducted. Results Sixty patients were involved in the study. Sixty-eight percent (41) were men, with a mean age of 81.85±5.58 years and length of stay in HD 49.88±40.29 months. The sequential four steps resulted in a prevalence of confirmed sarcopenia of 20% and of severe sarcopenia of 20%. Correlation of the different variables defined by the EWGSOP2 with the scales of MIS, Barthel, Frail, Charlson and PASE was analyzed. It is observed that the SARC-F but not BIA correlates with the functionality tests. The GFD is the test that correlates with more variables, both functional and anthropometric. Of the severity measurement scales, the SPPB is the one that correlates with the greatest number of variables. Conclusion These findings question the four-step EWGSOP2 assessment for very elderly hemodialysis patients and suggest that 20% had confirmed severe sarcopenia. Functionality scales correlated better with GFD and SPPB.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ander Vergara Arana ◽  
Mireia Molina ◽  
Andrés Villegas ◽  
Luis Alberto Sã¡nchez Cã¡mara ◽  
Patricia De Sequera Ortiz ◽  
...  

Abstract Background and Aims Age and chronic kidney disease have been described as mortality risk factors for coronavirus disease 2019 (COVID-19). Currently, an important percentage of patients in hemodialysis are elderly. This study aimed to investigate the impact of COVID-19 in this population and to determine risk factors associated with mortality. Method Data was obtained from the Spanish COVID-19 CKD Working Group Registry, that included patients in renal replacement therapy (dialysis and kidney transplantation) infected by COVID-19. From March 18, 2020, to August 27, 2020, 1165 patients on hemodialysis affected by COVID-19 were included in the Registry. A total of 328 patients were under 65 years-old and 837 were 65 years old or older (elderly group). Results Mortality was 18.6% higher (95% confidence interval (CI): 13.8%-23.4%) in the elderly hemodialysis patients compared to the non-elderly group (see figure). Death from COVID-19 infection was increased 5.5-fold in hemodialysis patients compared to mortality in the general population for a similar period, and there was an age-associated mortality increase in both populations (see figure 1). In multivariate Cox regression analysis, age (hazard ratio (HR) 1.58, 95% CI: 1.31-1.92), dyspnea at presentation (HR 1.61, 95% CI: 1.20-2.16), pneumonia (HR 1.76, 95% CI: 1.12-2.75) and admission to hospital (HR 4.13, 95% CI: 1.92-8.88) were identified as independent mortality risk factors in the elderly hemodialysis population. Treatment with glucocorticoids reduced the risk of death (HR 0.71, 95% CI: 0.51-0.98) in aged patients on hemodialysis. Conclusion Mortality is dramatically increased in elderly hemodialysis patients affected by COVID-19. Age, dyspnea at presentation, pneumonia or hospitalization are factors associated with a worse prognosis, after adjusting dialysis population to other confounding factors. Treatment with glucocorticoids could be a therapeutic option for this specific population.


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