Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still mix up CKD with chronic kidney insufficiency or failure, For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus, health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is “solved” by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated aging and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal COVID-19 and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality which is 10- o 100-fold higher than similar age peers, and life expectancy is shortened by around 40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth global cause of death by 2040 and the second cause of death in Spain before the end of the century, a time when 1 in 4 Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded CIBER network research structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients (AAKP) and the European Kidney Health Alliance (EKHA). Leading Spanish kidney researchers grouped in the kidney collaborative research network REDINREN have now applied for the RICORS call of collaborative research in Spain with the support of the Spanish Society of Nephrology, ALCER and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true.
Sarcopenia is a highly prevalent condition in persons on hemodialysis. In stable very elderly (75- to 95-year-old) persons on chronic hemodialysis, we prospectively studied the European Working Group on Sarcopenia in Older People (EWGSOP2) steps stability over time in 37 controls and their response to a 12-week intradialytic lower limb exercise program in 23 persons. Overall dropout was 15% and the main cause for dropout was death (8%). Thus, 33 controls and 18 exercise participants were evaluated at 12 weeks. In controls, comorbidity, nutrition, dependency and frailty scales, anthropometric assessments, EWGSOP2 step values and the prevalence of suspected, confirmed, and severe sarcopenia as assessed by EWGSOP2 remained stable. By contrast, in persons that completed the exercise program a significant improvement in the sit-to-stand-5 test was noted at the end of the 12-week exercise program (19.2 ± 4.9 to 15.9 ± 5.9 seconds, p = 0.001), consistent with the lower limb nature of the exercise program, that persisted 12 weeks after completion of the program. Exercise also improved the FRIED frailty scale (1.7 ± 1.0 to 1.1 ± 0.6, p = 0.004). In conclusion, EWGSOP2 steps remain stable in stable very elderly persons in hemodialysis and sit-to-stand-5 is responsive to a short-term intradialytic lower limb exercise program. These results may help define EWGSOP2-based primary endpoints in future large scale clinical trials assessing exercise interventions.
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