A closer look at the trajectory of physical functioning in chronic hemodialysis

Loon, Ismay van; Hamaker, Marije E.; Boereboom, F. T. J.; Grooteman, Muriël P.C.; Dorpel, René M A van den; Nubé, Menso J.; Wee, Piet M. ter; Verhaar, Marianne C.; Bots, Michiel L.

doi:10.1093/ageing/afx006

Cited by 18 publications

(9 citation statements)

References 21 publications

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“…van Loon et al . [ 131 ] also demonstrated that physical performance declines while on haemodialysis, especially for older patients. These reports appear at odds with a study by John et al .…”

Section: How Should We Care For the Frail Patient With Ckd?mentioning

confidence: 99%

Frailty and chronic kidney disease: current evidence and continuing uncertainties

Nixon

Bampouras

Pendleton

et al. 2017

Clinical Kidney Journal

153

134

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Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.

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Section: How Should We Care For the Frail Patient With Ckd?mentioning

confidence: 99%

Frailty and chronic kidney disease: current evidence and continuing uncertainties

Nixon

Bampouras

Pendleton

et al. 2017

Clinical Kidney Journal

153

134

View full text Add to dashboard Cite

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“…For inpatients, the mean age was 55 years in this study, which was younger than 65 years reported from Sweden [15]. Elderly dialysis patients could have more age-related comorbidities, such as atherosclerosis and diabetes mellitus, increased levels of frailty and malnutrition, higher risk of cognitive dysfunction, which may contribute to poor physical performance and clinical outcome compared to younger patients [16,[19][20][21][22][23][24]. Second, glomerulonephritis was the leading cause of ESKD in China, while diabetes and hypertension were more common in the USA, European countries, and some other counties in Asia [6,10,11,[14][15][16]25].…”

Section: Discussionmentioning

confidence: 64%

Hospitalizations of Chronic Dialysis Patients: A National Study in China

et al. 2023

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Background Patients receiving chronic dialysis are usually with multiple comorbidities and at high-risk for hospitalization, which lead to tremendous healthcare resources utilization. This study aims to explore the characteristics of hospitalizations among chronic dialysis patients in China. Methods Hospital admissions from January 2013 to December 2015 were extracted from a national inpatient database in China. Chronic dialysis, including hemodialysis and peritoneal dialysis, were identified according to inpatients discharge records and International Classification of Diseases-10 (ICD-10) codes. The primary kidney disease, causes of admissions, modalities of dialysis, and comorbidities were analyzed. Multivariable Logistic regression model was used to assess the association of patient characteristics with multiple hospitalizations per year. Results Altogether, 266,636 hospitalizations from 124,721 chronic dialysis patients were included in the study. The mean age was 54.46±15.63 years and 78.29% of them were receiving hemodialysis. The leading cause of hospitalizations was dialysis access-related, including dialysis access creation (25.06%) and complications of access (21.09%). The following causes were non-access surgery (1.89%), cardiovascular disease (1.66%), and infectious diseases (1.43%). One fourth of the patients were hospitalized more than once per year. Multivariate Logistic regression models indicated that the primary kidney disease of diabetic kidney disease (odds ratio [OR]: 1.16, 95% confidence interval [CI]: 1.11-1.22) or hypertensive nephropathy (OR: 1.33, 95% CI: 1.27-1.40), coronary heart disease (OR: 1.09, 95% CI: 1.05-1.14), cancer (OR: 1.21, 95% CI: 1.13-1.30), or modality of peritoneal dialysis (OR: 2.67, 95% CI: 2.59-2.75) were risk factors for multiple hospitalizations. Conclusion Our study described characteristics and revealed the burden of hospitalizations of chronic dialysis patients in China. These findings highlight the importance of effective and efficient management strategies to reduce the high burden of hospitalization in dialysis population.

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“…Despite the association between haemodialysis (HD) and a rapid decline in physical and cognitive function, many older comorbid patients default onto HD. 1,2 The Frail Elderly Patient Outcomes on Dialysis (FEPOD) study demonstrated quality of life (QOL) is similar on HD and assisted peritoneal dialysis (asPD) with frailty being the principal association with QOL, 3 but better treatment satisfaction with asPD, which was predominantly delivered as healthcare-assisted automated PD (APD). An extension of the FEPOD trial showed better symptom control in patients on asPD compared to those on conservative care with similar kidney treatment satisfaction scores.…”

Section: Introductionmentioning

confidence: 99%

A novel programme of supportive two-exchange assisted continuous ambulatory peritoneal dialysis for frail patients with end-stage kidney disease

2022

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We have developed a supportive two-exchange assisted continuous ambulatory peritoneal dialysis (asCAPD) programme for the older frail person who cannot do autonomous PD and do not want or are considered to be too high risk for haemodialysis (HD). Evaluation of the programme was determined by data collected retrospectively from patient records. Primary outcome was comparison of symptoms at start of dialysis and 3 months following dialysis start. Secondary outcomes were survival and peritonitis rate. Over a 4-year period (2016–2020), 49 patients with mean age 79.6 years (range 47–90) enrolled in the programme with eGFR 7.7 ± 2.6 ml/min (mean ± SD) at dialysis start. Forty-one patients had been on asCAPD for >3 months. There was an improvement in all symptoms at 3 months compared to baseline: anorexia (46% to 15%), fatigue (46% to 15%), shortness of breath (27% to 2%) and oedema (51% to 32%). One-year survival was 55%. Peritonitis rate was 0.52 episodes per patient year. The novel supportive two-exchange asCAPD programme shows potential improvement of symptoms after 3 months and may provide an acceptable dialysis modality for the frail co-morbid person with established kidney failure. More detailed study and evaluation are needed.

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A closer look at the trajectory of physical functioning in chronic hemodialysis

Cited by 18 publications

References 21 publications

Frailty and chronic kidney disease: current evidence and continuing uncertainties

Frailty and chronic kidney disease: current evidence and continuing uncertainties

Hospitalizations of Chronic Dialysis Patients: A National Study in China

A novel programme of supportive two-exchange assisted continuous ambulatory peritoneal dialysis for frail patients with end-stage kidney disease

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