Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients

Abstract

BackgroundThis study aimed to evaluate the prevalence of sedentarism, and to assess physical capacity and nutritional status in a cohort of older patients on peritoneal dialysis (PD), with respect to age-matched non-dialysis CKD population, using highly accessible, simple methods, namely the Rapid Assessment of Physical activity (RAPA) test and the 30″ Sit-to-stand (STS) test.MethodsThis cross-sectional multicenter study included 151 renal patients older than 60 years; 71 pts. (44 m, age 72 ± 7 yrs) were on PD and 80 pts. (63 m, age 74 ± 7 yrs) were affected by 3–4 stage CKD.ResultsThe prevalence of sedentary/underactive patients was double of that of the active patients as assessed by RAPA test, both in the PD (65.3%) and in the CKD (67.5%) cohort.The 30"STS test showed a reduced physical performance in both groups: 84.5% of PD patients and 87.5% of CKD patients did not reach the expected number of stands by age and gender. A malnutrition-inflammation score (MIS) ≥ 6 occurred in 37 % of PD patients and in 2.5 % of CKD patients. In PD patients, an independent significant association was observed between 30”STS test and MIS (beta -0.510, p = 0.013), as well as between RAPA and MIS (beta -0.544, p = 003) and phase angle (beta -0.506, p = 0.028).ConclusionsA high prevalence of low- performance capacity and sedentarism has been detected among elderly patients on PD or with CKD stage 3–4. Apart from age, a condition of malnutrition-inflammation was the major determinant of poor physical activity and capacity in PD patients. Better body composition seems to be positively associated with physical activity in PD and with physical capacity in CKD patients. Routine clinical management should include a close evaluation of nutritional status and evaluation of physical activity and capacity which can be easily assessed by RAPA and 30″STS tests.

The Exercise Perceptions of People Treated with Peritoneal Dialysis

“…Lack of knowledge regarding benefits of exercise among people being treated with PD was also a finding in this study and was associated with age as an exercise barrier. Older age is associated with low level of physical activity and declined exercise capacity in CKD, HD and PD populations (Zuo et al 2013; Cobo et al 2015; Cupisti et al 2017). Given that education regarding exercise is not part of routine practice in dialysis care (Bennett et al 2017), it is likely that people treated with PD, especially those of older age, may lack knowledge regarding appropriate exercise regimens.…”

“…People with ESKD receiving PD experience low activity levels (Painter et al 2017). These low activity levels are a result of chronic fatigue (Bonner et al 2010; Painter et al 2017), poor nutritional status (Zuo et al 2013; Cupisti et al 2017), co‐morbidities (Kang et al 2017; Painter et al 2017), older age (Bonner et al 2010; Zuo et al 2013) and the burden of dialysis treatment time (Oishi et al 2012). Physical inactivity can lead to significant weight gain, muscle wasting and an increased risk of other comorbidities such as cardiovascular disease, anxiety and depression (Finlay & Mark 2017).…”

Exercise and physical activity for people receiving peritoneal dialysis: Why not?

“…16 Furthermore, frailty and sarcopenia can lead to fracture, hospitalization, and death. The association between muscle strength, inflammation, and mortality and poor physical function in dialysis patients 17 suggests this is a significant issue for people receiving PD.…”

Counteracting the Metabolic Effects of Glucose Load in Peritoneal Dialysis Patients; an Exercise-Based Approach

“…Another study reported a high prevalence of low-performance capacity among elderly patients treated with PD. Interestingly, performance level of PD patients did not appear to differ from the cohort of non-dialysis CKD patients [48]. Objectively measured physical function and ability to perform activities of daily living and self-care have been reported to be reduced across the CKD-Dialysis-Transplant spectrum [49].…”