Sarcopenia and Frailty: Challenges in Mainstream Nephrology Practice

Wong, Limy; Duque, Gustavo; McMahon, Lawrence P.

doi:10.1016/j.ekir.2021.05.039

Cited by 30 publications

(33 citation statements)

References 101 publications

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“…However, protein restriction may inhibit hepatic albumin synthesis [ 138 ], which might be further suppressed by inflammatory signals [ 139 ], characterizing DN [ 140 ]. Furthermore, diabetes [ 141 ] as well as CKD [ 142 ] are associated with sarcopenia, and the likelihood of sarcopenia among diabetics increases 2.54-fold in the presence of DN [ 141 ]. Renal protein wasting, discussed above, possibly contributes to sarcopenia, and intuitively one would favor enriched protein intake rather than a low-protein diet specifically in this population.…”

Section: Clinical Perspectivesmentioning

confidence: 99%

Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

Heyman

Dwyer

Sibony

et al. 2022

Cells

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Albuminuria, a hallmark of diabetic nephropathy, reflects not only injury and dysfunction of the filtration apparatus, but is also affected by altered glomerular hemodynamics and hyperfiltration, as well as by the inability of renal tubular cells to fully retrieve filtered albumin. Albuminuria further plays a role in the progression of diabetic nephropathy, and the suppression of glomerular albumin leak is a key factor in its prevention. Although microalbuminuria is a classic manifestation of diabetic nephropathy, often progressing to macroalbuminuria or overt proteinuria over time, it does not always precede renal function loss in diabetes. The various components leading to diabetic albuminuria and their associations are herein reviewed, and the physiologic rationale and efficacy of therapeutic interventions that reduce glomerular hyperfiltration and proteinuria are discussed. With these perspectives, we propose that these measures should be initiated early, before microalbuminuria develops, as substantial renal injury may already be present in the absence of proteinuria. We further advocate that the inhibition of the renin–angiotensin axis or of sodium–glucose co-transport likely permits the administration of a normal recommended or even high-protein diet, highly desirable for sarcopenic diabetic patients.

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Section: Clinical Perspectivesmentioning

confidence: 99%

Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

Heyman

Dwyer

Sibony

et al. 2022

Cells

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“…Biologisch alte Dialysepatienten haben geringe physiologische Reserven und damit ein erhöhtes Risiko für Krankheit und Tod. Diese Besonderheiten alter Dialysepatienten beschreibt am besten das Frailty-Konzept: Der angelsächsische Begriff beschreibt eine erhöhte Vulnerabilität infolge zunehmender Anhäufung körperlicher und psychosozialer Defizite infolge eines altersbedingten Abbaus verschiedener Organsysteme 6 , 7 . Frailty ist damit nicht identisch mit Multimorbidität und Gebrechlichkeit, aber ein Konzept für das erhöhte gesundheitliche Risiko während des Alterns.…”

Section: Der Alte Dialysepatientunclassified

“…bioelektische Impedanzanalyse (BIA): misst den Ernährungszustand und die Muskelmasse 6 , 20 , 29 , 30…”

Section: Physical Performance: Testen Messen Verfolgenunclassified

“…Unver-ändert zeigen Nephrologen jedoch ein großes Interesse an diesem Thema, da die Verordnung von "Sporttherapie während der Dialyse" wie kein anderes Medikament zahlreiche positive Effekte auf die Patienten hat und zu einem längeren und besseren Leben unserer Patienten beiträgt. Organsysteme [6,7]. Frailty ist damit nicht identisch mit Multimorbidität und Gebrechlichkeit, aber ein Konzept für das erhöhte gesundheitliche Risiko während des Alterns.…”

Section: Introductionunclassified

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Sport und Bewegungsmöglichkeiten bei älteren Dialysepatienten

Degenhardt¹,

Anding-Rost

2022

Dialyse aktuell

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ZUSAMMENFASSUNGAlte Dialysepatienten sind in besonderem Maße durch Bewegungsmangel und Inaktivität gefährdet. Wir stellen hier sowohl den aktuellen Stand der Diskussion als auch eigene Erfahrungen mit „Sport während der Dialyse“ vor. Mit praktischen Hinweisen machen wir Vorschläge, wie ein Trainingsprogramm an der Dialyse gestaltet werden kann. Größte Hindernisse für die Umsetzung einer Dialysetrainingstherapie während der Hämodialyse sind die Unkenntnis über Wirksamkeit und Umsetzung der Trainingsprogramme sowie eine bisher noch weitgehend fehlende Finanzierung durch das Gesundheitssystem.

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“… 9 Based on data from 41 randomised controlled trials (RCT), Heiwe et al reported practical improvements in aerobic capacity, muscular function and walking capacity in patients with CKD after exercise, 10 indicators that are the core of frailty. 11 In other words, exercise is an essential non-pharmacological strategy to improve frailty symptoms in patients with CKD, the latter being a significant cause of sedentary behaviour in such population. 12 Because of this, some researchers and guidelines recommend that healthcare providers prescribe exercise for patients with CKD.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic effects of exercise interventions for patients with chronic kidney disease: an umbrella review of systematic reviews and meta-analyses

et al. 2022

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ObjectiveTo conduct an overview of meta-analyses evaluating the impact of exercise interventions on improving health outcomes in patients with chronic kidney disease (CKD).DesignAn umbrella review of systematic review and meta-analyses of intervention trials was performed.Data sourcesPubMed, Web of Science, Embase and the Cochrane Database of Systematic Reviews were searched from inception to 9 March 2021 for relevant articles.Eligibility criteria for selecting studiesEligible meta-analyses compared the effects of usual care with and without exercise in patients with CKD. Health outcomes included those related to cardiovascular risk factors, physical fitness, dialysis-related symptoms, dialysis adequacy and health-related quality of life. Systematic reviews and meta-analyses that included fewer than 3 RCTs or fewer than 100 participants were excluded from the analysis.ResultsA total of 31 eligible systematic reviews and meta-analyses were included that assessed 120 outcomes. For physical fitness, there was a moderate effect size for cardiorespiratory fitness, muscle strength and body composition and small effect size for muscle endurance. The effect sizes for cardiovascular risk factors, dialysis-related symptoms and health-related quality of life outcomes were small. According to the Grading of Recommendations Assessment, Development and Evaluation framework, most outcomes were low or very low quality.ConclusionExercise appears to be a safe way to affect concomitant cardiovascular risk factors, such as blood pressure, improve physical fitness and health-related quality of life and reduce dialysis-related symptoms in patients with CKD.PROSPERO registration numberCRD42020223591.

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Sarcopenia and Frailty: Challenges in Mainstream Nephrology Practice

Cited by 30 publications

References 101 publications

Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

Diabetic Proteinuria Revisited: Updated Physiologic Perspectives

Sport und Bewegungsmöglichkeiten bei älteren Dialysepatienten

Therapeutic effects of exercise interventions for patients with chronic kidney disease: an umbrella review of systematic reviews and meta-analyses

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