Subjective and objective physical limitations in high-functioning renal dialysis patients

Blake, Catherine; O'Meara, Yvonne M.

doi:10.1093/ndt/gfh538

Cited by 53 publications

(56 citation statements)

References 17 publications

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“…This type of assessment of physical performance has been widely used in the study of CKD patients [13], and well validated against more detailed assessments [14].…”

Section: Functional Muscle Assessmentmentioning

confidence: 99%

Functional Electrical Stimulation to the Dorsiflexors and Quadriceps in Children with Cerebral Palsy

Linden

Hazlewood

Hillman

et al. 2008

Pediatric Physical Therapy

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Background. Chronic renal replacement therapy patients exhibit reduction in skeletal muscle function as a result of a combination of metabolic effects and muscle fibre size reduction. The aim of this study was to compare muscle mass with function in patients with chronic kidney disease (CKD) at stages 4 and 5 on haemodialysis (HD) and peritoneal dialysis (PD), and investigate the associations of muscle wasting in a cross-sectional cohort. Methods. We studied 134 patients (60 HD, 28 PD and 46 CKD 4). The three groups were well matched for age, sex, diabetes and dialysis vintage. Cross-sectional area (CSA) of muscle and fat was measured from a standardized multi-slice CT scan of a 6 cm long section of thigh. CSA of soft tissue was taken from appropriate fat and muscle densities. Functional assessment was by the sit-to-stand 60 test, assessing both the number of sit-to-stands possible under controlled conditions in 60 s (STS 60), and the time taken to perform five sit-to-stand movements (STS 5). Data were collected on a wide range of potential determinants of muscle CSA.Results. There were no significant differences in haemoglobin between males or females or between any of the groups studied. Serum phosphate and calcium-phosphate product were higher in HD patients as compared to CKD4 patients, but there were no differences in these variables when comparing PD patients with either CKD4 or HD patients. Muscle CSA correlated well with objective functional assessments in males (STS 60 R ¼ 0.52, P<0.0001) and females (R ¼ 0.41, P ¼ 0.004), and STS performance was reduced in dialysed patients as compared with CKD 4. Univariate analysis demonstrated that muscle CSA was associated with serum albumin concentration (R ¼ 0.49, P<0.0001), age (R ¼ À0.35, P ¼ 0.005) and C-reactive protein (R ¼ À0.34, P ¼ 0.004). Creatinine clearance, dialysis adequacy, dialysis vintage and timeaveraged serum bicarbonate, calcium and phosphate concentrations were not correlated with muscle CSA. Conclusion. In conclusion, patients with dialysistreated CKD 5 exhibited more functionally significant muscle wasting than patients with CKD 4. This may be amenable to modification with targeted exercise or amelioration of factors associated with observed differences in muscle mass.

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“…This type of assessment of physical performance has been widely used in the study of CKD patients [13], and well validated against more detailed assessments [14].…”

Section: Functional Muscle Assessmentmentioning

confidence: 99%

Functional Electrical Stimulation to the Dorsiflexors and Quadriceps in Children with Cerebral Palsy

Linden

Hazlewood

Hillman

et al. 2008

Pediatric Physical Therapy

View full text Add to dashboard Cite

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“…In studying mental function, however, we have the advantage that the defects may be reversible, so that patients can be used as their own controls when different treatments are compared. A further approach, as employed by Blake and O'Meara, 54 is to study selected highfunctioning patients with few comorbidities in whom the effects of uremia may be more easily distinguished. Studies in animals maintained on dialysis should also be considered.…”

Section: How To Assess Benefitmentioning

confidence: 99%

Approaches to Uremia

Meyer

Hostetter

2014

Journal of the American Society of Nephrology

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The development of dialysis was a dramatic step forward in medicine, allowing people who would soon have died because of lack of kidney function to remain alive for years. We have since found, however, that the "artificial kidney" does not live up fully to its name. Dialysis keeps patients alive but not well. Part of the residual illness that dialysis patients experience is caused by retained waste solutes that dialysis does not remove as well as native kidney function does. New means are available to identify these toxic solutes, about which we currently know remarkably little, and knowledge of these solutes would help us to improve therapy. This review summarizes our current knowledge of toxic solutes and highlights methods being explored to identify additional toxic solutes and to enhance the clearance of these solutes to improve patient outcomes.

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“…Without doubt, dialysis as practiced even in 1972 was effective at sustaining life and awakening patients from coma. However, despite some important incremental advances in ESRD care, people living on dialysis today suffer a large number of still largely unaddressed disabilities (Table 1) (1). It is important to note that many also suffer from the complications of their primary disease process, particularly diabetes and hypertension, and even restoration of normal kidney function does not reverse these.…”

Section: Residual Syndrome In Uremiamentioning

confidence: 99%

Searching for Uremic Toxins

Dobre

Meyer

Hostetter

2013

Clinical Journal of the American Society of Nephrology

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SummaryTreatment of uremia by hemodialysis has become widespread over the last 40 years and has improved substantially over that time. However, people treated with this modality continue to suffer from multiple disabilities. Retention of organic solutes, especially those poorly removed by hemodialysis, likely contributes to these disabilities. Certain classes of solutes are removed less well than urea by hemodialysis and by the normal kidney. These include protein-bound solutes, relatively large solutes, sequestered compounds, and substances removed at rates higher than urea by the normal kidney. Several strategies could be used to discover the solutes responsible for residual morbidities in standardly dialyzed people. Rather than continue to focus only on urea removal as an index for dialysis adequacy, finding additional approaches for removing toxic solutes with characteristics different from urea (and the similar small solutes it represents) is a desirable and feasible goal.

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Subjective and objective physical limitations in high-functioning renal dialysis patients

Cited by 53 publications

References 17 publications

Functional Electrical Stimulation to the Dorsiflexors and Quadriceps in Children with Cerebral Palsy

Functional Electrical Stimulation to the Dorsiflexors and Quadriceps in Children with Cerebral Palsy

Approaches to Uremia

Searching for Uremic Toxins

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