Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study

Abstract

Background: Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods: This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3-5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results: In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47-0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion: We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.

Oral function, nutritional status and physical status in Japanese independent older adults

“…In the present study, there was no direct association between ODK and frailty, which was different from other studies 33,34 . The reason may depend on a mediator of nutritional status.…”

“…In the present study, there was no direct association between ODK and frailty, which was different from other studies. 33,34 The reason may depend on a mediator of nutritional status. The previous studies did not include nutritional status to assess the association between ODK and frailty.…”

Association between dry mouth and physical frailty among community‐dwelling older adults in Japan: The Otassha Study

“…The main finding of the present study was that the severity of xerostomia was an independent factor associated with physical frailty, even after adjusting for the effects of confounding factors, such as general health status and oral function, which were reported to be associated with physical frailty in previous multivariate F I G U R E 2 Correlation between the Summated Xerostomia Inventory score and the amount of resting saliva analyses. 4,10,39,40,44,45 Ramsay et al 16 reported that the accumulated xerostomia status was associated with physical frailty among older British men. We confirmed similar findings in this study, which targeted community-dwelling men and women in Japan.…”

“…The models included the severity of physical frailty as the outcome. Based on previous studies, [11][12][13]17,[37][38][39][40][41] the following variables were considered covariates: age, sex, number of comorbidities, polypharmacy, smoking status, cognitive impairment, wellbeing status, BMI, educational status, number of present teeth, articulatory oral motor skill and chewing ability. We prepared the directed acyclic graph (DAG) to identify the variables that required adjustment in the multivariable models and thereby minimise the effects of confounding bias and avoid over-adjustment of the variables.…”

Relationships between cystatin C and creatinine‐based eGFR with low tongue pressure in Japanese rural community‐dwelling older adults

“…It was reported that there is a high prevalence of frailty in patients with chronic kidney disease (CKD) and a significant association between frailty and motor skills, affecting swallowing in patients with CKD (Kosaka et al, 2020 ). Kamijo et al ( 2018 ) reported that in peritoneal dialysis patients, low tongue pressure is a risk factor for sarcopenia.…”