Decreased mobility after starting dialysis is an independent risk factor for short‐term mortality after initiation of dialysis

Arai, Yohei; Kanda, Eiichiro; Kikuchi, Hiroaki; Yamamura, Chisato; Hirasawa, Suguru; Aki, Shota; Inaba, Naoto; Aoyagi, Makoto; Tanaka, Hiroyuki; Tamura, Tomohide; Sasaki, Sei

doi:10.1111/nep.12202

Cited by 20 publications

(30 citation statements)

References 30 publications

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“…The prevalence of impaired mobility in patients reaching ESRD was 7%-34% among the included studies (32)(33)(34)(35)(36)(37)(38)(39). Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Association Of Functional or Cognitive Impairment And Frailtmentioning

confidence: 99%

“…Nine studies addressed mobility, and all nine reported immobility to be significantly associated with a higher risk of mortality, independent of sex and calendar age (32)(33)(34)(35)(36)(37)(38)(39)(40). Mobility status was assessed in all studies by using data on whether the patient was dependent for transfers and walking without objectifying actual mobility (for instance, by measuring gait speed).…”

Section: Association Of Functional or Cognitive Impairment And Frailtmentioning

confidence: 99%

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Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

Kallenberg¹,

Kleinveld²,

Dekker

et al. 2016

CJASN

159

124

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Background and objectives Older patients reaching ESRD have a higher risk of adverse health outcomes. We aimed to determine the association of functional and cognitive impairment and frailty with adverse health outcomes in patients reaching ESRD. Understanding these associations could ultimately lead to prediction models to guide tailored treatment decisions or preventive interventions.Design, setting, participants, & measurements We searched MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, PsycINFO, and COCHRANE for original studies published until February 8, 2016 reporting on the association of functional or cognitive impairment or frailty with adverse health outcome after follow-up in patients reaching ESRD either with or without RRT.Results Of 7451 identified citations, we included 30 articles that reported on 35 associations. Mean age was .60 years old in 73% of the studies, and geriatric conditions were highly prevalent. Twenty-four studies (80%) reported on functional impairment, seven (23%) reported on cognitive impairment, and four (13%) reported on frailty. Mortality was the main outcome measure in 29 studies (97%), and one study assessed functional status trajectory. In 34 of 35 (97%) associations reported, functional or cognitive impairment or frailty was significantly and independently associated with adverse health outcomes. The majority of studies (83%) were conducted in selected patient populations, mainly patients on incident dialysis.Conclusions Functional and cognitive impairment and frailty in patients reaching ESRD are highly prevalent and strongly and independently associated with adverse health outcomes, and they may, therefore, be useful for risk stratification. More research into their prognostic value is needed.

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Section: Association Of Functional or Cognitive Impairment And Frailtmentioning

confidence: 99%

Section: Association Of Functional or Cognitive Impairment And Frailtmentioning

confidence: 99%

Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

Kallenberg¹,

Kleinveld²,

Dekker

et al. 2016

CJASN

159

124

View full text Add to dashboard Cite

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“…Depressive symptoms were present in 24%-55% of patients in the studies that applied a systematic assessment (20,23,27,35), whereas the prevalence of the International Statistical Classification of Diseases diagnosis depression ranged from 4% to 28% (23,29,39,41). Prevalence of cognitive impairment ranged from 6% to 13% in general (25,26,29,31,40) and was 41% in the very old (18). No studies assessed the relation between falls or social environment and poor outcome in the incident dialysis population.…”

Section: Assessment and Prevalence Of Geriatric Impairmentsmentioning

confidence: 99%

“…However, when focusing on the database studies, which included the vast majority of patients, depressive symptoms were associated with mortality in two studies (OR, 1.30; 95% CI, 1.00 to 1.60 [41] and OR, 1.08; 95% CI, 1.01 to 1.14 [35]), and in one study, depression was associated with noncardiovascular mortality (HR, 1.94; 95% CI, 1.10 to 3.42 [20]). In elderly patients, impaired mobility was associated with 1-year mortality in an univariate analysis of a single publication (OR, 4.22; 95% CI, 1.87 to 9.57) (18), and total dependence for transfers was independently associated with 3-and 6-month mortality (OR, 6.53; 95% CI, 5.38 to 7.92 and OR, 1.7; 95% CI, 1.4 to 2.0, respectively) (25,26). Dependence in ADLs was associated with mortality in two of three studies (OR, 1.41; 95% CI, 1.08 to 1.85) (31,42).…”

Section: Relation Of Geriatric Impairments and Mortalitymentioning

confidence: 99%

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The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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Background and objectives With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most vulnerable among these patients might benefit from conservative therapy. Whether assessment of geriatric impairments would contribute to the decision-making process of dialysis initiation is unknown.Design, setting, participants, & measurements A systematic Medline and Embase search was performed on December 1, 2015 to identify studies assessing the association between risk of mortality or hospitalization and one or more geriatric impairments at the start of dialysis therapy, including impairment of cognitive function, mood, performance status or (instrumental) activities of daily living, mobility (including falls), social environment, or nutritional status.Results Twenty-seven studies were identified that assessed one or more geriatric impairments with respect to prognosis. The quality of most studies was moderate. Only seven studies carried out an analysis of elderly patients ($70 years old). Malnutrition and frailty were systematically assessed, and their relation with mortality was clear. In addition, cognitive impairment and functional outcomes at the initiation of dialysis were related to an increased mortality in most studies. However, not all studies applied systematic assessment tools, thereby potentially missing relevant impairment. None of the studies applied a geriatric assessment across multiple domains.Conclusions Geriatric impairment across multiple domains at dialysis initiation is related to poor outcome. However, information in the elderly is sparse, and a systematic approach of multiple domains with respect to poor outcome has not been performed. Because a geriatric assessment has proved useful in predicting outcome in other medical fields, its potential role in the ESRD population should be the subject of future research.

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Bioengineering Organs for Blood Detoxification

Legallais

Kim

Mihaila

et al. 2018

Adv Healthcare Materials

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For patients with severe kidney or liver failure the best solution is currently organ transplantation. However, not all patients are eligible for transplantation and due to limited organ availability, most patients are currently treated with therapies using artificial kidney and artificial liver devices. These therapies, despite their relative success in preserving the patients' life, have important limitations since they can only replace part of the natural kidney or liver functions. As blood detoxification (and other functions) in these highly perfused organs is achieved by specialized cells, it seems relevant to review the approaches leading to bioengineered organs fulfilling most of the native organ functions. There, the culture of cells of specific phenotypes on adapted scaffolds that can be perfused takes place. In this review paper, first the functions of kidney and liver organs are briefly described. Then artificial kidney/liver devices, bioartificial kidney devices, and bioartificial liver devices are focused on, as well as biohybrid constructs obtained by decellularization and recellularization of animal organs. For all organs, a thorough overview of the literature is given and the perspectives for their application in the clinic are discussed.

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Decreased mobility after starting dialysis is an independent risk factor for short‐term mortality after initiation of dialysis

Abstract: Not only impaired mobility at the start of dialysis but also a decline in mobility after starting dialysis is associated with short-term mortality after initiation of dialysis.

Cited by 20 publications

References 30 publications

Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

Functional and Cognitive Impairment, Frailty, and Adverse Health Outcomes in Older Patients Reaching ESRD—A Systematic Review

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Bioengineering Organs for Blood Detoxification

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