Frailty and Protein-Energy Wasting in Elderly Patients with End Stage Kidney Disease

Kim, Jun Chul; Kalantar-Zadeh, Kamyar; Kopple, Joel D.

doi:10.1681/asn.2012010047

Cited by 258 publications

(251 citation statements)

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“…A number of adverse conditions have been associated epidemiologically with these impairments, including physical deconditioning, muscle atrophy, anemia, a propensity toward increased serum inflammatory markers, and lower quality of life. 4,6,7 The relative contributions of these putative causes to impaired exercise capacity and reduced physical performance are not well defined.Another poorly explored area is the clinical consequences to CKD patients who manifest these disorders. No one, to my knowledge, has previously reported whether reduced exercise capacity or physical performance associates with increased morbidity or mortality in nondialyzed CKD patients.…”

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confidence: 99%

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confidence: 99%

“…Further studies will be necessary to examine the causal factors that are responsible for these findings. Given the current high interest in the problem of frailty in CKD patients, 3,5,7 it can be anticipated that much new information on this question will become available in the near future.…”

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Physical Performance and All-Cause Mortality in CKD

Kopple

2013

Journal of the American Society of Nephrology

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It is well documented that measures of exercise capacity and physical performance are impaired in people with ESRD who are undergoing maintenance dialysis therapy. 1-3 Several studies have also described impaired exercise capacity in CKD patients who have lesser degrees of reduced GFR, and who are not receiving chronic dialysis treatment. 4,5 The causes for impaired exercise capacity and physical performance are not entirely clear. A number of adverse conditions have been associated epidemiologically with these impairments, including physical deconditioning, muscle atrophy, anemia, a propensity toward increased serum inflammatory markers, and lower quality of life. 4,6,7 The relative contributions of these putative causes to impaired exercise capacity and reduced physical performance are not well defined.Another poorly explored area is the clinical consequences to CKD patients who manifest these disorders. No one, to my knowledge, has previously reported whether reduced exercise capacity or physical performance associates with increased morbidity or mortality in nondialyzed CKD patients. The article published by Roshanravan et al. in this issue of JASN is unique in that it is the first to address the question of whether physical performance is associated with mortality rates. 8 It examined this question in 385 patients who were not receiving chronic dialysis therapy, but had stage 2-4 CKD. Patients were recruited from two prospective cohorts: the Seattle Kidney Study and the University of Maryland Study of Chronic Kidney Disease. There were some differences in the characteristics of the patients in these two separate cohorts, but these differences would not be expected to invalidate the results of the study. 8 Physical performance was measured by usual gait speed (walking 4 m at the patient's usual pace), timed up and go test (TUAG) (time to stand from a seated position and walk around a cone placed 4 m distant), 6-minute walking distance, and handgrip strength (HGS). For some study participants, the reduction in GFR was rather modest. The inclusion criteria required the estimated GFR (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration study equation 9 to be ,90 ml/min per 1.73 m 2 . Other inclusion criteria were that the patient was not receiving chronic renal replacement treatment at the time of the physical performance assessment, did not have a stroke, was not using a wheel chair, and had completed at least one physical performance measurement. Mortality rate was monitored over a median duration of 3 years.The mean age of the participants was 61613 years, and the mean eGFR was 41619 ml/min per 1.73 m 2 . The results of this innovative study indicate that measures of physical performance of the lower extremities were at least 30% below predicted values and were strongly associated with mortality rates. Each 0.1-m/s decrement in gait speed was associated with a 26% higher risk for all-cause death (hazard ratio, 1.26; 95% confidence interval, 1.09 to 1.47). Each 1-second longer TUAG was associate...

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Physical Performance and All-Cause Mortality in CKD

Kopple

2013

Journal of the American Society of Nephrology

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“…These characteristics and associated pathologies are reviewed elsewhere in the literature, 5,[9][10][11] and while the diagnostic criteria share similarities they are not identical. For example, weight loss is part of the definition of both cachexia in chronic illness and PEW in renal disease, but the duration of the weight loss differs (weight loss of 5% over 6 months in cachexia as opposed to 5% over 3 months in PEW).…”

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“…The evidence-based development of these terms is essential to enable health care professionals to clearly identify and differentiate between such conditions. This greater understanding of the difference and interplay between cachexia, PEW and sarcopenia in ESRD Sarcopenia of old age 9 Cachexia in chronic illness 10 Protein energy wasting in renal disease 5,11 (i) Weight Not stated, but weight gain is expected in obese sarcopenia whereas weight loss can occur otherwise Oedema-free "unintentional" weight loss of at least 5% in 12 months or less in the presence of underlying illness.…”

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