Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis

Mori, Katsuhito; Nishide, Kozo; Okuno, Senji; Shoji, Tetsuo; Emoto, Masanori; Tsuda, Akihiro; Nakatani, Shinya; Imanishi, Yasuo; Ishimura, Eiji; Yamakawa, Tomoyuki; Shoji, Shigeichi; Inaba, Masaaki

doi:10.1186/s12882-019-1271-8

Cited by 100 publications

(136 citation statements)

References 24 publications

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“…These findings suggest that uremia may have a role in the pathogenesis AF, but the mechanism remains to be investigated. While a previous 9-year cohort study in Japan showed that DM was highly associated with all-cause mortality in patients undergoing hemodialysis (adjusted HR: 2.39; p < 0.001) [26], the present study showed that DM was not significantly associated with the risk of mortality. This discrepancy may result from the difference in race, glucose control status or relative short study period of the present study.…”

Section: Discussioncontrasting

confidence: 97%

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

et al. 2020

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BackgroundAtrial fibrillation (AF) is highly prevalent, occurring in 1%-2% of the adult population, increasing the risk of stroke, and resulting in considerable healthcare costs. While stroke is a major complication of AF, end-stage renal disease (ESRD) patients also have a high risk of stroke, suggesting that AF is a possible risk factor for mortality of ESRD patients. However, whether the existence of AF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients remains to be defined.Methods . The end points were mortality of patients or the end of the study. Incident ESRD patients who were on maintenance hemodialysis for more than 3 months were eligible for inclusion. Cox proportional regression and Kaplan-Meier survival curves were used to determine the association between predictors and mortality. The association between AF and echocardiographic parameters, causes of death were also investigated. ResultsOf the 393 incident ESRD patients at initiation of hemodialysis, 57 (14.5%) had AF and the median age was 71 years. Patients with AF were significantly older; showed significantly higher C-reactive protein levels, more heart failure, chronic obstructive pulmonary disease and mortality. Multivariate Cox regression showed that AF had a hazard ratio of 4.1 (95% confidence interval: 2.4-7.0) for mortality. Age-specific analysis showed that AF was significantly associated with mortality in all age groups. Echocardiography measurements including ejection fraction and left ventricular hypertrophy (LVH) were similar in AF and non-AF patients. Cause-specific analysis showed that AF significantly associated with overall cardiovascular death and death due to acute myocardial infarction/coronary artery disease and sepsis. ConclusionsAF at the initiation of hemodialysis predicts higher mortality risk of incident ESRD patients regardless of age. The systolic function and degree of LVH were similar in AF and non-AF patients. The association between AF and sepsis-related death suggested the role of systemic inflammation on the pathogenesis of AF.

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Section: Discussioncontrasting

confidence: 97%

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

et al. 2020

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“…The inverse relationship between Kt/V and physical performance was consistently shown in other studies, suggesting that this relationship is likely to be a universal phenomenon [24,34,36,46]. We speculate that the low muscle mass and subsequent decreased volume of distribution of urea in the body (V) in patients with low GS and HS resulted in a relative increase in the value of Kt/V without affecting the true dialysis efficacy [47].…”

Section: Discussionsupporting

confidence: 61%

“…Compared to the elderly population, in which the prevalence of sarcopenia is 11% [33], CKD patients are likely to be much more prone to its occurrence, with an estimated prevalence of 30 -60% [20,21,24,[34][35][36]. The two main components of sarcopenia, muscle strength and mass, are dissociated in the setting of ESRD, and the muscle strength is more important than muscle mass in terms of patient outcomes [20,35].…”

Section: Discussionmentioning

confidence: 99%

“…As shown in Table 2, GS and HS were significantly associated with comorbidity scores and poor physical status (Charlson comorbidity scores of 4 [2,4] vs. 4 [3,5] vs. 5 [3,5] vs. 5 [4,5] and Liu comorbidity scores of 4 [3,5] vs. 4 [3,6] vs. 6 [4,7] vs. 6 [4,7] for the normal GS and HS, normal GS and low HS, low GS and normal HS, and low GS and HS groups, respectively; p < 0.001 for both comparisons). In addition, patients with low GS and HS showed profoundly impaired cognitive functioning as assessed by the MMSE and the KDQOL-SF (28 [26,29] vs. 27 [24,28] vs. 27 [25,30] vs. 27 [23,29] low GS and HS groups; p = 0.030 and 0.007, respectively). The social activity index was relatively maintained in the low GS and HS groups.…”

Section: Associations Among Physical Performance Comorbidity Index Smentioning

confidence: 99%

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Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

Lee

Kim

Jung

et al. 2020

Preprint

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Background Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance.Methods We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.Results The prevalence of low gait speed and handgrip strength was 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes.Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.

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“…Compared to the elderly population, in which the prevalence of sarcopenia is 11% [32], CKD patients are likely to be much more prone to its occurrence, with an estimated prevalence of 30 -60% [20,21,24,[33][34][35]. The two main components of sarcopenia, muscle strength and mass, are dissociated in the setting of ESRD, and the muscle strength is more important than muscle mass in terms of patient outcomes [20,34].…”

Section: Discussionmentioning

confidence: 99%

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

Lee

Kim

Jung

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance. Methods We obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia. Results The prevalence of low gait speed and handgrip strength was 28.2% and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes. Conclusion Gait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.

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Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis

Cited by 100 publications

References 24 publications

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

The influence of atrial fibrillation on the mortality of incident ESRD patients undergoing maintenance hemodialysis

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

Gait speed and handgrip strength as predictors of all-cause mortality and cardiovascular events in hemodialysis patient

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