Loss of appendicular muscle mass in haemodialysis patients is associated with increased self‐reported depression, anxiety and lower general health scores

Alston, Helen; Burns, Áine; Davenport, Andrew

doi:10.1111/nep.13075

Cited by 33 publications

(28 citation statements)

References 42 publications

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“…As part of UK National Health Service guidelines to request patient feedback on treatment received, all patients attending for routine outpatient dialysis treatments under the care of a university hospital were asked to complete a questionnaire recording the frequency of dialysis-associated symptoms and time to recovery using a previously reported visual analogue scale [4,14], and also a distress thermometer score, a screening tool for assessing psychological stress [19]. Hospital-computerised medical records were reviewed to obtain co-morbidity which had been recorded according to the Stoke-Davies grading [20] and frailty using the Canadian geriatric frailty score [21].…”

Section: Methodsmentioning

confidence: 99%

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

2019

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Background: Dialysis is a life-sustaining treatment, but many patients suffer symptoms during dialysis and take time to recover. Previous reports have linked recovery time to intra-dialytic hypotension and rapid solute clearances, whereas others have reported an association with psychological factors. As such, we wished to investigate which factors were important in determining symptom self-reporting and delayed recovery times. Methods: We recorded self-reported patient intra-dialytic symptoms, recovery times along with sessional dialysis prescriptions, blood pressure and urea clearance, and distress thermometer scores to assess psychological factors. Findings: Six hundred twenty-three dialysis patients were studied; 621 treated by haemodiafiltration, 60.8% male, mean age 64.5 ± 16.2 years, and 46.1% diabetic. Almost half (49.6%) reported recovery within 1 h. On multivariate analysis, patient self-reported symptom scores were associated with longer post-dialysis recovery times (odds ratio (OR) 1.61, 95% confidence limits (CL) 1.33-1.95), higher distress thermometer scores (OR 1.3 CL (1.3-1.39), but lower hand grip strength (OR 0.85 CL (0.93-0.94), all p < 0.001, and younger rather than older patients (OR 0.98 CL (0.97-0.99) p = 0.005. We found no association with ultrafiltration rates or weight loss.Discussion: Compared to earlier studies, our patients treated by haemodiafiltration reported fewer symptoms and shorter recovery times. Patients with higher self-reported distress thermometer scores had both longer post-dialysis recovery times and greater dialysis symptom scores. Younger patients reported more dialysis symptoms and longer recovery times than older patients. Future studies investigating patient self-reported recovery times and dialysis-associated symptoms should also consider interventions to reduce patient psychological factors as well as dialysis practices.

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Section: Methodsmentioning

confidence: 99%

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

2019

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“…In the present study, the prevalence of SARC-F ≥4 was higher among hemodialysis patients than among the general community-dwelling elderly population [12][13][14]. Patients with chronic kidney disease are more likely to experience greater muscle loss and decreased physical function, termed sarcopenia, because of a combination of multiple factors, including metabolic acidosis, vitamin D deficiency, insulin resistance, anemia, reduced physical activity, testosterone deficiency in men, protein losses with dialysis, dietary restrictions, and depression [7,8,29]. Moreover, in the present study, the prevalence of SARC-F ≥4 increased with age, comorbidities, depressive symptoms, and frailty, in agreement with the findings of previous studies [12,13,15,30].…”

Section: Discussionmentioning

confidence: 55%

“…Sarcopenia may be more severe among vulnerable populations, such as those with end-stage renal disease. In hemodialysis patients, the prevalence of sarcopenia was reported to be between 12.7% and 33.7% [4][5][6], and those with sarcopenia have an increased risk of fractures, anxiety, depression, cardiovascular complications, and mortality [4,[7][8][9]. Therefore, early identification and interventions for hemodialysis patients with sarcopenia are essential for effective disease management.…”

Section: Introductionmentioning

confidence: 99%

SARC‐F Questionnaire: Rapid and Easy Tool for Identifying Physical Limitations in Hemodialysis Patients

Yamamoto

Matsuzawa

Harada

et al. 2019

JCSM Clinical Reports

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Background SARC-F is a simple questionnaire for rapidly assessing physical function and screening for sarcopenia. This study aimed to determine whether the SARC-F questionnaire is useful for identifying impaired physical function and the risk of physical limitations in hemodialysis patients. Methods and resultsThis cross-sectional study included 281 patients undergoing hemodialysis at two dialysis units. SARC-F, handgrip strength, leg strength, one-leg standing time, usual gait speed, and short physical performance battery (SPPB) score were measured. Patients were classified according to the SARC-F score (SARC-F <4 and SARC-F ≥4), indicating the risk of sarcopenia. Furthermore, we defined physical limitations as handgrip strength of <26 kg for men and <18 kg for women, leg strength of <40%, usual gait speed of ≤0.8 m/s, and SPPB score of ≤8 points. To calculate the areas under the curves (AUCs) of the SARC-F score for physical limitations, receiver-operating characteristic curve analysis was performed. SARC-F ≥4 was observed in 75 (26.7 %) hemodialysis patients. The SARC-F ≥4 group had a significantly lower handgrip and leg strength, shorter one-leg standing time, slower usual gait speed, and lower SPPB score than the SARC-F <4 group, even after adjusting for potential confounders (all P <0.001). Further, SARC-F demonstrated good accuracy in identifying the risk of physical limitations (all AUCs > 0.75). Conclusions The SARC-F questionnaire is useful for screening impaired physical function and for identifying the risk of physical limitations in hemodialysis patients and can be easily and rapidly administered to this patient group in clinical practice.

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“…However, as our home HD patient numbers had fallen from 21 in 2015 to 8 in 2019, we reviewed our shared-care policy. [6][7][8] However, previous studies have reported that older more co-morbid dialysis patients report less depression and lower distress thermometer scores than younger healthier patients, 24 and older patients generally have lower dietary intake, which may account for no differences in potassium or phosphate control. As probably expected, patients who performed shared-HD care were younger, had lower frailty 16 and functional Karnofsky scores 17 and less co-morbidity including diabetes, 18 and were physical stronger compared to those who were dependent upon the dialysis center staff.…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, there were no differences in potential markers of compliance with dietary restriction in terms of potassium and phosphate control, or volume control as assessed by NTproBNP and fluid removal on dialysis, which would appear to contradict Orem's self-care model and other psychological theorems which have suggested that patients who take greater care of their own medical care have less depression, and are more motivated to perform and promote activities designed to maintain improve health care. [6][7][8] However, previous studies have reported that older more co-morbid dialysis patients report less depression and lower distress thermometer scores than younger healthier patients, 24 and older patients generally have lower dietary intake, which may account for no differences in potassium or phosphate control. 25 Dialysis sessions, dialysis adequacy, ultrafiltration rates, changes in blood pressure during dialysis, and frequency of symptomatic intra-dialytic hypotension requiring nursing interventions did not differ.…”

Section: Discussionmentioning

confidence: 99%

The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control

Maharjan

Davenport

2019

Hemodialysis International

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Introduction: Traditionally hemodialysis (HD) treatments are undertaken by dialysis staff. Self-care has been reported to improve psychological well-being and treatment compliance for patients with chronic diseases. We evaluated our shared-care HD program to determine whether shared-care benefits patients.Methods: We reviewed the electronic health care and HD sessional records and psychological distress thermometer (DT) scores of patients in our HD centers. HD shared care was classified as grade 0-none, grade 1 patients weighing themselves and measuring blood pressure (BP), grade 2 performs HD, and grade 3 additionally troubleshoots problems.Findings: We reviewed 675 HD patients; mean age 64.1 AE 16.3 years, 62.3% male, 45.9% diabetic, Stoke-Davies co-morbidity grade 1 (1-1), frailty score 4 (3-5), DT 3 (0-5). 60.3% performed no shared care, 19% grade 1, 14.8% grade 2, and 6% grade 3. Patients performing more shared care were younger, less frail, less co-morbid, and physically stronger. We then propensity matched 113 patients with grade ≥ 2 shared care for age and frailty with 113 no shared-care patients. Fewer shared-care patients were prescribed antihypertensives (50.7 vs. 70.7%, P < 0.01), and had lower serum N terminal probrain natriuretic peptide 3033 (1083-8502) vs. 4814(1514-135821) pg/mL), phosphate (1.62 AE 0.49 vs. 1.78 AE 0.62 mmol/L), and higher albumin (40.7 AE 4.3 vs. 38.0 AE 4.3 g/ L), all P < 0.05 but no differences in psychological DT scores.Discussion: Although there was no significant benefit in psychological well-being, as measured by the self-reported DT, patients performing more shared care demonstrated other benefits in terms of blood pressure and volume control.

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Loss of appendicular muscle mass in haemodialysis patients is associated with increased self‐reported depression, anxiety and lower general health scores

Cited by 33 publications

References 42 publications

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

Patient-reported intra-dialytic symptoms and post-dialysis recovery times are influenced by psychological distress rather than dialysis prescription

SARC‐F Questionnaire: Rapid and Easy Tool for Identifying Physical Limitations in Hemodialysis Patients

The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control

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