Muscle strength, mobility, quality of life and falls in patients on maintenance haemodialysis: A prospective study

Wang, Amanda Y; Sherrington, Catherine; Toyama, Tadashi; Gallagher, Martin; Cass, Alan; Hirakawa, Yochiro; Li, Qiang; Sukkar, Louisa; Snelling, Paul; Jardine, Meg

doi:10.1111/nep.12749

Cited by 32 publications

(24 citation statements)

References 28 publications

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“…Our findings on the robust, independent association between SPPB‐derived lower extremity function and mortality are consistent with previous reports of the association between the SPPB and dialysis risk in prevalent ESRD patients . Our study extends these findings from prevalent ESRD patients to KT recipients who are very highly selected from the dialysis population and who undergo an invasive procedure with subsequent immunosuppression.…”

Section: Discussionsupporting

confidence: 91%

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

Nastasi

McAdams‐DeMarco

Schrack

et al. 2018

American Journal of Transplantation

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†Co-first authors.Prediction models for post-kidney transplantation mortality have had limited success (C-statistics ≤0.70). Adding objective measures of potentially modifiable factors may improve prediction and, consequently, kidney transplant (KT) survival through intervention. The Short Physical Performance Battery (SPPB) is an easily administered objective test of lower extremity function consisting of three parts (balance, walking speed, chair stands), each with scores of 0-4, for a composite score of 0-12, with higher scores indicating better function. SPPB performance and frailty (Fried frailty phenotype) were assessed at admission for KT in a prospective cohort of 719 KT recipients at Johns Hopkins Hospital (8/2009 to 6/2016) and University of Michigan (2/2013 to 12/2016). The independent associations between SPPB impairment (SPPB composite score ≤10) and composite score with post-KT mortality were tested using adjusted competing risks models treating graft failure as a competing risk. The 5-year posttransplantation mortality for impaired recipients was 20.6% compared to 4.5% for unimpaired recipients (p < 0.001). Impaired recipients had a 2.30-fold (adjusted hazard ratio [aHR] 2.30, 95% confidence interval [CI] 1.12-4.74, p = 0.02) increased risk of postkidney transplantation mortality compared to unimpaired recipients. Each one-point decrease in SPPB score was independently associated with a 1.19-fold (95% CI 1.09-1.30, p < 0.001) higher risk of post-KT mortality. SPPB-derived lower extremity function is a potentially highly useful and modifiable objective measure for pre-KT risk prediction.

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Section: Discussionsupporting

confidence: 91%

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

Nastasi

McAdams‐DeMarco

Schrack

et al. 2018

American Journal of Transplantation

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“…In our study age was an independent predictor of reduced HRQoL. This may be explained as a combination of the burden of kidney disease and aging in general, which is known to affect HRQoL …”

Section: Discussionmentioning

confidence: 48%

“…It is possible that the reduction in physical function and the loss of freedom is experienced differently for men than women in this elderly population . Both genders experience a worsened HRQoL during the first year on the waiting list suggesting that the waiting time and the reduced kidney function may itself be a burden …”

Section: Discussionmentioning

confidence: 99%

Changes in health‐related quality of life in older candidates waiting for kidney transplantation

et al. 2018

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“…From a preventive and rehabilitative point of view, this syndrome is a potentially modifiable risk factor, as previous studies conducted in HD populations have shown that single frailty components, such as low physical activity, muscle strength, and slow gait speed can be improved following exercise-based interventions [11]. Although frailty has been consistently shown to be associated with falls in HD patients [4,12,13], few studies have explored the relationship between objective frailty-related physical function measures and falls [1,2,4,12,14,15]. Results from these studies seem to indicate that, in predicting falls, composite indices of physical function [14,15] may be more useful than single component assessments [2].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

“…Although frailty has been consistently shown to be associated with falls in HD patients [4,12,13], few studies have explored the relationship between objective frailty-related physical function measures and falls [1,2,4,12,14,15]. Results from these studies seem to indicate that, in predicting falls, composite indices of physical function [14,15] may be more useful than single component assessments [2]. However, the identification of which individual frailty/ physical function components may be more closely associated with falls is of paramount importance, as this would eventually allow exercise-based rehabilitation programs to be tailored to reduce the occurrence of falls in CKD-5 patients on HD.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: a prospective cohort study

et al. 2020

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Background: Stage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls. Previous research has shown that frailty is one of the primary contributors to the increased risk of falling in this clinical population. However, HD patients often present with abnormalities of cardiovascular function such as baroreflex impairment and orthostatic dysregulation of blood pressure (BP) which may also be implicated in the aetiology of falling. Therefore, we aimed to explore the relative importance of frailty and cardiovascular function as potential exercise-modifiable predictors of falls in these patients. Methods: Ninety-three prevalent CKD-5 patients on HD from three Renal Units were recruited for this prospective cohort study, which was conducted between October 2015 and August 2018. At baseline, frailty status was assessed using the Fried's frailty phenotype, while physical function was evaluated through timed up and go (TUG), five repetitions chair sit-to-stand (CSTS-5), objectively measured physical activity, and maximal voluntary isometric strength. Baroreflex and haemodynamic function at rest and in response to a 60°head-up tilt test (HUT-60°) were also assessed by means of the Task Force Monitor. The number of falls experienced was recorded once a month during 12 months of follow-up.Results: In univariate negative binomial regression analysis, frailty (RR: 4.10, 95%CI: 1.60-10.51, p = 0.003) and other physical function determinants were associated with a higher number of falls. In multivariate analysis however, only worse baroreflex function (RR: 0.96, 95%CI: 0.94-0.99, p = 0.004), and orthostatic decrements of BP to HUT-60°(RR: 0.93, 95%CI: 0.87-0.99, p = 0.033) remained significantly associated with a greater number of falls. Eighty falls were recorded during the study period and the majority of them (41.3%) were precipitated by dizziness symptoms, as reported by participants.(Continued on next page)

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Muscle strength, mobility, quality of life and falls in patients on maintenance haemodialysis: A prospective study

Cited by 32 publications

References 28 publications

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

Pre-Kidney Transplant Lower Extremity Impairment and Post-Kidney Transplant Mortality

Changes in health‐related quality of life in older candidates waiting for kidney transplantation

The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: a prospective cohort study

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