Relationship Between Renal Function and Physical Performance in Elderly Hospitalized Patients

Abstract

Chronic kidney disease (CKD) is increasingly recognized as a cause of worsening physical functioning in older patients. The Short Physical Performance Battery (SPPB) is highly reliable in older populations, but no data on older hospitalized patients with different degrees of kidney function are available. We aimed at testing the association between estimated glomerular filtration rate (eGFR) and SPPB, either global score (range 0-12) or its individual components (muscle strength, balance, and walking speed, each ranging from 0 to 4), in a sample of older hospitalized patients. Our series consisted of 486 patients aged 65 or more consecutively enrolled in 11 acute care medical wards participating to a multicenter observational study. eGFR was obtained by the Chronic Kidney Disease Epidemiological Collaboration (CKD-EPI) equation. Physical performance was objectively measured by the SPPB. The relationship between eGFR and SPPB was investigated by multiple linear regression analysis. Physically impaired patients (SPPB total score < 5) were older, had lower serum albumin and MiniMental State Examination (MMSE) scores as well as higher overall co-morbidity, prevalence of stroke, cancer, and anemia compared to those with intermediate (SPPB = 5-8) and good physical performance (SPPB = 9-12). Fully adjusted multivariate models showed that eGFR (modeled as 10 mL/min per 1.73 m 2 intervals) was independently associated with the SPPB total score (B = 0.49; 95% confidence interval [CI] = 0.18-0.66; p = 0.003), balance (B = 0.30; 95% CI = 0.10-0.49; p = 0.005), and muscle strength (B = 0.06; 95% CI = 0.01-0.10; p = 0.043), but not with walking speed (B = -0.04; 95% CI = -0.09-0.11; p = 0.107). In conclusion, reduced renal function is associated with poorer physical performance in older hospitalized patients. SPPB is worthy of testing to monitor changes in physical performance in elderly CKD patients.

Impact of home-based aerobic exercise on the physical capacity of overweight patients with chronic kidney disease

“…A greater risk of having a frailty phenotype was observed in another cohort of patients with CKD in more advanced stages of the disease; this phenotype was associated with a 2.5-fold greater risk of death and with the need to start dialysis [30]. The association of CKD with a higher risk of developing limitations in the physical domain of frailty has also been shown in reports focused on exercise capacity and physical functioning [31,32]. Although frailty was not the focus of the present study, the beneficial effects in several markers of physical functioning provided by the home-based exercise give insights into the potential of such interventions for frailty-related physical disturbances.…”

The effectiveness and safety of modest exercise in Japanese patients with chronic kidney disease: a single-armed interventional study

“…Moreover, lower physical activity is getting recognized as a risk factor for mortality in these patients, and deeply associated with poor outcomes [18]. Although there have been reported a limited number of study to access the direct association, some studies showed exercise training contribute shortening hospitalization [19,20] and longer survival [21] with better physical functions. We believe that exercises should be an effective treatment to improve survival in CKD patients.…”

Functional Dependence and Mortality in the International Dialysis Outcomes and Practice Patterns Study (DOPPS)

“…Recent estimates suggest individuals with CKD stage 3b have a threefold increased risk of developing dependence in daily activities such as bathing, dressing, and personal care compared to individuals without renal impairment 16 . Furthermore, there appears to be a faster rate of functional decline 17 . However, studies in the dialysis population are limited to small single center studies of older patients with little information on the difficulties that younger individuals report 15, 16 .…”