Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

Abstract

Background Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. Objective The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. Method This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. Results A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.2 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). The FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. Conclusion Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.

Validation of the functional assessment of anorexia/cachexia therapy instrument to assess quality of life in maintenance hemodialysis patients with cachexia

“…Previous studies have found that ACS has a high level of differentiation in patients with MHD cachexia. 27 However, this study not only further verifies this point but also comprehensively evaluates the reliability and validity of FAACT and its subscales. In terms of reliability (Table 2), Cronbach's alpha was acceptable, but PWB, EWB, and FWB had reliability of less than 0.74, whereas the overall FAACT and the ACS outperformed other disease detection instruments.…”

Characteristics of Frailty in Haemodialysis Patients

“…Some definitions of cachexia, and sarcopenia include measurement of physical activity, such as gait speed, or sit to stand ( Evans et al, 2008 ; Cruz-Jentoft et al, 2019 ; McKeaveney et al, 2021 ). However, these timed tests may be confounded in dialysis patients due to mineral bone disease and impracticable for the increasing number of wheelchair-bound dialysis patients.…”

“…We measured self-reported energy expenditure, and although there was no difference in REE, however overall TEE was lower in frail patients, when active energy expenditure was determined. Other studies have used the Fatigue questionnaire (FACIT-F) ( McKeaveney et al, 2021 ), a 40-item measure that assesses self-reported fatigue and its impact upon daily activities and function. However, the results of this questionnaire can be confounded by fatigue secondary to anaemia and volume overload ( Yoowannakul et al, 2021 ), and psychological distress.…”

“…There have been a number of definitions of cachexia ( Evans et al, 2008 ), based on unintentional weight loss, low body mass index (BMI), along with loss of muscle mass, physical strength, fatigue, reduced appetite, and laboratory indices. Besides gender, age and ethnicity ( Yoowannakul et al, 2018 ), some of these factors may be additionally confounded in the HD patient due to hydration status, dietary restriction and active management, including achieving haemoglobin targets ( Tangvoraphonkchai & Davenport, 2018 , McKeaveney et al, 2021 ).…”

Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis

“…These partly, but not entirely, overlapping syndromes (3,11) are part of a wide spectrum of nutritional and functional abnormalities in patients on HD, although an important common denominator appears to be tissue loss (11). Importantly, one of the criteria for the definition of PEW, also referred to as kidney cachexia, is an increase in inflammatory parameters (4,12). In contrast, inflammation is not included in the diagnostic criteria of sarcopenia (13).…”