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维持性血液透析患者衰弱表型对日常生活活动能力的影响
应金萍, 蔡根莲, 潘梦燕, 孙小仙, 邵碧云, 项世龙, 俞伟萍, 陈江华, 袁静
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维持性血液透析患者衰弱表型对日常生活活动能力的影响
Effect of frailty phenotype on activities of daily living in maintenance hemodialysis patients
目的 调查维持性血液透析（maintenance hemodialysis，MHD）患者衰弱和日常生活活动能力现状，探讨衰弱表型对日常生活活动能力的影响。 方法 研究对象为2019年3月至2020年3月在浙江大学医学院附属第一医院肾脏病中心进行MHD的患者。采用横断面调查方法收集其人口学及实验室资料，分别采用Fried衰弱表型及日常生活活动能力量表评估衰弱及日常生活活动能力，分别在日常生活活动能力、躯体生活自理能力、工具性日常生活能力方面比较功能正常组与功能下降组间基本资料及不同衰弱表型的差异，采用Pearson相关分析及二元Logistic回归分析法分析衰弱与日常生活活动能力的相关性及日常生活活动能力的影响因素。 结果 共676例MHD患者被纳入本研究，其中男性434例（64.2%），女性242例（35.8%）；年龄（59.2±19.4）岁；中位透析龄59.0（25.3，110.0）个月；衰弱患者159例（23.5%），衰弱前期230例（34.0%），无衰弱287例（42.5%）；日常生活活动能力下降者163例（24.1%），其中躯体生活自理能力下降者131例（19.4%），工具性日常生活能力下降者161例（23.8%）。Pearson相关分析结果显示，衰弱得分与日常生活活动能力得分（r=0.728，P<0.001）、躯体生活自理能力得分（r=0.669，P<0.001）和工具性日常生活能力得分（r=0.729，P<0.001）均呈正相关。二元Logistic回归分析结果显示，年龄大和衰弱表型中的身体活动量低、疲乏、步速减慢及握力低是患者日常生活活动能力、躯体生活自理能力及工具性日常生活活动能力的独立影响因素（均P<0.05）。 结论 MHD患者衰弱的患病率为23.5%，24.1%患者的日常生活活动能力下降。年龄大和衰弱表型中的身体活动量低、疲乏、步速减慢及握力低是MHD患者的日常生活活动能力差、躯体生活自理能力差及工具性日常生活活动能力差的独立影响因素。
Objective To investigate the status of frailty and activities of daily living (ADL) in maintenance hemodialysis (MHD) patients, and to explore the effect of frailty phenotype on ADL. Methods The patients who underwent MHD in Kidney Disease Center of the First Affiliated Hospital from March 2019 to March 2020 were enrolled in this study. The demographic and laboratorial data were collected by cross-sectional survey method. Fried frailty phenotype scale and ADL scale were used to evaluate the frailty and ADL, respectively. The differences of basic data and different frailty phenotypes between the normal function group and the function decline group were compared in terms of ADL, physical self-maintenance ability and instrumental ADL ability. Pearson correlation analysis was used to analyze the correlation between frailty and ADL, and binary logistic regression analysis was used to analyze the influencing factors of ADL. Results A total of 676 MHD patients were included in this study, including 434 males (64.2%) and 242 females (35.8%). The age was (59.2±19.4) years old, and the median dialysis age was 59.0 (25.3, 110.0) months. There were 159 frailty patients (23.5%), 230 pre-frailty patients (34.0%), and 287 non-frailty patients (42.5%). The ADL was decreased in 163 patients (24.1%), including 131 patients (19.4%) with decreased physical self-maintenance ability and 161 patients (23.8%) with decreased instrumental ADL ability. Pearson correlation analysis showed that the frailty score was positively correlated with total ADL score (r=0.728, P<0.001), physical self-maintenance ability score (r=0.669, P<0.001) and instrumental ADL ability score (r=0.729, P<0.001). Binary logistic regression analysis results showed that older age and lower physical activity, fatigue, slowed steps and lower grip strength in the frailty phenotypes were the independent influencing factors of ADL, physical self-maintenance ability and instrumental ADL ability (all P<0.05). Conclusions The prevalence of frailty is 23.5% in MHD patients, and 24.1% of MHD patients have decreased ADL. Elder age and lower physical activity, fatigue, reduced step counts, and lower grip strength in frailty phenotypes are the independent influencing factors for poor ADL, poor physical self-maintenance ability and poor instrumental ADL ability.
肾透析 / 日常生活活动 / 危险因素 / 衰弱表型 {{custom_keyword}} /
Renal dialysis / Activities of daily living / Risk factors / Frailty phenotype {{custom_keyword}} /
杨克魁 , {{custom_editor}}
表1 维持性血液透析患者日常生活活动能力各组间基本资料比较 |
| 项目 | 躯体生活自理(PSM)能力 | 工具性日常生活活动(IADL)能力 | 日常生活活动(ADL)能力 | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 功能正常(n=545) | 功能下降(n=131) | 统计量 | P值 | 功能正常(n=515) | 功能下降(n=161) | 统计量 | P值 | 功能正常(n=513) | 功能下降(n=163) | 统计量 | P值 | |
| 男性[例(%)] | 348(63.9) | 86(65.6) | 0.148 | 0.700 | 332(64.5) | 102(63.4) | 0.066 | 0.797 | 330(76.0) | 104(24.0) | 0.015 | 0.903 |
| 原发病[例(%)] | 23.214 | <0.001 | 27.840 | <0.001 | 28.451 | <0.001 | ||||||
| 慢性肾小球肾炎 | 345(63.3) | 58(44.3) | 331(64.3) | 72(44.7) | 330(64.3) | 73(44.8) | ||||||
| 高血压肾病 | 30(5.5) | 17(13.0) | 29(5.6) | 18(11.2) | 29(5.7) | 18(11.0) | ||||||
| 糖尿病肾病 | 101(18.5) | 41(31.3) | 89(17.3) | 53(32.9) | 88(17.2) | 54(33.1) | ||||||
| 其他 | 69(12.7) | 15(11.5) | 66(12.8) | 18(11.2) | 66(12.9) | 18(11.0) | ||||||
| 文化程度[例(%)] | -3.087 | 0.002 | -3.360 | 0.001 | -3.264 | 0.001 | ||||||
| 小学及以下 | 95(17.4) | 40(30.5) | 87(16.9) | 48(29.8) | 87(17.0) | 48(29.4) | ||||||
| 初中 | 180(33.0) | 44(33.6) | 170(33.0) | 54(33.5) | 169(32.9) | 55(33.7) | ||||||
| 高中及中等技术学校 | 144(26.4) | 22(16.8) | 137(26.6) | 29(18.0) | 137(26.7) | 29(17.8) | ||||||
| 大专及以上 | 126(23.1) | 25(19.1) | 121(23.5) | 30(18.6) | 120(23.4) | 31(19.0) | ||||||
| 配偶为主要照料者[例(%)] | 413(75.8) | 85(64.9) | 6.462 | 0.011 | 392(76.1) | 106(65.8) | 6.680 | 0.001 | 391(76.2) | 107(65.6) | 7.130 | 0.008 |
| 已婚[例(%)] | 468(85.9) | 115(87.8) | 0.326 | 0.568 | 444(86.2) | 139(86.3) | 0.002 | 0.969 | 442(86.2) | 141(86.5) | 0.012 | 0.912 |
| 市级医保[例(%)] | 417(76.5) | 81(61.8) | 11.736 | 0.001 | 393(76.3) | 105(65.2) | 7.781 | 0.005 | 392(76.4) | 106(65.0) | 8.262 | 0.040 |
| 年龄(岁) | 56.0(45.0，66.5) | 77.0(68.0，83.0) | -12.454 | <0.001 | 56.0(45.0，66.0) | 75.0(67.0，83.0) | -13.169 | <0.001 | 55.0(45.0，65.5) | 75.0(67.0，83.0) | -13.189 | <0.001 |
| 透析龄(月) | 57.0(24.5，108.0) | 66.0(27.0，112.0) | -0.564 | 0.573 | 59.0(26.0，110.0) | 59.0(24.0，108.5) | -0.476 | 0.634 | 59.0(25.5，110.5) | 59.0(24.0，107.0) | -0.477 | 0.633 |
| Charlson合并症指数(分) | 2.13±1.85 | 4.78±1.83 | 0.459 | 0.498 | 2.04±1.82 | 4.60±1.85 | 0.035 | 0.851 | 2.04±1.82 | 4.56±1.85 | 0.049 | 0.826 |
| 血清白蛋白(g/L) | 40.62±3.32 | 38.28±3.71 | 4.947 | 0.026 | 40.72±3.29 | 38.39±3.65 | 5.271 | 0.022 | 40.74±3.29 | 38.38±3.63 | 4.686 | 0.031 |
| 血红蛋白(g/L) | 109.97±14.50 | 106.50±15.27 | 2.371 | 0.124 | 110.25±14.24 | 106.25±15.77 | 6.263 | 0.013 | 110.25±14.27 | 106.31±15.68 | 5.606 | 0.018 |
| 血钙(mmol/L) | 2.28±0.23 | 2.26±0.23 | 2.079 | 0.150 | 2.28±0.23 | 2.26±0.24 | 6.584 | 0.011 | 2.28±0.23 | 2.26±0.24 | 5.846 | 0.016 |
| 血钾(mmol/L) | 4.93±0.67 | 4.77±0.79 | 5.070 | 0.025 | 4.94±0.67 | 4.78±0.78 | 5.761 | 0.017 | 4.94±0.67 | 4.78±0.80 | 4.778 | 0.029 |
| 透前血肌酐(μmol/L) | 927.43±269.58 | 699.18±241.66 | 3.844 | 0.050 | 943.43±264.92 | 690.53±233.32 | 4.393 | 0.036 | 943.60±265.42 | 693.09±233.01 | 4.525 | 0.034 |
| 血磷(mmol/L) | 1.67(1.39，2.01) | 1.55(1.26，2.00) | -1.758 | 0.079 | 1.68(1.40，2.01) | 1.54(1.27，1.99) | -2.316 | 0.021 | 1.68(1.40，2.01) | 1.54(1.26，2.00) | -2.313 | 0.021 |
| 透前血尿素氮(mmol/L) | 23.17(19.15，26.87) | 19.84(15.17，25.64) | -4.483 | <0.001 | 23.32(19.18，27.01) | 20.00(15.14，25.79) | -4.924 | <0.001 | 23.20(19.18，27.03) | 20.05(15.17，25.83) | -4.766 | <0.001 |
| C反应蛋白(mg/L) | 2.10(0.80，5.30) | 5.30(1.90，16.67) | -5.906 | <0.001 | 2.07(0.80，5.30) | 4.65(1.84，14.10) | -5.854 | <0.001 | 2.10(0.80，5.20) | 5.00(1.84，15.80) | -6.185 | <0.001 |
| 注：ADL能力量表得分大于14分为有不同程度的功能下降；PSM能力量表得分大于6分为功能下降；IADL能力量表得分大于8分为功能下降；服从正态分布的计量资料用 |
表2 维持性血液透析患者不同衰弱表型的日常生活活动能力比较 |
| 项目 | 体重下降[例(%)] | 疲乏[例(%)] | 身体活动量低[例(%)] | 步速减慢[例(%)] | 握力低[例(%)] | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| 无 | 有 | 无 | 有 | 无 | 有 | 无 | 有 | 无 | 有 | |
| 躯体生活自理(PSM)能力 | ||||||||||
| 功能正常(n=545) | 491(90.1) | 54(9.9) | 521(95.6) | 24(4.4) | 465(85.3) | 80(14.7) | 479(87.9) | 66(12.1) | 364(66.8) | 181(33.2) |
| 功能下降(n=131) | 94(71.8) | 37(28.2) | 32(24.4) | 99(75.6) | 15(11.5) | 116(88.5) | 11(8.4) | 120(91.6) | 21(16.0) | 110(84.0) |
| χ2 | 30.481 | 359.388 | 279.938 | 334.628 | 110.988 | |||||
| P值 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||||
| 工具性日常生活活动(IADL)能力 | ||||||||||
| 功能正常(n=515) | 471(91.5) | 44(8.5) | 495(96.1) | 20(3.9) | 449(87.2) | 66(12.8) | 466(90.5) | 49(9.5) | 354(68.7) | 161(31.3) |
| 功能下降(n=161) | 114(70.8) | 47(29.2) | 58(36.0) | 103(64.0) | 31(19.3) | 130(80.7) | 24(14.9) | 137(85.1) | 31(19.3) | 130(80.7) |
| χ2 | 44.893 | 297.562 | 274.918 | 351.292 | 122.502 | |||||
| P值 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||||
| 日常生活活动(ADL)能力 | ||||||||||
| 功能正常(n=513) | 469(91.4) | 44(8.6) | 494(96.3) | 19(3.7) | 448(87.3) | 65(12.7) | 464(90.4) | 49(9.6) | 353(68.8) | 160(31.2) |
| 功能下降(n=163) | 116(71.2) | 47(28.8) | 59(36.2) | 104(63.8) | 32(19.6) | 131(80.4) | 26(16.0) | 137(84.0) | 32(19.6) | 131(80.4) |
| χ2 | 43.573 | 300.172 | 275.359 | 344.211 | 122.027 | |||||
| P值 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | |||||
表3 维持性血液透析患者日常生活活动（ADL）能力功能下降影响因素的回归模型（二元Logistic回归分析，n=676） |
| 模型参数 | B | 标准误 | Wald χ2 | P值 | OR值 | OR的95%CI |
|---|---|---|---|---|---|---|
| 年龄(岁) | 0.034 | 0.014 | 6.018 | 0.014 | 1.034 | 1.007~1.062 |
| 透前血肌酐(μmol/L) | -0.003 | 0.001 | 13.498 | <0.001 | 0.997 | 0.996~0.999 |
| 体重下降(是/否) | 1.132 | 0.398 | 8.086 | 0.004 | 3.102 | 1.422~6.769 |
| 疲乏(是/否) | 1.431 | 0.395 | 13.118 | <0.001 | 4.184 | 1.928~9.076 |
| 身体活动量低(是/否) | 1.772 | 0.359 | 24.311 | <0.001 | 5.885 | 2.909~11.904 |
| 步速减慢(是/否) | 2.478 | 0.343 | 52.265 | <0.001 | 11.915 | 6.086~23.326 |
| 握力低(是/否) | 0.928 | 0.359 | 6.690 | 0.010 | 2.528 | 1.252~5.106 |
| 常量 | -4.311 | 1.111 | 15.043 | <0.001 | 0.013 |
| 注：多因素分析纳入的因素为年龄、原发病、文化程度、主要照顾者、医保支付、血清白蛋白、血红蛋白、血钙、血磷、血钾、透前尿素氮、透前血肌酐、C反应蛋白、是否体重下降、是否疲乏、是否身体活动量低、是否步速减慢及是否握力低 |
表4 维持性血液透析患者躯体生活自理（PSM）能力功能下降影响因素的回归模型（二元Logistic回归分析，n=676） |
| 模型参数 | B | 标准误 | Wald χ2 | P值 | OR值 | OR的95%CI |
|---|---|---|---|---|---|---|
| 疲乏(是/否) | 2.199 | 0.401 | 30.111 | <0.001 | 9.020 | 4.112~19.786 |
| 身体活动量低(是/否) | 1.925 | 0.417 | 21.265 | <0.001 | 6.855 | 3.025~15.536 |
| 步数减慢(是/否) | 2.840 | 0.428 | 44.002 | <0.001 | 17.117 | 7.396~39.617 |
| 握力低(是/否) | 1.407 | 0.444 | 10.045 | 0.002 | 4.084 | 1.711~9.749 |
| 年龄(岁) | 0.044 | 0.016 | 7.667 | 0.006 | 1.045 | 1.013~1.078 |
| 常量 | -8.643 | 1.180 | 53.685 | <0.001 | 0.001 |
| 注：多因素分析纳入因素为年龄、原发病、文化程度、主要照顾者、医保支付、血清白蛋白、血钾、透前血肌酐、透前尿素氮、C反应蛋白、是否体重下降、是否疲乏、是否身体活动量低、是否步速减慢及是否握力低 |
表5 维持性血液透析患者工具性日常生活活动（IADL）能力功能下降影响因素的回归模型（二元Logistic回归分析，n=676） |
| 模型参数 | B | 标准误 | Wald χ2 | P值 | OR值 | OR的95%CI |
|---|---|---|---|---|---|---|
| 年龄(岁) | 0.033 | 0.014 | 5.479 | 0.019 | 1.033 | 1.005~1.062 |
| 透前血肌酐(μmol/L) | -0.003 | 0.001 | 14.477 | <0.001 | 0.997 | 0.996~0.999 |
| 体重下降(是/否) | 1.228 | 0.405 | 9.170 | 0.002 | 3.414 | 1.542~7.558 |
| 疲乏(是/否) | 1.346 | 0.398 | 11.460 | 0.001 | 3.843 | 1.763~8.378 |
| 身体活动量低(是/否) | 1.827 | 0.368 | 24.644 | <0.001 | 6.218 | 3.022~12.793 |
| 步数减慢(是/否) | 2.633 | 0.352 | 55.815 | <0.001 | 13.914 | 6.974~27.761 |
| 握力低(是/否) | 0.969 | 0.366 | 7.011 | 0.008 | 2.636 | 1.286~5.400 |
| 常量 | -4.321 | 1.127 | 14.690 | <0.001 | 0.013 |
| 注：多因素分析纳入因素为年龄、原发病、文化程度、主要照顾者、医保支付、血清白蛋白、血红蛋白、血钙、血磷、血钾、透前血肌酐、透前尿素氮、C反应蛋白、是否体重下降、是否疲乏、是否身体活动量低、是否步速减慢及是否握力低 |
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<b><i>Background:</i></b> Hemodialysis is the main approach for renal replacement therapy in patients with end-stage renal disease (ESRD) in China. The timing of dialysis initiation is one of the key factors influencing patient survival and prognosis. Over the past decade, the relationship between the timing of dialysis initiation and mortality has remained unclear in patients with ESRD in China. <b><i>Methods:</i></b> Patients who commenced maintenance hemodialysis from 2009 to 2014 from 24 hemodialysis centers in Mainland China were enrolled in the study (<i>n</i> = 1,674). Patients were divided into 2 groups based on the year they started hemodialysis (patients who started hemodialysis from 2009 to 2011, and patients who started hemodialysis from 2012 to 2014). Analysis of the yearly change in the estimated glomerular filtration rate (eGFR) at the initiation of dialysis was performed for the 2 groups. Meanwhile, the patients were divided into 3 groups based on their eGFR at the initiation of dialysis (&#x3c;4, 4–8, and &#x3e;8 mL/min/1.73 m<sup>2</sup>). For these 3 groups, the relationship between the eGFR at the start of dialysis and mortality were analyzed. <b><i>Results:</i></b> The average eGFRs were 5.68 and 5.94 mL/min/1.73 m<sup>2</sup> for 2009–2011 and 2012–2014, respectively. Compared with the 2009–2011 group, the proportion of patients with diabetes in 2012–2014 increased from 26.7 to 37.7%. The prognosis of patients with different eGFRs at the start of dialysis was analyzed using Kaplan-Meier survival curves. After adjusting for confounding factors through a Cox regression model, no significant difference was demonstrated among the 3 groups (&#x3c;4 mL/min/1.73 m<sup>2</sup> was used as the reference, in comparison with 4–8 mL/min/1.73 m<sup>2</sup> [<i>p</i> = 0.681] and &#x3e;8 mL/min/1.73 m<sup>2</sup> [<i>p</i> = 0.403]). <b><i>Conclusion:</i></b> In Mainland China, the eGFR at the start of dialysis did not change significantly over time from 2008 to 2014 and had no association with the mortality of patients with ESRD.
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Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.
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Frailty is a construct originally coined by gerontologists to describe cumulative declines across multiple physiological systems that occur with aging and lead individuals to a state of diminished physiological reserve and increased vulnerability to stressors. Fried et al. provided a standardized definition for frailty, and they created the concept of frailty phenotype which incorporates disturbances across interrelated domains (shrinking, weakness, poor endurance and energy, slowness, and low physical activity level) to indentify old people who are at risk of disability, falls, institutionalization, hospitalization, and premature death. Some authors consider the presence of lean mass reduction (sarcopenia) as part of the frailty phenotype. The frailty status has been documented in 7 % of elderly population and 14 % of not requiring dialysis CKD adult patients. Sarcopenia increases progressively along with loss of renal function in CKD patients and is high in dialysis population. It has been documented that prevalence of frailty in hemodialysis adult patients is around 42 % (35 % in young and 50 % in elderly), having a 2.60-fold higher risk of mortality and 1.43-fold higher number of hospitalization, independent of age, comorbidity, and disability. The Clinical Frailty Scale is the simplest and clinically useful and validated tool for doing a frailty phenotype, while the diagnosis of sarcopenia is based on muscle mass assessment by body imaging techniques, bioimpedance analysis, and muscle strength evaluated with a handheld dynamometer. Frailty treatment can be based on different strategies, such as exercise, nutritional interventions, drugs, vitamins, and antioxidant agents. Finally, palliative care is a very important alternative for very frail and sick patients. In conclusion, since the diagnosis and treatment of frailty and sarcopenia is crucial in geriatrics and all CKD patients, it would be very important to incorporate these evaluations in pre-dialysis, peritoneal dialysis, hemodialysis, and kidney transplant patients in order to detect and consequently treat the frailty phenotype in these groups.
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The population undergoing dialysis is aging worldwide, particularly in Japan. The clinical condition of frailty is the most problematic expression in the elderly population. Potential pathophysiological factors of frailty present in patients with CKD and are accentuated in patients with ESRD. The aim of this study was to identify the prevalence and predictors of frailty in Japanese HD patients. This study was a multicenter, cross-sectional and observational investigation conducted at 6 institutions. To evaluate frailty, the modified Fried’s frailty phenotype adjusted for Japanese as the self-reported questionnaire was used. Of the 542 patients visiting each institution, 388 were enrolled in this study. In total, 26.0% of participants were categorized as not-frailty, 52.6% as pre-frailty and 21.4% as frailty. The prevalence of frailty increased steadily with age and was more prevalent in females than in males and the subjects with frailty received polypharmacy. A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: female gender (odds ratio [OR] = 3.661, 95% confidence interval [CI] 1.398-9.588), age (OR = 1.065, 95% CI 1.014-1.119), age ≥ 75 years old (OR = 4.892, 95% CI 1.715-13.955), body mass index (BMI) < 18.5 (OR = 0.110, 95% CI 0.0293-0.416), number of medications being taken (OR = 1.351, 95% CI 1.163-1.570), diabetes mellitus (DM) (OR = 2.765, 95% CI 1.081-7.071) and MNA-SF ≤ 11 (OR = 7.405, 95% CI 2.732-20.072). Frailty was associated with the accumulation of risk factors. The prevalence of frailty in Japanese patients with HD was relatively lower than that previously reported in Western developed countries; however, it was extremely high compared to the general population regardless of age. Our findings suggest that frailty might be associated with an increase in the prevalence of adverse health outcomes in patients with HD. {{custom_citation.content}}
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| [6] |
Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.
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| [7] |
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| [8] |
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| [9] |
Among community-dwelling older adults, frailty is associated with heightened markers of inflammation and subsequent mortality. Although frailty is common among end-stage renal disease (ESRD) patients, the role of frailty and markers of inflammation in this population remains unclear. We quantified these associations in patients on the kidney transplant waitlist and tested whether frailty and/or markers of inflammation improve waitlist mortality risk prediction.We studied 1975 ESRD patients on the kidney transplant waitlist (November 1, 2009, to February 28, 2017) in a multi-center cohort study of frailty. Serum inflammatory markers (interleukin-6 [IL-6], soluble tumor necrosis factor-α receptor-1 [sTNFR1], and C-reactive protein [CRP]) were analyzed in 605 of these participants; we calculated the inflammatory index score using IL-6 and sTNFR1. We compared the C-statistic of an established registry-based prediction model for waitlist mortality adding frailty and/or inflammatory markers (1 SD change in log IL-6, sTNFR1, CRP, or inflammatory index).The registry-based model had moderate predictive ability (c-statistic = 0.655). Frailty was associated with increased mortality (2.19; 95% confidence interval [CI], 1.26-3.79) but did not improve risk prediction (c-statistic = 0.646; P = 0.65). Like frailty, IL-6 (2.13; 95% CI, 1.41-3.22), sTNFR1 (1.70; 95% CI, 1.12-2.59), CRP (1.68; 95% CI, 1.06-2.67), and the inflammatory index (2.09; 95% CI, 1.38-3.16) were associated with increased mortality risk; unlike frailty, adding IL-6 (c-statistic = 0.777; P = 0.02), CRP (c-statistic = 0.728; P = 0.02), or inflammatory index (c-statistic = 0.777; P = 0.02) substantially improved mortality risk prediction.Frailty and markers of inflammation were associated with increased waitlist mortality risk, but only markers of inflammation significantly improved ESRD risk prediction. These findings help clarify the accelerated aging physiology of ESRD and highlight easy-to-measure markers of increased waitlist mortality risk.
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| [10] |
The aim of this study was to investigate the frequency of frailty and the association of vitamin D levels and the frailty phenotype among non-geriatric dialysis patients.Seventy-four stable, chronic hemodialysis patients from the hemodialysis unit of the hospital were enrolled in the study. The patients' medical histories and laboratory findings were obtained from the medical records of the dialysis unit. Serum parathyroid hormone and 25-hydroxy vitamin D levels were determined using chemiluminometric immunoassays. Frailty was defined by Fried et al. as a phenotype; shrinking, weakness, self-reported exhaustion, decreased activity and slowed walking speed were evaluated.Forty-one (55%) of the patients were males. The patients were divided into 3 groups according to frailty scores: 39 (53%) patients were frail, 6 (8%) patients were intermediately frail, and 28 (39%) patients were normal. Significant differences were found for 25-hydroxy vitamin D and hemoglobin levels among the groups; however, no differences were observed in body mass index, comorbidities, sex, marital status, education, disease and dialysis durations, or parathyroid hormone, creatinine, serum calcium, phosphorus, and potassium levels.Weakness and slowness are serious outcomes of both vitamin D deficiency and frailty, and vitamin D deficiency has been associated with increased risks of decreased physical activity, falls, fractures and death in postmenopausal women and older men. Although studies on frailty have focused on older adults, growing evidence indicates that the frailty phenotype is becoming a factor associated with poor health outcomes in non-geriatric populations with chronic disease.
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| [11] |
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| [12] |
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| [13] |
To quantify the prevalence of frailty in adults of all ages undergoing chronic hemodialysis, its relationship to comorbidity and disability, and its association with adverse outcomes of mortality and hospitalization.Prospective cohort study.Single hemodialysis center in Baltimore, Maryland.One hundred forty-six individuals undergoing hemodialysis enrolled between January 2009 and March 2010 and followed through August 2012.Frailty, comorbidity, and disability on enrollment in the study and subsequent mortality and hospitalizations.At enrollment, 50.0% of older (≥ 65) and 35.4% of younger (<65) individuals undergoing hemodialysis were frail; 35.9% and 29.3%, respectively, were intermediately frail. Three-year mortality was 16.2% for nonfrail, 34.4% for intermediately frail, and 40.2% for frail participants. Intermediate frailty and frailty were associated with a 2.7 times (95% confidence interval (CI) = 1.02-7.07, P =.046) and 2.6 times (95% CI = 1.04-6.49, P =.04) greater risk of death independent of age, sex, comorbidity, and disability. In the year after enrollment, median number of hospitalizations was 1 (interquartile range 0-3). The proportion with two or more hospitalizations was 28.2% for nonfrail, 25.5% for intermediately frail, and 42.6% for frail participants. Although intermediate frailty was not associated with number of hospitalizations (relative risk = 0.76, 95% CI = 0.49-1.16, P =.21), frailty was associated with 1.4 times (95% CI = 1.00-2.03, P =.049) more hospitalizations independent of age, sex, comorbidity, and disability. The association between frailty and mortality (interaction P =.64) and hospitalizations (P =.14) did not differ between older and younger participants.Adults of all ages undergoing hemodialysis have a high prevalence of frailty, more than five times as high as community-dwelling older adults. In this population, regardless of age, frailty is a strong, independent predictor of mortality and number of hospitalizations.© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
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| [14] |
Activities of daily living (ADL) in aged hemodialysis patients decrease by many factors as hemodialysis therapy, various disease-related complications and underlying disease for rehabilitation. But the correlation between low ADL and mortality remains unclear. We assessed the levels of ADL and effects of rehabilitation in hemodialysis patients with low ADL. Moreover, the association between the baseline functional independence measure (FIM) or rehabilitation treatment effects and all-cause mortality were investigated.This prospective cohort study included 182 inpatients on maintenance hemodialysis, who underwent rehabilitation for a decline in ADL. Before and after initiating rehabilitation, ADL were assessed using FIM.The total baseline FIM was 65.1±26.9 (motor items: 39.5±18.7; cognitive items: 25.6±10.7). After rehabilitation, the total FIM increased to 77.1±33.1 (motor items: 50.9±24.4; cognitive items: 26.1±10.8). The baseline FIM, presence or absence of FIM increase, and albumin were significantly associated with mortality. Moreover, the mortality hazard ratio in patients with FIM ≤67 and no FIM increase was 20-fold significantly higher than that in patients with FIM ≥68 and FIM increase. The cognitive items and albumin were significantly associated with the rehabilitation effects in multivariate analysis.Although the FIM decreased by half in hemodialysis patients, rehabilitation improved their FIM (particularly the motor items). The FIM was a novel predictive marker of 3-year mortality in these patients, and an increased FIM after rehabilitation resulted in better prognosis. Moreover, the effectiveness of rehabilitation may depend on maintaining cognitive functions.
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| [15] |
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| [16] |
In light of the recent trend toward earlier dialysis initiation and its association with mortality among patients with end-stage renal disease, we hypothesized that frailty is associated with higher estimated glomerular filtration rate (eGFR) at dialysis start and may confound the relation between earlier dialysis initiation and mortality.We examined frailty among participants of the Comprehensive Dialysis Study (CDS), a special study of the US Renal Data System, which enrolled incident patients from September 1, 2005, through June 1, 2007. Patients were followed for vital status through September 30, 2009, and for time to first hospitalization through December 31, 2008. We used multivariate logistic regression to model the association of frailty with eGFR at dialysis start and proportional hazards regression to assess the outcomes of death or hospitalization.Among 1576 CDS participants included, the prevalence of frailty was 73%. In multivariate analysis, higher eGFR at dialysis initiation was associated with higher odds of frailty (odds ratio [OR], 1.44 [95% CI, 1.23-1.68] per 5 mL/min/1.73 m(2); P <.001). Frailty was independently associated with mortality (hazard ratio [HR], 1.57 [95% CI, 1.25-1.97]; P <.001) and time to first hospitalization (HR, 1.26 [95% CI, 1.09-1.45]; P <.001). While higher eGFR at dialysis initiation was associated with mortality (HR, 1.12 [95% CI, 1.02-1.23] per 5 mL/min/1.73 m(2); P =.02), the association was no longer statistically significant after frailty was accounted for (HR, 1.08 [95% CI, 0.98-1.19] per 5 mL/min/1.73 m(2); P =.11).Frailty is extremely common among patients starting dialysis in the United States and is associated with higher eGFR at dialysis initiation. Recognition of signs and symptoms of frailty by clinicians may prompt earlier initiation of dialysis and may explain, at least in part, the well-described association between eGFR at dialysis initiation and mortality.
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| [17] |
Patients treated with dialysis have low levels of physical functioning and activity. Whether this translates into frailty or not may depend on how the frailty phenotype is operationalized. This is a secondary analysis of data from the Renal Exercise Demonstration Project to evaluate two methods of operationalizing the Fried phenotype for frailty: Using measured walking speed and muscle weakness (FRAILmeas) and using substitution of the Physical Function Scale (PF) from the SF-36 questionnaire for walking speed and muscle weakness (FRAILsubst). Complete data for both measures were available for 188 hemodialysis patients. The frailty score (FRAILmeas) was the sum of criteria scores for measured gait speed, chair stand, body mass index, vitality, and physical activity. The frailty score (FRAILsubst) substituted the PF scale score (<75) as a surrogate measure for gait speed and for weakness. The frailty score ranged from 0 to 5. Scores ≥3 were categorized as frail, and <3 as not frail. The substitution of the PF score for walking speed and muscle weakness resulted in 78% of patients being categorized as frail compared to 24% using actual measured walking speed and muscle weakness (P <.001). The component of frailty that had the highest prevalence was low physical activity (average 54% of subjects). Frailty (using the FRAILmeas) was higher in patients with increasing age, female gender, and lower self-reported PF. Frailty is highly prevalent in hemodialysis patients; however, measured constructs of the components of frailty should be used to report the frailty phenotype.© 2012 The Authors. Hemodialysis International © 2012 International Society for Hemodialysis.
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| [18] |
陈琰, 郑淑蓓, 郑育, 等. 维持性血液透析患者的衰弱情况及其影响因素[J]. 中华肾脏病杂志, 2017, 33(10): 763-769. DOI: 10.3760/cma.j.issn.1001-7097.2017.10.007.
目的 了解维持性血液透析（MHD）患者的衰弱情况及其影响因素，并且探讨衰弱评分与冠状动脉钙化的相关性。 方法 病例来自2015年1月至2016年1月在本院血液透析中心行MHD治疗的127例患者，收集入选患者的临床资料和血生化资料，采用衰弱症状学量表进行衰弱评分，多层螺旋计算机断层成像测定冠状动脉钙化积分（CACs）。根据不同衰弱评分分成无衰弱组、衰弱前期组和衰弱组，分析比较各组患者的临床资料、血生化资料及CACs。Spearman相关分析评估衰弱评分与各指标的相关性。多分类有序Logistic回归分析评估影响MHD患者衰弱的因素。 结果 入选127例MHD患者中无衰弱组46例（36.22%），衰弱前期组45例（35.43%），衰弱组36例（28.35%）。3组患者的年龄、糖尿病病史、血红蛋白、血白蛋白、血前白蛋白、血C反应蛋白（CRP）、血成纤维细胞生长因子23（FGF23）、左室舒张末内径差异均有统计学意义（均P＜0.05）；3组患者钙化程度差异有统计学意义（F=31.769，P＜0.001）。MHD患者衰弱评分与年龄（r=0.545，P＜0.001）、合并糖尿病（r=0.236，P=0.008）、CRP（r=0.245，P=0.006）、FGF23（r=0.189，P=0.034）、CACs（r=0.396，P＜0.001）呈正相关，与血红蛋白（r=-0.257，P=0.004）、血白蛋白（r=-0.380，P＜0.001）、血前白蛋白（r=-0.313，P＜0.001）呈负相关。年龄（OR=1.076）、CRP（OR=1.176）、白蛋白（OR=0.796）、合并冠状动脉钙化（OR=2.465）是MHD患者合并衰弱的影响因素（均P＜0.05）。 结论 MHD患者中衰弱发生率高，衰弱的发生和年龄、CRP、血白蛋白、合并冠状动脉钙化相关。
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叶丽钦, 周莹, 张海林, 等. 维持性血液透析患者衰弱及其表型对生活质量的影响研究[J]. 中华护理杂志, 2018, 53(9): 1072-1077. DOI: 10.3761/j.issn.0254-1769.2018.09.011.
目的 调查维持性血液透析患者衰弱和生活质量的现状，并探讨衰弱表型对患者生活质量的影响。方法 采用Fried衰弱表型评估方法、生活质量量表对江苏省连云港市6所医院的501例维持性血液透析患者进行调查。结果 维持性血液透析患者衰弱的患病率为43.11%；生活质量中的生理健康总得分为（195.14 ± 80.35）分，心理健康总得分为（197.39 ± 92.04）分；衰弱程度与患者生活质量中的生理健康及心理健康均呈负相关（P<0.001）。衰弱表型中的疲乏、步速减慢和身体活动量低是患者生理健康和心理健康的主要影响因素（P<0.05）。结论 维持性血液透析患者的生活质量较低，衰弱患病率高，衰弱表型中的疲乏、步速减慢和身体活动量低可影响患者的生活质量。
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| [20] |
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| [21] |
Functional dependence is an important determinant of longevity and quality of life. The purpose of the current study was to determine the prevalence and correlates of functional dependence among patients with end-stage renal disease (ESRD) receiving maintenance dialysis. We enrolled 148 participants with ESRD from five clinics. Functional status, as measured by basic and instrumental activities of daily living (ADL, IADL), was ascertained by validated questionnaires. Functional dependence was defined as needing assistance in at least one of seven IADLs or at least one of four ADLs. Demographic characteristics, chronic health conditions, anthropometric measurements, and laboratories were assessed by a combination of self-report and chart review. Cognitive function was assessed with a neurocognitive battery, and depressive symptoms were assessed by questionnaire. Mean age of the sample was 56.2 ± 14.6 years. Eighty-seven participants (58.8%) demonstrated dependence in ADLs or IADLs, 70 (47.2%) exhibited IADL dependence alone, and 17 (11.5%) exhibited combined IADL and ADL dependence. In a multivariable-adjusted model, stroke, cognitive impairment, and higher systolic blood pressure were independent correlates of functional dependence. We found no significant association between demographic characteristics, chronic health conditions, depressive symptoms or laboratory measurements, and functional dependence. Impairment in executive function was more strongly associated with functional dependence than memory impairment. Functional dependence is common among ESRD patients and independently associated with stroke, systolic blood pressure, and executive function impairment. © 2015 International Society for Hemodialysis.
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| [22] |
张兰, 孙超, 程艳娇, 等. 维持性血液透析患者生理功能和生活质量的横断面调查及影响因素分析[J]. 中国血液净化, 2019, 18(4): 237-241. DOI: 10.3969/j.issn.1671-4091.2019.04.007.
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李晓霞, 贾林沛. 维持性血液透析患者日常生活能力的影响因素分析[J]. 中华现代护理杂志, 2018, 24(36): 4386-4389. DOI: 10.3760/cma.j.issn.1674-2907.2018.36.010.
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Background/Aims: Decision-making in elderly patients considering dialysis is highly complex. With the increasing number of elderly with end-stage kidney disease (ESKD), it may be important to assess geriatric impairments in this population. The aim of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study was to assess the prevalence of geriatric impairments and frailty in the elderly ESKD population by means of a geriatric assessment (GA), which is a comprehensive tool for overall health assessment. Methods: This study included 285 patients >= 65 years: 196 patients at the time of dialysis initiation and 89 patients who chose maximal conservative management (MCM). The GA assessed cognition, mood, nutritional status, (instrumental) activities of daily living (ADL), mobility, comorbidity burden, quality of life and overall frailty. Results: The mean age of the participants was 78 years and 36% were women. Of the incident dialysis patients, 77% started haemodialysis and 23% started peritoneal dialysis. Geriatric impairments were highly prevalent in both dialysis and MCM patients. Most frequently impaired geriatric domains in the dialysis group were functional performance (ADL 29%, instrumental ADL (iADL) 79%), cognition (67%) and comorbidity (41%). According to the GA, 77% in the dialysis group and 88% in the MCM group had 2 or more geriatric impairments. In the MCM group, functional impairment (ADL 45%, iADL 85%) was highly prevalent. Conclusions: Geriatric impairments are highly prevalent in the elderly ESKD population. Since impairments can be missed when not searched for in regular (pre) dialysis care, the first step of improving nephrologic care is awareness of the extensiveness of geriatric impairment. (c) 2018 The Author(s) Published by S. Karger AG, Basel
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郭晓斌, 朱昀, 宫萍, 等. 老年住院患者日常生活能力调查及影响因素分析[J]. 中华老年医学杂志, 2017, 36(1): 49-52. DOI: 10.3760/cma.j.issn.0254-9026.2017.01.013.
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张晗, 王志会, 王丽敏, 等. 中国社区老年居民日常生活活动能力失能状况调查[J]. 中华流行病学杂志, 2019, 40(3): 266-271. DOI: 10.3760/cma.j.issn.0254-6450.2019.03.003.
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Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients' activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients.A total of 303 elderly patients with CKD stage 3-5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models.The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00-1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17-19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70-0.92, P=0.0012) were the independent risk factors of ADL impairment.Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.© 2020 Chang et al.
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| [28] |
The aim of the present study was to determine the intensity, duration, frequency and prevalence of postdialysis fatigue (PDF) in patients on chronic hemodialysis (PCD) with and without functional disability. Patients underwent assessment of functional ability by the Katz ADL (activity daily living) questionnaire and the Lawton and Brody scale for the instrumental activity daily living (IADL) fatigue using the SF‐36 Vitality Subscale, comorbidity through the Charlson comorbidity score index (CDI), and time of recovery after hemodialysis (TIRD). We studied 271 PCD. ADL and IADL disabilities were present in 75 (27.6%) and 168 (62%) patients, respectively. Patients with ADL disability were significantly older and showed higher CDI scores, and lower levels of serum albumin and Kt/V. Prevalence of PDF was significantly higher in patients with ADL disability as well as its severity, intensity, duration and frequency. Patients with IADL disability were significantly older, had a higher CCI score, had lower levels of serum albumin and Kt/V, and had a higher severity, intensity, duration and frequency of PDF. At multivariate regression analysis, ADL disability was positively associated with age, prevalence and severity of PDF, and dialysate temperature and inversely associated with serum albumin levels. IADL disability was instead positively associated with age and dialysate temperature and inversely associated with serum albumin levels. In conclusion, prevalence and severity of PDF are significantly higher in PCD with ADL disability than in those without it. This knowledge may have important implications for the development of interventions to reduce PDF in PCD.
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| [29] |
Patients with chronic kidney disease (CKD) are at high risk of progression to end stage renal disease and cardiovascular events. Physical activity may reduce these risks by improving metabolic health. We tested associations of physical activity with central components of metabolic health among people with moderate-severe non-diabetic CKD.We performed a cross-sectional study of 47 people with CKD (estimated GFR <60 ml/min/1.73 m) and 29 healthy control subjects. Accelerometry was used to measured physical activity over 7 days, the hyperinsulinemic-euglycemic clamp was used to measure insulin sensitivity, and DXA was used to measured fat mass. We tested associations of physical activity with insulin sensitivity, fat mass, blood pressure, serum lipid concentrations, and serum high sensitivity C-reactive protein concentration using multivariable linear regression, adjusting for possible confounding factors.Participants with CKD were less active than participants without CKD (mean (SD) 468.1 (233.1) versus 662.3 (292.5) counts per minute) and had lower insulin sensitivity (4.1 (2.1) versus 5.2 (2.0 (mg/min)/(μU/mL)), higher fat mass (32.0 (11.4) versus 29.4 (14.8) kg), and higher triglyceride concentrations (153.2 (91.6) versus 99.6 (66.8) mg/dL). With adjustment for demographics, comorbidity, medications, and estimated GFR, each two-fold higher level of physical activity was associated with a 0.9 (mg/min)/(μU/mL) higher insulin sensitivity (95% CI 0.2, 1.5, p = 0.006), an 8.0 kg lower fat mass (-12.9, -3.1, p = 0.001), and a 37.9 mg/dL lower triglyceride concentration (-71.9, -3.9, p = 0.03). Associations of physical activity with insulin sensitivity and triglycerides did not differ significantly by CKD status (p-values for interaction >0.3).Greater physical activity is associated with multiple manifestations of metabolic health among people with moderate-severe CKD.
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| [33] |
Muscle weakness is a risk factor for mortality in haemodialysis (HD) patients; we wished to determine whether measuring the composition of the arm with bioimpedance was associated with arm muscle strength.We measured pinch strength (PS) and hand grip strength (HGS) in 250 adult HD patients with corresponding post-dialysis multifrequency bioelectrical assessments with segmental body analysis.Mean age 64.0 ± 15.6, 66% male and 45.6% diabetic. The maximum HGS in the dominant or non-fistula arm was 18.9 ± 9.2 kg and PS 4.09 ± 1.96 kg respectively, with a correlation of r = 0.80, p < 0.001. HGS was associated with body cell mass (β 0.37, p < 0.001) and PS with appendicular muscle mass (β 0.06, p < 0.001). Both HGS and PS were independently associated with the ratio of extracellular water (ECW) to total body water (TBW); β -139.5, p = 0.024, β -44.8, p < 0.001 in the arm. The presence of an arterio-venous fistula increased the ECW/TBW ratio in the arm from 0.383 ± 0.009 to 0.390 ± 0.012, p < 0.05.Muscle strength measured by HGS and PS was associated with both markers of whole body and segmental body composition within the arm, particularly ECW/TBW. Bioimpedance measurements and assessment of muscle strength should be measured in the non-fistula arm.© 2016 S. Karger AG, Basel.
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| [34] |
Protein-energy wasting (PEW) is very common in patients with chronic kidney disease and those undergoing maintenance dialysis. Reduced handgrip strength is associated with PEW and considered as a reliable nutritional parameter that reflects loss of muscle mass. This study aimed to evaluate the handgrip strength and its relationship with the Malnutrition-Inflammation Score (MIS) among Iranian dialysis patients.The study population consisted of 83 randomly selected hemodialysis patients from the dialysis centers in Kerman, Iran. Handgrip strength was measured using a dynamometer according to the recommendations of the American Society of Hand Therapists. All the patients were interviewed and the MIS of the patients were recorded. Results. The PEW was prevalent in Kerman hemodialysis patients, with 83% and 17% having mild and moderate PEW based on MIS, respectively. Handgrip strength was significantly associated with age, sex, height, weight, and diabetes mellitus. After adjustment for age, handgrip strength was significantly associated with nutritional assessment markers on the basis of the MIS.Handgrip strength can be incorporated as a reliable tool for assessing nutrition status in clinical practice. However, further research is needed to determine the reference values and cutoff points both in healthy people and in hemodialysis patients to classify muscle wasting.
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| [35] |
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