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Yuan G, Yang Y, Lin Y, Lin J, Wu Y. Current status and development trends in CKD with frailty research from 2000 to 2021: a bibliometric analysis. Ren Fail 2024; 46:2292142. [PMID: 38178378 PMCID: PMC10773684 DOI: 10.1080/0886022x.2023.2292142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/01/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION The prevalence of chronic kidney disease (CKD) is gradually increasing in the elderly population. At the same time, frailty has become one of the research hotspots in the field of geriatrics. Bibliometric analyses help to understand the direction of a field. Therefore, this study aimed to analyze the status and emerging trends of frailty in CKD patients. DATA AND METHODS The Web of Science Core Collection (WoSCC) database was screened for relevant literature published between 1 January 2000 and 31 December 2021. Next, publications were analyzed for information including authors, journals, cited references, citing journals, institutions, countries and regions, high-frequency keywords and co-citations using VOSviewer, Microsoft Excel, and R software. RESULTS A total of 2223 articles were obtained, from which 613 relevant articles were selected based on title and abstract screening. There was an upward trend in the number of annual publications and Johansen KL was considered the most contributing author in the field. The Clinical Journal of the American Society of Nephrology was the most productive research journal. Johns Hopkins University is the most published organization. The United States is the global leader in the field and contributes the most to research. Research hotspots focus on epidemiological studies of frailty and frailty intervention. CONCLUSIONS This study presents a comprehensive bibliometric analysis of CKD and frailty research. Key findings highlight the current focus on early screening and assessment of frailty in CKD patients, as well as physical function interventions in frail patients.
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Affiliation(s)
- Guowei Yuan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yaqin Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yujie Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiarong Lin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Yuchi Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Department of Hemodialysis, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Arias-Guillén M, Romano B, Yuguero-Ortiz A, López-Lazcano A, Guerrero S, Villegas V, Martínez M, Clemente N, Gómez M, Rodas L, Broseta JJ, Quintela M, Maduell F, Bayés B. Frailty in hemodialysis patients: results of a screening program and multidisciplinary interventions. Clin Kidney J 2023; 16:2174-2184. [PMID: 37915889 PMCID: PMC10616445 DOI: 10.1093/ckj/sfad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 11/03/2023] Open
Abstract
Background The number of frail patients of advanced age with end-stage kidney disease (ESKD) undergoing hemodialysis is increasing globally. Here we evaluated a frailty screening program of ESKD patients starting hemodialysis, and subsequent multidisciplinary interventions. Methods This was a prospective observational study of ESKD patients in a hemodialysis program. Patients were evaluated for frailty (Fried frail phenotype) before and after a 12-month period. Patients followed standard clinical practice at our hospital, which included assessment and multidisciplinary interventions for nutritional (malnutrition-inflammation score, protein-energy wasting), physical [short physical performance battery (SPPB)] and psychological status. Results A total of 167 patients (mean ± standard deviation age 67.8 ± 15.4 years) were screened for frailty, and 108 completed the program. At screening, 27.9% of the patients were frail, 40.0% pre-frail and 32.1% non-frail. Nutritional interventions (enrichment, oral nutritional supplements, intradialytic parenteral nutrition) resulted in stable nutritional status for most frail and pre-frail patients after 12 months. Patients following recommendations for intradialytic, home-based or combined physical exercise presented improved or stable in SPPB scores after 12 months, compared with those that did not follow recommendations, especially in the frail and pre-frail population (P = .025). A rate of 0.05 falls/patient/year was observed. More than 60% of frail patients presented high scores of sadness and anxiety. Conclusions Frailty screening, together with coordinated interventions by nutritionists, physiotherapists, psychologists and nurses, preserved the health status of ESKD patients starting hemodialysis. Frailty assessment helped in advising patients on individual nutritional, physical or psychological needs.
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Affiliation(s)
- Marta Arias-Guillén
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Bárbara Romano
- Department of Endocrinology and Nutrition, Hospital Clínic, Barcelona, Spain
| | - Anna Yuguero-Ortiz
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital Clínic, Barcelona, Spain
| | - Ana López-Lazcano
- Clinical Health Psychology Section, Psychiatry and Clinical Psychology Service, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
| | - Sonia Guerrero
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Vanesa Villegas
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Mar Martínez
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Nuria Clemente
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Miquel Gómez
- Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Fundació Clínic per la Recerca Biomèdica (FCRB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lida Rodas
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - José Jesús Broseta
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Marta Quintela
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Francisco Maduell
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
| | - Beatriu Bayés
- Department of Renal Transplantation and Nephrology, Hospital Clínic, Barcelona, Spain
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Zhang F, Wang H, Bai Y, Zhang Y, Huang L, Zhang H. Prevalence of physical frailty and impact on survival in patients with chronic kidney disease: a systematic review and meta-analysis. BMC Nephrol 2023; 24:258. [PMID: 37661257 PMCID: PMC10476333 DOI: 10.1186/s12882-023-03303-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Frailty is common in chronic kidney disease (CKD) patients and becomes more prevalent as kidney disease progresses. This study aimed to investigate the prevalence of physical frailty and quantify the relationship between frailty and mortality risk in patients with CKD. METHODS PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Clinicaltrial.gov, and major renal academic conferences were systematically searched, and additional references to relevant articles were manually searched. The prevalence of physical frailty and the risk of mortality based on random-effects models were assessed using percentages and hazard ratio (HR) with a 95% confidence interval (CI). RESULTS A total of 139 articles, including 1,675,482 participants, met the eligibility criteria for the meta-analysis. The results showed that 34.5% (95% CI 31.0 to 38.1%) of CKD patients showed signs of frailty, and 39.4% (95% CI 35.4 to 43.5%) had prefrail symptoms. Compared to non-frail patients, the risk of mortality was increased by 94.1% (95% CI 1.586 to 2.375) in frail patients and 34.5% (95% CI 1.231 to 1.469) in prefrail patients. CONCLUSION The high prevalence of frailty and prefrail in adults with CKD and resulting in premature death emphasize the importance of measuring frailty, which provides important prognostic information and may provide opportunities for interventions to improve the prognosis of patients with CKD.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ying Zhang
- Department of Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Tonelli M, Wiebe N, Gill JS, Bello AK, Hemmelgarn BR, Chan CT, Lloyd A, Thadhani RI, Thompson S. Frailty and Clinical Outcomes in Patients Treated With Hemodialysis: A Prospective Cohort Study. Kidney Med 2023; 5:100684. [PMID: 37502378 PMCID: PMC10368915 DOI: 10.1016/j.xkme.2023.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Rationale and Objective Frailty is common among people with kidney failure treated with hemodialysis (HD). The objective was to describe how frailty evolves over time in people treated by HD, how improvements in frailty and frailty markers are associate with clinical outcomes, and the characteristics that are associated with improvement in frailty. Study Design Prospective cohort study. Setting and Participants Adults initiating thrice weekly in-center HD in Canada. Exposure We classified frailty using a 5-point score (3 or more indicates frailty) based on physical inactivity, slowness or weakness, poor endurance or exhaustion, and malnutrition. We categorized the frailty trajectory as never present, improving, deteriorating, and always present. Outcomes All-cause death, hospitalizations, and placement into long-term care. Analytical Approach We examined the association between time-varying frailty measures and these outcomes using Cox and negative binomial models, after adjustment for potential confounders. Results 985 participants were included and followed up for a median of 33 months; 507 (51%) died, 761 (77%) experienced ≥1 hospitalization and 115 (12%) entered long-term care. Overall, 760 (77%) reported frailty during follow-up. Three-quarters (78%) of those with frailty at baseline remained frail throughout the follow-up, 46% without baseline frailty became frail, and 23% with baseline frailty became nonfrail. Higher frailty scores were associated with an increased risk of mortality (fully adjusted HR, 1.58 per unit; 95% CI, 1.39-1.80) and an increased rate of hospitalization (RR, 1.16 per unit; 95% CI, 1.09-1.23). Compared with those who were frail throughout the follow-up, participants with frailty at baseline but improving during follow-up showed a lower mortality (HR, 0.59; 95% CI, 0.42-0.81), and a lower rate of hospitalization (RR, 0.70; 95% CI, 0.56-0.87). Limitations There was missing data on frailty at baseline and during follow-up. Conclusions Frailty was associated with a higher risk of poor outcomes compared with those without frailty, and participants whose status improved from frail to nonfrail showed better clinical outcomes than those who remained frail. These findings emphasize the importance of identifying and implementing effective treatments for frailty in patients receiving maintenance HD.
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Affiliation(s)
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Canada
| | - John S. Gill
- Department of Medicine, University of British Columbia, Canada
| | | | | | | | - Anita Lloyd
- Department of Medicine, University of Alberta, Canada
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Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Somatic Symptoms of Depression Lose Association with Mortality upon Adjustment for Frailty: Analysis from the Fitness Haemodialysis Cohort. Int J Nephrol 2023; 2023:4518843. [PMID: 37388527 PMCID: PMC10307017 DOI: 10.1155/2023/4518843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The somatic symptom component of depression is associated with increased hospitalisation and mortality and poorer health-related quality of life (HRQOL). However, the relationship of subsets of depression symptoms with frailty and outcomes is not known. This study aimed to (1) explore the relationship between the Clinical Frailty Scale (CFS) and components of depression and (2) their association with mortality, hospitalisation, and HRQOL in haemodialysis recipients. Methods We conducted a prospective cohort study of prevalent haemodialysis recipients, with deep bio-clinical phenotyping including CFS and PHQ-9 somatic (fatigue, poor appetite, and poor sleep) and cognitive component scores. EuroQol EQ-5D summary index assessed HRQOL at the baseline. Electronic linkage to English national administration datasets ensured robust follow-up data for hospitalisation and mortality events. Findings. Somatic (β = 0.067; 95% C.I. 0.029 to 0.104; P < 0.001) and cognitive (β = 0.062; 95% C.I. 0.034 to 0.089; P<0.001) components were associated with increased CFS scores. Both somatic (β = -0.062; 95% C.I. -0.104 to -0.021; P<0.001) and cognitive (β = 0.052; 95% C.I. -0.081 to -0.024; P < 0.001) scores were associated with lower HRQOL. Somatic scores lost mortality association on addition of CFS to the multivariable model (HR1.06; 95% C.I. 0.977 to 1.14; P=0.173). Cognitive symptoms were not associated with mortality. Neither the component score was associated with hospitalisation on multivariable analyses. Conclusions Both somatic and cognitive depression symptoms are associated with frailty and poorer HRQOL in haemodialysis recipients but were not associated with mortality or hospitalisation when adjusted for frailty. The risk profile of depression somatic scores may be related to overlap with symptoms of frailty.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Gender Disparity in Expression of Sarcopenia in Haemodialysis Recipients: Analysis from the FITNESS Cohort. Int J Nephrol 2023; 2023:5885059. [PMID: 37363696 PMCID: PMC10290558 DOI: 10.1155/2023/5885059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/01/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
Background There has been little exploration of the interplay between sarcopenia and frailty in haemodialysis, particularly regarding gender difference. We aimed to (1) assess whether ultrasound-derived low muscle mass (LMM) and sarcopenia are more common in male or female haemodialysis recipients; (2) assess whether age influences any observed gender difference, and (3) explore the interplay between sarcopenia, frailty, and gender in haemodialysis recipients. Methods This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis with frailty phenotype (FP) scores. Bilateral anterior thigh thickness (BATT) was obtained according to an established ultrasound protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, LMM, and sarcopenia with a priori covariables, stratified by gender. Results In total of 223 studies, participants had ultrasound measurements. Males showed greater prevalence of LMM. On adjusted analyses, LMM was associated with lower hand grip strength in males (β = -4.17; 95% C.I. -7.57 to -0.77; P=0.02), but not females (β = -1.88; 95% C.I. -5.41 to 1.64; P=0.29). LMM was also associated with slower walking speed in both males (β = -0.115; 95% C.I. -0.258 to -0.013; P=0.03) and females (β = -0.152; 95% C.I. -0.300 to -0.005; P=0.04). Sarcopenia was associated with greater odds of frailty on adjusted models in males (OR = 9.86; 95% C.I. 1.8 to 54.0; P=0.01), but not females (OR = 5.16; 95% C.I. 0.22 to 124; P=0.31). Conclusions The clinical expression and significance of sarcopenia differ substantially between males and females on haemodialysis. Further work is required to elucidate underlying mechanisms and guide tailored treatment.
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Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Barbosa EMS, Pereira AG, Mori V, da Silva Neves R, Vieira NM, Silva MZC, Seki MM, Rodrigues HCN, Costa NA, Ponce D, Balbi AL, Zornoff LAM, Azevedo PS, Polegato BF, de Paiva SAR, Minicucci MF, de Souza Dorna M. Comparison between FRAIL Scale and Clinical Frailty Scale in predicting hospitalization in hemodialysis patients. J Nephrol 2023; 36:687-693. [PMID: 36547774 PMCID: PMC9773694 DOI: 10.1007/s40620-022-01532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND To assess the prevalence of frailty by the Clinical Frailty Scale (CFS) and the 5-item FRAIL scale and their association with hospitalization in hemodialysis (HD) patients. METHODS This was a prospective observational study. We included patients of both genders ≥ 18 years old in HD treatment for at least 3 months. Demographic, clinical, and routine laboratory data were retrieved from the medical charts. Two different frailty assessment tools were used, the CFS and the FRAIL scale. Participants were followed up for 9 months and hospitalizations for all causes were evaluated. A Venn diagram was constructed to show the overlap of possible frailty and pre-frailty. Cox regression was used to identify the association between frailty and hospitalization. The significance level was 5%. RESULTS A total of 137 subjects were included in the analysis. The median age was 61 (52-67) years and 60% were male. The hospitalization rate and mortality in 9 months were 22.6% and 7.29%, respectively. Regarding frailty, the overall prevalence was 13.8% assessed by CFS and 36.5% according to the FRAIL scale. In the Cox regression, frailty by FRAIL scale was associated with a 2.8-fold increase in the risk of hospitalization (OR = 2.880; 95% CI = 1.361-6.096; p = 0.006), but frailty assessed by the CFS was not associated with the need for hospitalization. CONCLUSION In HD patients, the FRAIL scale proved to be an easy-to-apply tool, identifying a high prevalence of frailty and being a predictor of hospital admission.
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Affiliation(s)
| | - Amanda Gomes Pereira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Vitória Mori
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Renan da Silva Neves
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Nayane Maria Vieira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Maryanne Zilli Canedo Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Marcos Mitsuo Seki
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Hellen Christina Neves Rodrigues
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Street 227 Block 68 s/n, East University Sector, Goiânia, Goiás, 74605-080, Brazil
| | - Nara Aline Costa
- Faculty of Nutrition, Universidade Federal de Goiás (UFG), Street 227 Block 68 s/n, East University Sector, Goiânia, Goiás, 74605-080, Brazil.
| | - Daniela Ponce
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - André Luís Balbi
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Paula Schmidt Azevedo
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Sérgio Alberto Rupp de Paiva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Marcos Ferreira Minicucci
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Mariana de Souza Dorna
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. A clinical frailty scale obtained from MDT discussion performs poorly in assessing frailty in haemodialysis recipients. BMC Nephrol 2023; 24:80. [PMID: 36997856 PMCID: PMC10062243 DOI: 10.1186/s12882-023-03126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The Clinical Frailty Scale (CFS) is a commonly utilised frailty screening tool that has been associated with hospitalisation and mortality in haemodialysis recipients, but is subject to heterogenous methodologies including subjective clinician opinion. The aims of this study were to (i) examine the accuracy of a subjective, multidisciplinary assessment of CFS at haemodialysis Quality Assurance (QA) meetings (CFS-MDT), compared with a standard CFS score via clinical interview, and (ii) ascertain the associations of these scores with hospitalisation and mortality. METHODS We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalisation. Frailty was assessed using the CFS after structured clinical interview. The CFS-MDT was derived from consensus at haemodialysis QA meetings, involving dialysis nurses, dietitians, and nephrologists. RESULTS 453 participants were followed-up for a median of 685 days (IQR 544-812), during which there were 96 (21.2%) deaths and 1136 hospitalisations shared between 327 (72.1%) participants. Frailty was identified in 246 (54.3%) participants via CFS, but only 120 (26.5%) via CFS-MDT. There was weak correlation (Spearman Rho 0.485, P < 0.001) on raw frailty scores and minimal agreement (Cohen's κ = 0.274, P < 0.001) on categorisation of frail, vulnerable and robust between the CFS and CFS-MDT. Increasing frailty was associated with higher rates of hospitalisation for the CFS (IRR 1.26, 95% C.I. 1.17-1.36, P = 0.016) and CFS-MDT (IRR 1.10, 1.02-1.19, P = 0.02), but only the CFS-MDT was associated with nights spent in hospital (IRR 1.22, 95% C.I. 1.08-1.38, P = 0.001). Both scores were associated with mortality (CFS HR 1.31, 95% C.I. 1.09-1.57, P = 0.004; CFS-MDT HR 1.36, 95% C.I. 1.16-1.59, P < 0.001). CONCLUSIONS Assessment of CFS is deeply affected by the underlying methodology, with the potential to profoundly affect decision-making. The CFS-MDT appears to be a weak alternative to conventional CFS. Standardisation of CFS use is of paramount importance in clinical and research practice in haemodialysis. TRIAL REGISTRATION Clinicaltrials.gov : NCT03071107 registered 06/03/2017.
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Affiliation(s)
- Benjamin M Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, B15 2WB, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, B15 2WB, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, B15 2WB, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, B15 2WB, Birmingham, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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Anderson BM, Wilson DV, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Ultrasound quadriceps muscle thickness is variably associated with frailty in haemodialysis recipients. BMC Nephrol 2023; 24:16. [PMID: 36653750 PMCID: PMC9847024 DOI: 10.1186/s12882-022-03043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Ultrasonographic quantitation of quadriceps muscle mass is increasingly used for assessment of sarcopenia, but its relationship with frailty in haemodialysis recipients is not known. This study explores the relationship between ultrasound-derived bilateral anterior thigh thickness (BATT), sarcopenia, and frailty by common frailty tools (Frailty Phenotype [FP], Frailty Index [FI], Edmonton Frailty [EFS], and Clinical Frailty Scale [CFS]). METHODS This was an exploratory analysis of a subgroup of adult prevalent (≥3 months) haemodialysis recipients deeply phenotyped for frailty. Ultrasound assessment of BATT was obtained with participants at an angle of ≤45°, with legs outstretched and knees resting at 10°-20°, according to an established protocol. Associations with frailty were explored via both linear and logistic regressions for BATT, Low Muscle Mass (LMM), and sarcopenia with stepwise adjustment for a priori covariables. RESULTS In total 223 study participants had ultrasound measurements. Frailty ranged from 34% for FP to 58% for FI. BATT was associated with increasing frailty on simple linear regression by all frailty tools, but lost significance on addition of covariables. Upon dichotomising frailty tools into Frail/Not Frail, BATT was associated with frailty by all tools on univariable analyses, but only retained association for EFS on the fully adjusted model (OR 0.97, 95% C.I. 0.94-1.00, P = 0.05). CONCLUSIONS Ultrasound measures of quadriceps thickness is variably associated with frailty in prevalent haemodialysis recipients, dependent upon the frailty tool used, but not independent of other variables. Further work is required to establish the added value of sarcopenia measurement in frail haemodialysis patients. TRIAL REGISTRATION Clinicaltrials.gov : NCT03071107 registered 06/03/2017.
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Affiliation(s)
- Benjamin M. Anderson
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Daisy V. Wilson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Muhammad Qasim
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- grid.414618.e0000 0004 6005 2224Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- grid.415490.d0000 0001 2177 007XDepartment of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK ,PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- grid.6572.60000 0004 1936 7486Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK ,grid.415490.d0000 0001 2177 007XDepartment of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- grid.415490.d0000 0001 2177 007XDepartment of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, B15 2WB UK ,grid.6572.60000 0004 1936 7486Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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10
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Hurst H, Young HML, Nixon AC, Ormandy P, Brettle A, Winterbottom A, Bekker H, Brown EA, Murtagh FEM, Da Silva-Gane M, Coyle D, Finnigan R. Outcomes and care priorities for older people living with frailty and advanced chronic kidney disease: a multi-professional scoping review. Age Ageing 2022; 51:6964934. [PMID: 36580559 DOI: 10.1093/ageing/afac296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 12/30/2022] Open
Abstract
The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older people (≥65 years) living with frailty and ACKD. More specifically how frailty is identified, what interventions have been studied and what outcomes have been reported including outcomes important to patients, families and carers. A scoping review was undertaken following the PRISMA-Scr guidelines. Nine databases were searched and a review team of five people followed a process using defined inclusion and exclusion criteria. Data were then analysed to answer the specific questions of the review. The World Health Organization's International Classification of Functioning Disability and Health was used to map outcomes across the domains. A total of 90 studies were included. The most reported frailty measure was the frailty phenotype. The most reported outcomes were mortality, hospitalisation and healthcare utilisation. Health-related quality of life was the most common patient-reported outcome measure. There were few intervention studies and limited evidence of patient and carer perspectives. This scoping review highlights important areas for further research in older people living with frailty and ACKD. This includes a 'gold standard' measure for identifying frailty, interventions and improvements in outcome measures that matter to patients (including studies that focus on carers and carer burden) and priority setting for future research.
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Affiliation(s)
- Helen Hurst
- The University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah M L Young
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Department of Research and Innovation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrew C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Salford, UK
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11
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Merchant RA, Vathsala A. Healthy aging and chronic kidney disease. Kidney Res Clin Pract 2022; 41:644-656. [PMID: 36328991 PMCID: PMC9731776 DOI: 10.23876/j.krcp.22.112] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/18/2022] [Accepted: 07/03/2022] [Indexed: 07/30/2023] Open
Abstract
The world population is aging and the prevalence of noncommunicable diseases such as diabetes, hypertension, and chronic kidney disease (CKD) will increase significantly. With advances in medical treatment and public health, the human lifespan continues to outpace the health span in such a way that the last decade of life is generally spent in poor health. In 2015, the World Health Organization defined healthy aging as 'the process of developing and maintaining the functional ability that enables wellbeing in older age.' CKD is increasingly being recognized as a model of accelerated aging and is associated with physical performance decline, cognitive decline, falls and fractures, poor quality of life, loss of appetite, and inflammation. Frailty and dementia are the final pathways and key determinants of disability and mortality independent of underlying disease. CKD, dementia, and frailty share a triangular relationship with synergistic actions and have common risk factors wherein CKD accelerates frailty and dementia through mechanisms such as uremic toxicity, metabolic acidosis and derangements, anorexia and malnutrition, dialysis-related hemodynamic instability, and sleep disturbance. Frailty accelerates glomerular filtration decline as well as dialysis induction in CKD and more than doubles the mortality risk. Anorexia is one of the major causes of protein-energy malnutrition, which is also prevalent in the aging population and warrants screening. Healthcare systems across the world need to have a system in place for the prevention of CKD amongst high-risk older adults, focusing on screening for poor prognostic factors amongst patients with CKD such as frailty, poor appetite, and cognitive impairment and providing necessary person-centered interventions to reverse underlying factors that may contribute to poor outcomes.
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Affiliation(s)
- Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Anantharaman Vathsala
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Nephrology, Department of Medicine, National University Hospital, Singapore, Singapore
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12
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Abstract
Sarcopaenia is a highly prevalent condition in persons on haemodialysis (HD). In stable very elderly (75–95 years old) persons on chronic HD, we prospectively studied the European Working Group on Sarcopaenia in Older People (EWGSOP2) steps stability over time in 37 controls and their response to a 12-week intradialytic lower limb exercise programme in 23 persons. Overall dropout was 15% and the main cause for dropout was death (8%). Thus 33 controls and 18 exercise participants were evaluated at 12 weeks. In controls, comorbidity, nutrition, dependency and frailty scales, anthropometric assessments, EWGSOP2 step values and the prevalence of suspected, confirmed and severe sarcopaenia as assessed by EWGSOP2 remained stable. In contrast, in persons who completed the exercise programme, a significant improvement in the five times sit-to-stand (STS-5) test was noted at the end of the 12-week exercise programme (19.2 ± 4.9–15.9 ± 5.9 seconds; P = .001), consistent with the lower limb nature of the exercise programme, that persisted 12 weeks after completion of the programme. Exercise also improved the Fried frailty scale (1.7 ± 1.0–1.1 ± 0.6; P = .004). In conclusion, EWGSOP2 steps remain stable in stable very elderly persons on HD and STS-5 is responsive to a short-term intradialytic lower limb exercise programme. These results may help define EWGSOP2-based primary endpoints in future large-scale clinical trials assessing exercise interventions.
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