Beyond sarcopenia: frailty in chronic haemodialysis patients.

Autor: Souweine JS; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France., Pasquier G; University of Montpellier, Academic Hospital (CHU) of Montpellier, Department of Parasitology/Mycology, National Reference Centre (CNR) for Leishmaniosis, Montpellier, France., Morena M; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France., Patrier L; Fondation Charles Mion AIDER Santé, Montpellier, France., Rodriguez A; Fondation Charles Mion AIDER Santé, Montpellier, France., Raynal N; Fondation Charles Mion AIDER Santé, Montpellier, France., Ohresser I; Fondation Charles Mion AIDER Santé, Montpellier, France., Benomar R; Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France., Hayot M; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Physiology, University Hospital Center of Montpellier, Montpellier, France., Mercier J; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Physiology, University Hospital Center of Montpellier, Montpellier, France., Gouzi F; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Physiology, University Hospital Center of Montpellier, Montpellier, France., Cristol JP; PhyMedExp, University of Montpellier, INSERM, CNRS, Department of Biochemistry and Hormonology, University Hospital Center of Montpellier, Montpellier, France.; Fondation Charles Mion AIDER Santé, Montpellier, France.
Jazyk: angličtina
Zdroj: Clinical kidney journal [Clin Kidney J] 2024 Jun 29; Vol. 17 (7), pp. sfae069. Date of Electronic Publication: 2024 Jun 29 (Print Publication: 2024).
DOI: 10.1093/ckj/sfae069
Abstrakt: Background: Frailty, characterized by vulnerability, reduced reserves and increased susceptibility to severe events, is a significant concern in chronic haemodialysis (HD) patients. Sarcopenia, corresponding to the progressive loss of muscle mass and strength, may contribute to frailty by reducing functional capacity, mobility and autonomy. However, consensus lacks on the optimal bedside frailty index for chronic HD patients. This study investigated the influence of frailty on chronic HD patient survival and explored the associated factors.
Methods: A total of 135 patients were enrolled from January to April 2019 and then followed up prospectively until April 2022. At inclusion, frailty was assessed by the Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB) tests including gait speed, standing balance and lower limb muscle strength.
Results: From a total of 114 prevalent chronic HD patients (66% men, age 67.6 ± 15.1 years), 30 died during the follow-up period of 23.7 months (range 16.8-34.3). Deceased patients were older, had more comorbidities and a higher sarcopenia prevalence ( P  < .05). The TUG and SPPB test scores were significantly reduced in patients who had died [SPPB total score: 7.2 ± 3.3 versus 9.4 ± 2.5; TUG time 8.7 ± 5.8 versus 13.8 ± 10.5 ( P  < .05)]. Multivariate analysis showed that a higher SPPB score (total value >9) was associated with a lower mortality risk [hazard ratio 0.83 (95% confidence interval 0.74-0.92); P  < .03). Each component of the SPPB test was also associated with mortality in univariate analysis, but only the SPPB balance test remained protective against mortality in multivariate analysis. Older age, lower handgrip strength and lower protein catabolic rate were associated with SPPB total scores <9, SPPB balance score and TUG time >10 s.
Conclusions: Screening for frailty is crucial in chronic HD patients, and incorporating SPPB, especially the balance test, provides valuable insights. Diminished muscle strength and inadequate protein intake negatively influence the SPPB score and balance in chronic HD patients. Effective identification and management of frailty can therefore improve outcomes.
Clinical Trial Registration Clinicaltrialsgov: NCT03845452.
Competing Interests: All authors declare they have no conflicts of interest.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)
Databáze: MEDLINE
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