Abstract Background and Aims Peritoneal dialysis (PD) is beneficial for older adults with end-stage renal disease (ESRD) because it allows for dialysis treatment in their own homes. The risk factors associated with specific prognoses in elderly PD patients need to be explored to continue stably without adverse events. However, the risk of adverse events specific to older adults on PD has not been thoroughly investigated. The critical risk factor for ESRD and aging is decreased physical function. The purpose of this study was to assess the association between physical function and outcomes in older adults on PD. Methods This was a single-center, prospective observational cohort study. Stable, ambulatory patients undergoing PD between April 1, 2014, and September 31, 2016, were enrolled. Six-minute walk distance (6MWD), short physical performance battery (SPPB), lower extremity muscle strength (LES), and 10-meter walk speed were measured for each patient. Laboratory data were also collected. All subjects were followed up until death or the end of the follow-up period (December 31, 2019). This ethical institution at the Seire Christopher University approved all procedures performed in this study. Informed consent was obtained from all the patients. Baseline patient characteristics and physical function were compared using an unpaired t-test or Mann-Whitney U test. Receiver operating characteristic curve analysis on mortality prediction was performed to calculate the area under the curve in the significant value of the unpaired t-test or Mann-Whitney U test. We used the Youden index to determine the optimal cut-off point, and patients were categorized into 2 groups by each cut-off value. The relationship between all-cause mortality and each variable was studied using Kaplan-Meier analysis and the log-rank test. All tests were assessed at a statistical significance of p<0.05. Results Thirty-seven patients were enrolled. Three patients refused to participate in the study, and one patient was excluded because they had a medical reason. Therefore, 33 patients (age: 74.8 ± 5.9 years) were finally included in the present study. The median follow-up time was 39 months (interquartile range: 28–49 months), during which 19 (57.6%) deaths occurred. Death during follow-up was significantly associated with lower 6MWD (234.6.9±115.8 vs. 351.9±105.8 m), lower serum albumin (Alb, 2.7±0.6 vs. 3.2±0.4 mg/dL), and lower Geriatric Nutritional Risk Index (GNRI, 79.7±9.9 vs. 88.5±7.1) than those who did not die (died vs. not died group, respectively). No other variables were significantly different between the groups. The cut-off value, discriminating those at high risk of mortality, for the 6MWD was 338m, Alb was 3.0 ml/dL, and GNRI was 83.7. In the Kaplan-Meier survival analysis and log-rank test, 6MWD, Alb, and GNRI were significantly associated with all-cause mortality. Conclusion This is the first study, to our knowledge, to show that lower 6MWD scores were associated with all-cause mortality in older adults on PD, suggesting that objective exercise tolerance measures may be useful for the risk stratification of older adults undergoing PD. Although the results were obtained from a small sample size, this study has clinical significance because older adults on PD are rare. The 6MWD is a useful measurement that reflects exercise tolerance, has good reliability, has low cost, and is easily applicable. The results of this study support those of previous studies in other groups showing that 6MWD and nutritional status significantly predicted prognosis. Therefore, low exercise tolerance and malnutrition may represent an important therapeutic target in this population.
We aimed to investigate the factors associated with dropout from a physical function assessment program among participants receiving outpatient hemodialysis (HD). The participants were divided into continuation and dropout groups and followed up for 3 years after the initial physical function assessment. Multivariate logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the dropout group to determine the factors associated with dropout from the physical function assessment program. The continuation and dropout groups included 43 and 58 participants, respectively. The continuation group had a significantly higher self-efficacy (SE) and age than the dropout group (p = 0.001, p = 0.047). Multivariate logistic regression analysis indicated that only SE (OR: 1.202, 95% CI: 1.082-1.334) remained a significant predictor after adjustment (p < 0.05). There is a need to evaluate SE to prevent dropout from physical functioning assessment programs.
INTRODUCTION AND AIMS: Background: The prevalence of falls among Stage 5 chronic kidney disease (CKD-5) patients undergoing haemodialysis (HD) therapy ranges from 26.3% to 47%, and is considerably higher than in the general healthy population.In addition to traditional risk factors such as older age, frailty, comorbidity, and polypharmacy, these patients often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease, which may contribute to an increased risk of falling.Particularly, it has been suggested that the dysregulation of blood pressure during orthostasis may play a role in the aetiology of falls in these patients.Purpose of the study: To compare the haemodynamic responses to a passive orthostatic challenge, as well as the baroreflex function, in HD patients with and without history of falls.METHODS: We recruited 62 adult people on HD from a single Renal Unit between October 2015 and December 2016.Fifty-two patients completed all baseline assessments and were included in this cross-sectional study.Participants were classified as "fallers" and "non-fallers" based on self-reported history of falls in the previous 12 months and objective recordings of falls over a 12 month period from the baseline assessment.Participants completed a passive orthostatic challenge consisting of lying down supine for 15 minutes, followed by head up tilting (HUT) at 60 degrees for 5 minutes on an automated tilt table.ECG signals, continuous (contBP) and oscillometric (OscBP) blood pressure measurements, and impedance cardiography were recorded continuously using the Task ForceV R Monitor 3040i (CNS systems, Graz, Austria), and the following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).Following normality checks, the comparison of "fallers" vs "non-fallers" was performed by means of either independent t-tests or Mann-Whitney tests.Significance levels were set at alpha¼ 0.05.RESULTS: Twenty-nine participants were classified as fallers (age¼ 57.4614.3years, gender¼ 55.2% M, dialysis vintage¼ 23.1626.2months, BMI¼ 27.2566.21,CCI¼ 5.162.3) and 23 as non-fallers (age¼ 63.4614.4years, gender¼ 65.2% M, dialysis vin-tage¼ 16.5615.6months, BMI¼ 30.3966.09,CCI¼ 5.162).No significant differences in sociodemographic and clinical characteristics were found between groups.Fallers experienced a significantly larger drop in systolic OscBP from supine to HUT (-8.87 vs -0.93 mmHg) compared with non-fallers.In addition, fallers had a lower number of baroreceptor events (6.869.1 vs 14.4616.4)and down-regulatory BEI (24.5628.7%vs 40.3615.3%) in the supine position.No differences in HR, SV, CO, TPR, and contBP were detected between the two groups at rest or in response to HUT.CONCLUSIONS: This cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with worse baroreflex function, as highlighted by the lower number of baroreceptor-mediated sequences of coupled HR and BP.Shortterm BP regulation warrants further investigation as BP drops during the transition from supine to HUT may be implicated in the aetiology of falls in HD.
Abstract Background This study investigated the association between the blood pressure response during hemodialysis (HD) and exercise tolerance or heart rate recovery (HRR) measured with cardiopulmonary exercise testing (CPX). Methods The study enrolled 23 patients who had been undergoing 4-h regular maintenance HD. The maximum workload (Load peak ), peak oxygen uptake (VO 2peak ), workload and oxygen uptake at the anaerobic threshold (Load AT and VO 2AT, respectively), and HRR were measured with CPX. The average systolic blood pressure during HD (SBP av ) was measured, and the number of times the SBP was less than 100 mmHg was determined in the 2-week period after CPX. Results The SBP av showed a significant correlation with Load AT ( r = 0.46) and Load peak ( r = 0.43, p < 0.05). The number of times the SBP was less than 100 mmHg showed a significant correlation with the HRR ( r = − 0.44, p < 0.05). Conclusion Exercise intolerance and HRR in HD patients may be associated with blood pressure instability during HD.
Background: Exercise therapy for patients with pediatric nephrotic syndrome is necessary to improve physical function to maintain the patient’s activities of daily life and school life while managing the risk of relapse; however, few studies have examined exercise therapy in the acute phase of the syndrome. This case study aimed to evaluate the efficacy and safety of exercise therapy in a patient with acute pediatric nephrotic syndrome being treated with steroids.
