Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial.

Background/Aims: Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor) fitness and clinical outcomes has never been tested in these patients. Methods: We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT), for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969). Results: During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001) and a similar relationship existed between the 6MWT, mortality (P<0.001) and hospitalizations (P=0.03). A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance (P=0.09). Conclusions: Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk populatio

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81&nbsp;years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

What to eat. the terapeutic and dietetic compliance of patients on peritoneal dialysis.

Nutrition education is important for patients on peritoneal dialysis. Yet, despite initial nutrition training and monthly reinforcements during follow-up visits, phosphorus control remains unsatisfactory. For this reason a meeting with an external renal dietician open to patients and their relatives was organized. Biographical data and average phosphorus levels for the 3 months prior to the meeting are shown in Table.1 Patients 11 (6 F - 5 M) Age (years) 63 (47-81) Time on Dialysis (months) 72 (6-348) Body Mass Index (kg/m2) 25.8 (22.3-32.4) Phosphorous mg/dl (average of 3 months) 5.95 (3.9-8.2)After a lecture delivered by the centre’s nephrologist, a questionnaire on phosphorus control was compiled by the participants. The renal dietician then explained how to: control dietary phosphorous intake, properly use chelating agents, reduce phosphorous in cooking and make smart food choices. A trained chef then demonstrated how to cook some regional recipes specifically reworked to reduce their phosphorous content without sacrificing taste. Participants then verified that the recipes were indeed appetizing. At this point, the same questionnaire given at the start of the meeting was re-given. From this, an improvement in the understanding of phosphorus control was seen. For example, in response to the question “Who is responsible for controlling phosphorus?” the percentage of patients correctly answering “the patient" rose from 55% before the meeting to 91% after the meeting. To successfully manage kidney disease patients and their relatives need to understand how to best control for phosphorous and this can only be done through continuous nutrition education. The Authors are waiting on the results of phosphorus levels for the next 3 months. The Authors would like to thank Baxter Healthcare for its organizational support

Posterior tibial nerve stimulation: is the once-a-week protocol the best option?

Aim of our study was to compare the results of posterior tibial nerve stimulation (PTNS) performed weekly with those of PTNS performed 3 times per week in patients with overactive bladder syndrome

Association of metabolic syndrome with cognitive function: the role of sex and age.

Background &amp; aims: Cognitive impairment is a prevalent condition in older populations, independently associated with disability and mortality. Some studies have suggested a negative correlation between metabolic syndrome (MetS) and cognitive functioning, but results in older subjects are controversial. The aim of this study was to evaluate the association of cognitive performance with MetS in an older unselected population. Methods: We evaluated the association of the Hodkinson Abbreviated Mental Test (AMT) score with MetS, as defined by the National Cholesterol Education Program's ATP-III criteria, in all 353 subjects aged 75+ living in Tuscania (Italy). Results: MetS was positively associated with the AMT score in multivariable linear regression analysis, after adjusting (B = 0.45, 95% CI = 0.04-0.90; p = 0.03). When the same regression model was analyzed after stratifying for sex, such an association was significant in women (B = 0.76, 95% CI = 0.16-1.36; p = 0.01), but not in men. Also, when the regression model was analyzed in women, MetS was associated with better cognition (B = 1.41, 95% CI = 0.51-2.30; p &lt; 0.01) among participants aged 80+. Conclusions: MetS is associated with better cognitive performance in community-dwelling elderly; such an association seems to depend upon the oldest female subjects. © 2008 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Posterior tibial nerve stimulation: is the once-a-week protocol the best option?

Aim of our study was to compare the results of posterior tibial nerve stimulation (PTNS) performed weekly with those of PTNS performed 3 times per week in patients with overactive bladder syndrome