Postural stability during standing and its association with physical and cognitive functions in non-dialysis chronic kidney disease patients.

PURPOSE: Chronic kidney disease (CKD) is characterised by poor physical function. A possible factor may be aberrant changes to balance and postural stability (i.e. ability to maintain centre of pressure (COP)). Previous research has exclusively focused on patients undergoing renal replacement therapy (RRT). The current study investigated postural stability in a group of CKD patients not requiring RRT. METHODS: 30 CKD patients (aged 57.0 ± 17.8 years, 47% female, mean eGFR 42.9 ± 27.2 ml/kg/1.73 m2) underwent a series of physical function assessments including the sit-to-stand-5 and -60, incremental shuttle walk test, gait speed, and short physical performance battery. Postural stability (defined as total COP ellipse (mm2) displacement) was measured using the Fysiometer board. Control reference data were provided by the manufacture. Cognitive function was assessed using the 'Montreal Cognitive Assessment-Basic' (MOCA-B)'. RESULTS: CKD patients had poorer postural stability during quiet standing than reference values across all age categories (≤ 39 years, 24.9 ± 11.3 vs. 10.4 ± 1.8 mm2; 40-59 years, 34.3 ± 19.0 vs. 17.7 ± 6.2 mm2; ≥ 60 years, 39.7 ± 21.2 vs. 16.8 ± 2.9 mm2, all comparisons P < 0.001). Reductions in postural stability were associated with both physical and cognitive functioning. In females only, postural stability worsened with declining renal function (r = - 0.790, P < 0.01). CONCLUSIONS: To our knowledge, this is the first and largest experimental report concerning measurement of postural stability of CKD patients not requiring RRT. Our findings suggest that postural stability is associated with worse physical and cognitive functioning in this patient group

Editorial: Nutrition and metabolism in kidney diseases

The impairment of kidney function, which occurs in chronic kidney disease (CKD) and acute kidney injury (AKI), promotes specific alterations in nutrient metabolism (1) and induces a pro-inflammatory state (2). These alterations affect the nutritional status of the patients and increase morbidity and mortality risk. Among the many factors that are associated with poor outcomes in this population, protein-energy wasting, malnutrition, and sarcopenia play a significant role. Nutritional management in individuals with impaired kidney function varies depending on the disease severity, nutritional status, cause of disease, comorbidities, medications, and treatment methods. Therefore, understanding the available methods for assessing nutritional status, establishing dietary requirements, and strategies for preventing or treating potential nutritional derangements is essential for optimal care of patients with kidney diseases. This Research Topic focuses on recent studies exploring nutrition and metabolism in CKD.</p

Physical activity, immune function and inflammation in kidney patients (the PINK study): a feasibility trial protocol.

INTRODUCTION: Patients with chronic kidney disease (CKD) display increased infection-related mortality and elevated cardiovascular risk only partly attributed to traditional risk factors. Patients with CKD also exhibit a pro-inflammatory environment and impaired immune function. Aerobic exercise has the potential to positively impact these detriments, but is under-researched in this patient population. This feasibility study will investigate the effects of acute aerobic exercise on inflammation and immune function in patients with CKD to inform the design of larger studies intended to ultimately influence current exercise recommendations. METHODS AND ANALYSIS: Patients with CKD, including renal transplant recipients, will visit the laboratory on two occasions, both preceded by appropriate exercise, alcohol and caffeine restrictions. On visit 1, baseline assessments will be completed, comprising anthropometrics, body composition, cardiovascular function and fatigue and leisure time exercise questionnaires. Participants will then undertake an incremental shuttle walk test to estimate predicted peak O2 consumption (VO2peak). On visit 2, participants will complete a 20 min shuttle walk at a constant speed to achieve 85% estimated VO2peak. Blood and saliva samples will be taken before, immediately after and 1 hour after this exercise bout. Muscle O2 saturation will be monitored throughout exercise and recovery. Age and sex-matched non-CKD 'healthy control' participants will complete an identical protocol. Blood and saliva samples will be analysed for markers of inflammation and immune function, using cytometric bead array and flow cytometry techniques. Appropriate statistical tests will be used to analyse the data. ETHICS AND DISSEMINATION: A favourable opinion was granted by the East Midlands-Derby Research Ethics Committee on 18 September 2015 (ref 15/EM/0391), and the study was approved and sponsored by University Hospitals of Leicester Research and Innovation (ref 11444). The study was registered with ISRCTN (ref 38935454). The results will be presented at relevant conferences, and it is anticipated that the reports will be published in appropriate journals in 2018

Differences in physical symptoms between those with and without kidney disease: a comparative study across disease stages in a UK population

Background: Those living with kidney disease (KD) report extensive symptom burden. However, research into how symptoms change across stages is limited. The aims of this study were to 1) describe symptom burden across disease trajectory, and 2) to explore whether symptom burden is unique to KD when compared to a non-KD population. Methods: Participants aged > 18 years with a known diagnosis of KD (including haemodialysis (HD) and peritoneal dialysis (PD)) and with a kidney transplant) completed the Leicester Kidney Symptom Questionnaire (KSQ). A non-KD group was recruited as a comparative group. Multinominal logistic regression modelling was used to test the difference in likelihood of those with KD reporting each symptom. Results: In total, 2279 participants were included in the final analysis (age 56.0 (17.8) years, 48% male). The main findings can be summarised as: 1) the number of symptoms increases as KD severity progresses; 2) those with early stage KD have a comparable number of symptoms to those without KD; 3) apart from those receiving PD, the most frequently reported symptom across every other group, including the non-KD group, was ‘feeling tired’; and 4) being female independently increased the likelihood of reporting more symptoms. Conclusions: Our findings have important implications for patients with KD. We have shown that high symptom burden is prevalent across the spectrum of disease, and present novel data on symptoms experienced in those without KD. Symptoms requiring the most immediate attention given their high prevalence may include pain and fatigue. Trial registration: The study was registered prospectively as ISRCTN11596292

Association of Ethnicity and Socioeconomic Status With COVID-19 Hospitalization and Mortality in Those With and Without Chronic Kidney Disease

In the United Kingdom, as of December 2021, there have been more than 11.5 million confirmed cases of COVID-19 and more than 170,000 deaths caused by SARS-CoV-2.S1 Data are being reported on subpopulations most at risk of COVID-19 and its most severe forms. Age, ethnicity, and socioeconomic position—fundamental components in health inequality—strongly influence health outcomes for both infectious and noncommunicable diseases, and COVID-19 has further exposed the strong association between these and adverse health outcomes.1There is substantial evidence that a disproportionate impact of COVID-19 exists on Black and South Asian ethnic groups.S2 Individuals from these groups are more likely to be infected by SARS-CoV-2 and have an increased risk of intensive care admission compared with those of White ethnicity.2 The mortality risk from COVID-19 among Black and Asian ethnic minority groups is approximately twice that of White patients.1,3 Socioeconomic status is also a key factor in COVID-19 outcome,4 and mortality rates from COVID-19 in the most deprived areas are more than double that of least deprived areas.5Many of the ethnic and socioeconomic disparities that increase susceptibility to COVID-19 also make individuals vulnerable to chronic kidney disease (CKD). The risk of CKD is higher in ethnic minority groups compared with White individuals at every CKD stage,6 and CKD is associated with greater hospitalization and mortality from COVID-19.7,S3,S4 Although the etiology of CKD involvement is multifactorial,S3 the interactions with ethnic and socioeconomic status have not been studied. Previous data suggest that inequalities in COVID-19 deaths by ethnic group exist among people with similar pre-existing conditions, including CKD7; however, to our knowledge, no study has investigated how ethnicity and socioeconomic status affect COVID-19 severity among those with CKD.</div

Peak aerobic capacity from incremental shuttle walk test in chronic kidney disease.

BACKGROUND: Assessment of cardiorespiratory fitness is an important outcome in chronic kidney disease (CKD). We aimed to develop a predictive equation to estimate peak oxygen uptake (VO2peak ) and power output (WPeak ), as measured during a cardiopulmonary exercise test (CPET), from the distance walked (DW) during the incremental shuttle walk test (ISWT). METHODS: Thirty-six non-dialysing patients with CKD [17 male, age: 61 ± 12 years, eGFR: 25±7 ml/min/1.73 m2 , body mass index (BMI): 31 ± 6 kg/m2 ] carried out laboratory-based CPET on a cycle ergometer and ISWT on two separate occasions. RESULTS: Linear regression revealed that DW/BMI was a significant predictor of VO2Peak (r = 0.78) (VO2Peak (ml/min/kg) = [0.5688 × (DW/BMI) (m)] + 11.50). No difference (p = 0.66) between CPET VO2Peak (19.9 ± 5.5 ml/min/kg) and predicted VO2Peak (19.9 ± 4.3 ml/min/kg) was observed. DW multiplied by body mass (BM) was a significant predictor of WPeak (r = 0.80) [WPeak (W) = (0.0018 × (DW × BM)) + 50.47]. No difference (p = 0.97) between CPET WPeak (116.2 ± 38.9 W) and estimated WPeak (113.9 ± 30.1 W) was seen. CONCLUSION: The present study demonstrates that VO2Peak and WPeak can be accurately estimated using the DW during an ISWT in CKD populations

Should we consider sarcopenia in pediatric patients with chronic kidney disease? A preliminary cross-sectional analysis

Background: Pediatric patients with chronic kidney disease (CKD) frequently present an inadequate nutritional profile and musculoskeletal impairments. We investigated sarcopenia and its related traits in children and adolescents with CKD. Methods: A cross-sectional study that enrolled pediatric patients with CKD (≥ 4 and < 18 years old). Physical function was assessed by handgrip strength and the 60-s sit-to-stand (STS-60) tests. Body composition measurement was performed by bioelectrical impedance analysis and anthropometry through mid-upper arm circumference (MUAC). Normative reference values from healthy pediatrics were used for identifying poor physical function and low MUAC. Probable sarcopenia was considered as low handgrip strength, whereas sarcopenia was defined by adding low MUAC. Results: Twenty-two pediatric patients with CKD (11 ± 4 years and 59% boys) were evaluated; eight on peritoneal dialysis (36%), six on hemodialysis (27%), and eight non-dialysis (36%). Regarding sarcopenia traits, we observed low physical function by handgrip strength and STS-60 in 59% and 100% of the patients, respectively, while low MUAC in 77%. Probable sarcopenia was found in 9% and sarcopenia in 50%, but prevalence did not differ among stages. Handgrip strength was strongly associated with MUAC (r = 0.90; p < 0.001); on the other hand, the STS-60 was not significantly associated with any of the body composition variables. Conclusion: Among pediatric patients with CKD, the prevalence of sarcopenia and its related traits was high. Nephrology professionals should consider the assessment of sarcopenia in this population, while more evidence is needed to determine its prognostic value. Graphical Abstract: [Figure not available: see fulltext.

Physical activity and risk of chronic kidney disease: systematic review and meta-analysis of 12 cohort studies involving 1,281,727 participants

The role of regular physical activity in preventing vascular and non-vascular disease is well established. Chronic kidney disease (CKD) is a major cause of global morbidity and mortality and largely preventable, but it is uncertain if regular physical activity can reduce the risk of CKD. Using a systematic review and meta-analysis of published observational cohort studies in the general population, we sought to assess the association between physical activity and CKD risk. Relevant studies with at least one-year of follow-up were sought from inception until 02 May 2022 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Relative risks (RRs) with 95% confidence intervals (CIs) for the maximum versus the minimal amount of physical activity groups were pooled using random effects meta-analysis. The quality of the evidence was evaluated using the GRADE tool. A total of 12 observational cohort studies comprising 1,281,727 participants and 66,217 CKD events were eligible for the analysis. The pooled multivariable-adjusted RR (95% CI) of CKD comparing the most versus the least physically active groups was 0.91 (0.85–0.97). The association was consistent across several study level subgroups. Exclusion of any single study at a time from the meta-analysis did not change the direction or significance of the association. There was no evidence of small study effects among contributing studies. The GRADE quality of the evidence was low. In the general population, individuals who are most physically active have a lowered risk of CKD compared to those who are not or least physically active. CRD42022327640

Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease: a secondary analysis of the ‘ExTra CKD’ trial

Background Chronic kidney disease (CKD) patients experience a high symptom burden including fatigue, sleep difficulties, muscle weakness and pain. These symptoms reduce levels of physical function (PF) and activity, and contribute to poor health-related quality of life (HRQoL). Despite the gathering evidence of positive physiological changes following exercise in CKD, there is limited evidence on its effect on self-reported symptom burden, fatigue, HRQoL and physical activity. Methods Thirty-six patients [mean ± SD 61.6 ± 11.8 years, 22 (61%) females, estimated glomerular filtration rate: 25.5 ± 7.8 mL/min/1.73 m2] not requiring renal replacement therapy underwent 12 weeks (3 times/week) of supervised aerobic exercise (AE), or a combination (CE) of AE plus resistance training. Outcomes included self-reported symptom burden, fatigue, HRQoL and physical activity. Results Exercise reduced the total number of symptoms reported by 17% and had favourable effects on fatigue in both groups. AE reduced the frequency of ‘itching’, ‘impotence’ and ‘shortness of breath’ symptoms, and the intrusiveness for symptoms of ‘sleep disturbance’, ‘loss of muscular strength/power’, ‘muscle spasm/stiffness’ and ‘restless legs’. The addition of resistance exercise in the CE group saw a reduction in ‘loss of muscular strength/power’. No changes were seen in subjective PF or physical activity levels. AE increased self-efficacy for physical activity. Conclusions Supervised exercise had favourable effects on symptom frequency and intrusiveness, including substantial improvements in fatigue. Although the intervention did not improve self-reported physical activity levels, AE increased patients’ self-efficacy for physical activity. These favourable changes in self-reported outcomes support the important role of exercise in CKD

Symptom-burden in people living with frailty and chronic kidney disease

BackgroundFrailty is independently associated with worse health-related quality of life (HRQOL) in chronic kidney disease (CKD). However, the relationship between frailty and symptom experience is not well described in people living with CKD. This study’s aim was to evaluate the relationship between frailty and symptom-burden in CKD.MethodsThis study is a secondary analysis of a cross-sectional observational study, the QCKD study (ISRCTN87066351), in which participants completed physical activity, cardiopulmonary fitness, symptom-burden and HRQOL questionnaires. A modified version of the Frailty Phenotype, comprising 3 self-report components, was created to assess frailty status. Multiple linear regression was performed to assess the association between symptom-burden/HRQOL and frailty. Logistic regression was performed to assess the association between experiencing symptoms frequently and frailty. Principal Component Analysis was used to assess the experienced symptom clusters.ResultsA total of 353 patients with CKD were recruited with 225 (64%) participants categorised as frail. Frail participants reported more symptoms, had higher symptom scores and worse HRQOL scores. Frailty was independently associated with higher total symptom score and lower HRQOL scores. Frailty was also independently associated with higher odds of frequently experiencing 9 out of 12 reported symptoms. Finally, frail participants experienced an additional symptom cluster that included loss of appetite, tiredness, feeling cold and poor concentration.ConclusionsFrailty is independently associated with high symptom-burden and poor HRQOL in CKD. Moreover, people living with frailty and CKD have a distinctive symptom experience. Proactive interventions are needed that can effectively identify and address problematic symptoms to mitigate their impact on HRQOL.</div