Abstract
BackgroundLow physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. We investigated the clinical relevance of gait speed and handgrip strength, the two most commonly used methods of assessing physical performance.MethodsWe obtained data regarding gait speed and handgrip strength from 277 hemodialysis patients and evaluated their relationships with baseline parameters, mental health, plasma inflammatory markers, and major adverse clinical outcomes. Low physical performance was defined by the recommendations suggested by the Asian Working Group on Sarcopenia.ResultsThe prevalence of low gait speed and handgrip strength was 28.2 and 44.8%, respectively. Old age, low serum albumin levels, high comorbidity index score, and impaired cognitive functions were associated with low physical performance. Patients with isolated low gait speed exhibited a general trend for worse quality of life than those with isolated low handgrip strength. Gait speed and handgrip strength showed very weak correlations with different determining factors (older age, the presence of diabetes, and lower serum albumin level for low gait speed, and lower body mass index and the presence of previous cardiovascular events for low handgrip strength). Patients with low gait speed and handgrip strength had elevated levels of plasma endocan and matrix metalloproteinase-7 and the highest risks for all-cause mortality and cardiovascular events among the groups (adjusted hazard ratio of 2.72, p = 0.024). Elderly patients with low gait speed and handgrip strength were at the highest risk for poor clinical outcomes.ConclusionGait speed and handgrip strength reflected distinctive aspects of patient characteristics and the use of both factors improved the prediction of adverse clinical outcomes in hemodialysis patients. Gait speed seems to be a better indicator of poor patient outcomes than is handgrip strength.
Highlights
Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate
All patients were monitored for major adverse events, which were defined as all-cause mortality and cardiovascular events, including acute coronary syndrome, symptomatic heart failure, cerebral infarction and hemorrhage, and peripheral artery disease, until June 2019
We reviewed the previous literature and selected the following candidate inflammatory markers: a proliferation-inducing ligand (APRIL), Bcell activating factor (BAFF), CXCL16, endocan, endostatin, follistatin, IL-6, IL-25, IL-18, monocyte chemoattractant protein-1 (MCP-1), MCP-2, MCP-4, matrix metalloproteinase-7 (MMP-7), Matrix metalloproteinase (MMP)-8, osteoprotegerin, PCSK9, receptor activator of nuclear factor-κΒ ligand (RANKL), and tumor necrosis factor-α (TNF-α)
Summary
Low physical performance in patients undergoing maintenance hemodialysis is associated with a high mortality rate. Well-established risk factors for major adverse events associated with ESRD include old age, preexisting cardiovascular disease, the presence of diabetes, and underdialysis [4,5,6,7,8,9,10]. The identification and management of potential risk factors is of particular importance because individualized therapeutic interventions might improve the clinical outcomes of ESRD patients. Uremic toxins in chronic kidney disease (CKD) patients are often associated with the chronic catabolic state of inflammation, oxidative stress, and nutritional imbalance and a high prevalence of cardiovascular events, all of which eventually lead to clinically evident sarcopenia. The optimal method of assessing physical performance in these populations has not yet been defined
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