Patients with chronic kidney disease experience substantial loss of muscle mass, weakness, and poor physical performance. As kidney disease progresses, skeletal muscle dysfunction forms a common ...pathway for mobility limitation, loss of functional independence, and vulnerability to disease complications. Screening for those at high risk for mobility disability by self-reported and objective measures of function is an essential first step in developing an interdisciplinary approach to treatment that includes rehabilitative therapies and counseling on physical activity. Exercise has beneficial effects on systemic inflammation, muscle, and physical performance in chronic kidney disease. Kidney health providers need to identify patient and care delivery barriers to exercise in order to effectively counsel patients on physical activity. A thorough medical evaluation and assessment of baseline function using self-reported and objective function assessment is essential to guide an effective individualized exercise prescription to prevent function decline in persons with kidney disease. This review focuses on the impact of kidney disease on skeletal muscle dysfunction in the context of the disablement process and reviews screening and treatment strategies that kidney health professionals can use in clinical practice to prevent functional decline and disability.
Background Frailty is a construct developed to characterize a state of reduced functional capacity in older adults. However, there are limited data describing the prevalence or consequences of ...frailty in middle-aged patients with chronic kidney disease (CKD). Study Design Observational study. Setting & Participants 336 non–dialysis-dependent patients with stages 1-4 CKD with estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 (by the CKD-EPI CKD Epidemiology Collaboration serum creatinine–based equation) or evidence of microalbuminuria enrolled in the Seattle Kidney Study, a clinic-based cohort study. Findings were compared with community-dwelling older adults in the Cardiovascular Health Study. Outcome Prevalence and determinants of frailty in addition to its association with the combined outcome of all-cause mortality or renal replacement therapy. Measurements We defined frailty according to established criteria as 3 or more of the following characteristics: slow gait, weakness, unintentional weight loss, exhaustion, and low physical activity. We estimated kidney function using serum cystatin C concentrations (eGFRcys ) to minimize confounding due to relationships of serum creatinine levels with muscle mass and frailty. Results The mean age of the study population was 59 years and mean eGFRcys was 51 mL/min/1.73 m2 . The prevalence of frailty (14.0%) was twice that of the much older non-CKD reference population ( P < 0.01). The most common frailty components were physical inactivity and exhaustion. After adjustment including diabetes, eGFRcys categories of <30 and 30-44 mL/min/1.73 m2 were associated with a 2.8- (95% CI, 1.3-6.3) and 2.1 (95% CI, 1.0-4.7)-fold greater prevalence of frailty compared with GFRcys ≥60 mL/min/1.73 m2 . There were 63 events during a median 987 days of follow-up. After adjustment, the frailty phenotype was associated with an estimated 2.5 (95% CI, 1.4-4.4)-fold greater risk of death or dialysis therapy. Limitations Cross-sectional study design obscures inference regarding temporal relationships between CKD and frailty. Conclusions Frailty is relatively common in middle-aged patients with CKD and is associated with lower eGFRcys and increased risk of death or dialysis therapy.
PDF