Markers of protein-energy wasting and physical performance in haemodialysis patients: A cross-sectional study

Background Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition...

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Published in:PloS one 2020-07, Vol.15 (7), p.e0236816-e0236816
Main Authors: Vanden Wyngaert, Karsten, Celie, Bert, Calders, Patrick, Eloot, Sunny, Holvoet, Els, Van Biesen, Wim, Van Craenenbroeck, Amaryllis H.
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Blood pressure
Cross-sectional studies
Dialysis
Energy
Exercise
Falls
Health risks
Health sciences
Hemodialysis
Hospitals
Internal medicine
Malnutrition
Medicine
Medicine and Health Sciences
Muscle strength
Nutritional status
Physical fitness
Proteins
Quadriceps muscle
Regression analysis
Regression models
Rehabilitation
Risk
Risk assessment
Walking
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container_end_page e0236816
container_issue 7
container_start_page e0236816
container_title PloS one
container_volume 15
creator Vanden Wyngaert, Karsten
Celie, Bert
Calders, Patrick
Eloot, Sunny
Holvoet, Els
Van Biesen, Wim
Van Craenenbroeck, Amaryllis H.
description Background Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.
doi_str_mv 10.1371/journal.pone.0236816
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Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0236816</identifier><identifier>PMID: 32730305</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Biology and Life Sciences ; Blood pressure ; Cross-sectional studies ; Dialysis ; Energy ; Exercise ; Falls ; Health risks ; Health sciences ; Hemodialysis ; Hospitals ; Internal medicine ; Malnutrition ; Medicine ; Medicine and Health Sciences ; Muscle strength ; Nutritional status ; Physical fitness ; Proteins ; Quadriceps muscle ; Regression analysis ; Regression models ; Rehabilitation ; Risk ; Risk assessment ; Walking</subject><ispartof>PloS one, 2020-07, Vol.15 (7), p.e0236816-e0236816</ispartof><rights>2020 Vanden Wyngaert et al. 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Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. 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Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>32730305</pmid><doi>10.1371/journal.pone.0236816</doi><orcidid>https://orcid.org/0000-0002-6984-1743</orcidid><orcidid>https://orcid.org/0000-0002-4782-5224</orcidid><orcidid>https://orcid.org/0000-0003-4728-9406</orcidid><oa>free_for_read</oa></addata></record>
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subjects Biology and Life Sciences
Blood pressure
Cross-sectional studies
Dialysis
Energy
Exercise
Falls
Health risks
Health sciences
Hemodialysis
Hospitals
Internal medicine
Malnutrition
Medicine
Medicine and Health Sciences
Muscle strength
Nutritional status
Physical fitness
Proteins
Quadriceps muscle
Regression analysis
Regression models
Rehabilitation
Risk
Risk assessment
Walking
title Markers of protein-energy wasting and physical performance in haemodialysis patients: A cross-sectional study
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