One of the real problems for patients on dialysis is their impaired physical functionality. It means normal life is more difficult for them, even as it is prolonged with the inclusion of dialysis therapy. The question has always been what is the biological cause. (In other words, is this a failure of dialysis to remove some toxin or blood component?)
It seems that that the correlation between the albumin to creatinine ratio (in their urine, UACR is the abbreviation) may be the key. Dr. Ryan Mello (Hennepin Healthcare, MN) was the lead author, Dr. Allyson Hart was the research head (along with team members Drs. KL Johansen, and A Murray, plus Ms. C Davey) for this recent study (BRINK, Brain in Kidney Disease) and reported as “Estimated GFR, Albuminuria, and Physical Function: The Brain in Kidney Disease (BRINK) Cohort Study” in Kidney Medical. The study included 571 subjects (45 y of age and older, with a mean age of 69.3 y) with and without chronic kidney disease, to discern the correlation of kidney disease with impaired physicality .
The subjects were grouped by their baseline eGFR (glomerular filtration rate- in units of mL/min/1.73m2); <30, 30 to 60, > 60 using the CKD-EPI equation (Chronic Kidney Disease Epidemiology Equation, which omits the race coefficient). Their physicality was determined via the Short Physical Performance Battery Tests (SPPB) via balance, chair standing, and gait speed. (This was the same testing used to discern my need for physical therapy after my recent trauma.) The SPPB results demonstrated some 38.9% of the participants were found to have impaired physical functionality .
The lower eGFR corresponded loosely to lower physicality , but the primary association was found to be the lower UACR. As such, this suggests vascular endothelial function and inflammation- and not muscle mass- was the mechanism involved in decreased physicality.
Roy, each time I red your blog I learn something new and am pushed to think about something I hadn’t thought about before. Thank you for sharing you knowledge with us!
Thank you for you comment. That is exactly whi I publish my blog.
Greetings Dr. Ackerman, what I find interesting about the study is that they predict 50% of Americans will have liver failure! Yikes. Majority of us better start getting in tune with our body/mind connection so that we can avoid such physical and cognitive malfunctions. Thank you for sharing. Sending love. Jaime
I didn’t see that prediction, Jaime. But, with our obesity (which often leads to diabetes), the couse to kidney failure is clear.
I think this is all a bit over my head, but if they are getting closer to understand this loss of function, it would be wonderful.
Yes, it is important to improve their quality of life, Alana.
It’s great to see continued research for kidney patients. I’ve known a few who had gone through years of dialysis and it’s heartbreaking to see what they go through.
We need not just ‘to keep them alive”, but find the ways “to help them thrive”, Martha.