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. 2021;145(1):44-54.
doi: 10.1159/000510624. Epub 2020 Oct 27.

The Effects of Chronic Dialysis on Physical Status, Quality of Life, and Arterial Stiffness: A Longitudinal Study in Prevalent Dialysis Patients

Rens J R Gadaen  1 , Jeroen P Kooman  2   3 , Tom Cornelis  4 , Frank M van der Sande  2 , Bjorn J Winkens  5 , Natascha J H Broers  2   3
Affiliations

The Effects of Chronic Dialysis on Physical Status, Quality of Life, and Arterial Stiffness: A Longitudinal Study in Prevalent Dialysis Patients

Rens J R Gadaen et al. Nephron. 2021.

Abstract

Introduction: It is widely known that dialysis patients have significantly impaired functional outcomes and arterial stiffness, but still few studies have investigated the effects of dialysis longitudinally by a multidimensional approach. We aimed to assess longitudinal patterns of physical activity (PA), physical functioning (PF), health-related quality of life (HrQoL), body composition (BC), and arterial stiffness in prevalent dialysis patients.

Materials and methods: Thirty-nine prevalent dialysis patients (23 conventional hemodialysis [CHD] and 16 peritoneal dialysis) with a mean vintage of 25.7 (±22.1) months were included in this observational prospective study with a 2-year follow-up, and at baseline 20 healthy controls were included. Measurements were performed every 6 months. HrQoL was assessed using the Short Form-36 (SF-36) questionnaire. PA was assessed using the SenseWear™ Pro3 accelerometer. PF was assessed by walking speed, the PF subscale of the SF-36, and handgrip strength (HGS). BC was assessed using the Body Composition Monitor® and arterial stiffness by measuring carotid-femoral pulse wave velocity (PWV). The longitudinal trend was assessed using linear mixed models, correcting for sex, age, and dialysis vintage. For PWV, the trend was additionally corrected for diabetes and systolic blood pressure.

Results: After correction, no statistically significant changes over time were observed for the parameters of PA, PF, HrQoL, and BC. In the combined group and in the group of CHD patients only, a significant change was observed for PWV (overall trend: p = 0.007 and p = 0.008, respectively). A statistically significant difference at baseline was observed between dialysis patients and healthy controls in all parameters, except for HGS and PWV.

Discussion/conclusion: We observed no statistically significant changes in functional outcomes during a 2-year follow-up period, but a significant increase was observed for arterial stiffness. These results might suggest that after a certain period in time, a relatively stable course is present in functional outcomes, but an ongoing deterioration in arterial stiffness occurs, which might increase the risk of cardiovascular disease and all-cause mortality in these patients.

Keywords: Cardiovascular risk; Functional outcomes; Longitudinal study; Prevalent dialysis.

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Conflict of interest statement

N.J.H.B. and J.P.K. received lectures fees from Fresenius Medical Care. R.J.R.G., T.C., F.M.v.d.S., and B.J.W. have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Longitudinal analyses of PWV. Data are given as mean with 95% confidence intervals. PWV, pulse wave velocity.
Fig. 2
Fig. 2
Overview of correlations at baseline. TEE, total energy expenditure; AEE, activity-related energy expenditure; PCS, physical component summary; SF-36 PF, Short Form-36 physical functioning; HGS, handgrip strength; LTI, lean tissue index; FTI, fat tissue index; FO, fluid overload.
See this image and copyright information in PMC

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