Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

Clare McKeaveney, Adrian Slee, Andrew Davenport, Gary Adamson, Ken Farrington, Denis Fouque, Kamyar Kalantar-Zadeh, John Mallett, Peter Maxwell, Robert Mullan, Helen Noble, Donal O'Donoghue, Sam Porter, David S. Seres, Joanne Shields, Miles Witham, Joanne Reid*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BackgroundResearch indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease specific definition for cachexia in chronic kidney disease (CKD) patient populations. ObjectiveThe primary objective was to identify cachexia in patients receiving haemodialysis (HD) using Evans et al. generic definition, and then follow up on these patients over 12 months.MethodThis was a longitudinal of 106 adult chronic haemodialysis patients attending two hospital HD units in the United Kingdom. Multiple measures relevant to cachexia including body mass index (BMI), muscle mass (Mid Upper Arm Muscle Circumference; MUAMC), handgrip strength (HGS), fatigue (Functional Assessment of Chronic Illness Therapy; FACIT), appetite (Functional Assessment of Anorexia/Cachexia Therapy; FAACT) and biomarkers (C-reactive protein (CRP); serum albumin; haemoglobin, and Erythropoietin Resistance Index (ERI)) were recorded. Baseline analysis included group differences analysed using independent t-test, dichotomized values using the X2 test and prevalence were reported using SPSS 24. Longitudinal analysis was conducted using repeated measures analysis. ResultsOne hundred and six patients (30 female and 76 male) were recruited with a mean age of 67.6 years (SD=13.18) and dialysis vintage of 4.92 years (SD=6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% over 6 months) or BMI (<20 kg/m2) and three or more clinical characteristics of cachexia (7). Seventy patients were available for analysis after 12 months (n=11 cachectic vs. n=59 not cachectic). FAACT and URR statistically distinguished cachectic patients (p=.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to be worse in cachectic patients. ConclusionGlobally, cachexia is a serious but frequently under-recognised problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further larger studies are required to establish a phenotype of cachexia in advanced CKD.
Original languageEnglish
JournalNephrology Dialysis Transplantation
Early online date05 Nov 2020
DOIs
Publication statusEarly online date - 05 Nov 2020

Keywords

  • Haemodialysis
  • Cachexia
  • Phenotype
  • Definition
  • Longitudinal analysis

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