Inflammation may be mechanism of decreased physical function in patients with CKD
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Researchers identified a correlation between urine albumin-to-creatine ratio and worse physical performance among individuals with and those without chronic kidney disease, according to data published in Kidney Medicine.
Therefore, endothelial function and inflammation could be significant mechanisms of decreased physical function.
“The association between [chronic kidney disease] CKD and outcomes such as physical performance may be complicated given the multitude of potential contributors, such as decreased glomerular filtration rate, a state of heightened inflammation and comorbid conditions,” Ryan Mello, MD, PhD, from the nephrology division and department of medicine at Hennepin Healthcare in Minnesota, and colleagues wrote. “Therefore, the identification of factors associated with decreased physical performance may help in the clinical care and decision-making for patients with CKD.”
In a cross-sectional analysis, researchers examined 571 adults with and those without CKD (mean age was 69.3 years) from the Brain in Kidney Disease (BRINK) study to determine if CKD correlates with impaired physical performance. Participants lived in Minnesota and were at least 45 years old.
Researchers enrolled participants in the following groups based on their baseline eGFR: less than 45 mL/min/1.73 m2, greater than 45 mL/min/1.73 m2 and less than 60 mL/min/1.73 m2, and at least 60 mL/min/1.73 m2. Further, researchers used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, without the race coefficient, and the CKD-EPI cystatin C equation to calculate the eGFR of all participants. Researchers also measured the models, measured as the urine albumin-to-creatinine ratio (UACR).
Participants completed the short physician performance battery, which tested them on balance, chair standing and gait speed. Results of this test were used to determine the physical performance of each participant. Researchers conducted univariate and multivariable logistic regression models to identify the relationship of eGFR and UACR with impaired physical performance.
Impaired physical performance was identified in 38.9% of participants.
Overall, 27.5% of participants had creatine-based eGFRs of less than 30 mL/min/1.73 m2; 48.3% had creatine-based eGFRs greater than 30 mL/min/1.73 m2 and less than 60 mL/min/1.73 m2; and 24.2% had creatine-based eGFRs of at least 60 mL/min/1.73 m2.
Similarly, 55.3% of participants had cystatin C-based eGFRs less than 30 mL/min/1.73 m2; 25.7% had cystatin C-based eGFRs greater than 30 mL/min/1.73 m2 and less than 60 mL/min/1.73 m2; and 19% had cystatin C-based eGFRs of at least 60 mL/min/1.73 m2.
Analyses revealed lower creatine-based eGFR, lower cystatin C-based eGFR and higher IACR correlated with an increased likelihood of impaired physical performance. When adjusted, the UACR corresponded with worse physical performance. Therefore, researchers suggested vascular endothelial function and inflammation may be significant mechanisms of decreased physical function.
“Additional studies on the longitudinal association between albuminuria and change in physical function over time are needed to determine whether baseline proteinuria predicts functional decline or whether the association varies with time, particularly with the initiation of kidney replacement therapy,” Mello and colleagues concluded.
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