Gustatory Dysfunction Is Closely Associated With Frailty in Patients With Chronic Kidney Disease.

OBJECTIVE: Gustatory function is frequently impaired in patients with chronic kidney disease (CKD), and the associated taste dysfunction contributes to compromised nutrition. Whether gustatory dysfunction is an underappreciated risk factor for frailty in patients with CKD remains unclear. The objective of this work was to examine the role of gustatory dysfunction as a risk factor for frailty in patients with CKD. METHODS: We prospectively enrolled patients with stage 3 or higher CKD from a single institute, with their gustatory function assessed using both objective (taste strip method) and subjective approaches, and frailty identified using the Edmonton frail scale, FRAIL scale, and Study of Osteoporotic Fracture (SOF) scale. Multiple regression analyses were performed to investigate whether results from gustatory function tests independently correlated with frailty. RESULTS: Among the enrolled patients with CKD, 14 (17.9%) were found to be frail. We discovered that higher taste strip scores, or better taste function, were significantly associated with a lower frail probability (odds ratio [OR] 0.74 per score, 95% confidence interval [CI] 0.57-0.97), independent of clinical features, while better subjective taste function (OR 0.84 per score, 95% CI 0.74-0.96) and better oral cavity intactness (OR, 0.94; 95% CI, 0.9-0.98) were similarly associated with a lower frail probability among patients with CKD. CONCLUSION: Gustatory dysfunction may be an important risk factor for frailty in patients with CKD. It is tempting to presume that interventions aiming to ameliorate such deficits may bear the potential of reducing frailty severity in this population with a high frailty burden.

Gustatory Function and the Uremic Toxin, Phosphate, Are Modulators of the Risk of Vascular Calcification among Patients with Chronic Kidney Disease: A Pilot Study.

Patients with chronic kidney disease (CKD) have an increased risk of vascular calcification (VC), including aortic arch calcification (AAC). Few investigated the influence of gustatory function on the probability of having VC. We examined whether gustatory function results modulated the probability of having VC in patients with CKD. We prospectively enrolled adults with CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2), with their AAC rated semi-quantitatively and gustatory function assessed by objective and subjective approaches. Multiple logistic regression was used to analyze the relationship between gustatory function results and AAC. Those with AAC had significantly better objective gustatory function in aggregate scores (p = 0.039) and categories (p = 0.022) and less defective bitter taste (p = 0.045) and scores (p = 0.037) than those without. Multiple regression analyses showed that higher aggregate scores (odds ratio (OR) 1.288, p = 0.032), or better gustatory function, and higher bitter taste scores (OR 2.558, p = 0.019) were each associated with a higher probability of having AAC among CKD patients; such an association was modulated by serum phosphate levels. In conclusion, better gustatory function was independently correlated with having AAC among CKD patients. A follow-up of VC severity may be an underrecognized component of care for CKD patients with a preserved gustatory function.

Complications observed in older new haemodialysis patients in Taiwan.

AIM: We aimed to evaluate the impacts of heomodialysis (HD) in older patients, and potential consequences of adverse events for health insurance costs. METHODS: Two hundred and fifty-five new patients (130 were younger than 65 years and 125 were older than 65 years) who had received conventional HD for at least 1 year were reviewed. RESULTS: Older patients had significantly more arteriovenous (AV) shunt failures (0.7 ± 0.1 vs 0.4 ± 0.07, P = 0.006) and hospitalisations (0.8 ± 0.1 vs 0.4 ± 0.09, P = 0.03) than younger ones. Stepwise multivariate linear regression analysis showed that AV shunt failure was an independent risk factor for hospitalisation. CONCLUSIONS: The relatively high risk of AV shunt failures and hospitalisation in older patients highlights the additional expenditure on HD required in terms of health insurance.

Absolute interdialytic weight gain is more important than percent weight gain for intradialytic hypotension in heavy patients.

AIM: Few published reports have mentioned the difference between absolute interdialytic weight gain (IDWG) and IDWG/DW (IDWG%), and subsequent effects on daily dialysis. The aim of present study was to evaluate the difference between absolute IDWG and IDWG% in new haemodialysis patients. METHOD: We retrospectively reviewed the records of 255 patients who recently received conventional haemodialysis for at least 1 year at the same centre from 1997 to 2008. The first 4 weeks after starting haemodialysis was defined as the pre-study period. Data were collected for 5-56 weeks. RESULTS: IDWG% value remained relatively constant in the first year of haemodialysis despite most patients having certain residual renal function. For haemodialysis outcomes, both absolute IDWG and IDWG% were significantly correlated with intradialytic hypotension (IDH) in men and heavy women. After dividing patients into four strata, which according to the gender and the median dry weight, stepwise multivariate linear regression analysis showed that absolute IDWG, rather than IDWG%, was an independent risk factor for IDH in heavy men (Beta = 0.585, P < 0.001) and heavy women (Beta= 0.458, P < 0.001). CONCLUSIONS: Absolute IDWG, rather than IDWG%, is an independent risk factor for IDH in heavy haemodialysis patients. Therefore, higher absolute IDWG needs to be strictly controlled despite the corresponding IDWG% possibly being relatively small in heavy haemodialysis patients.