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A geriatric perspective on chronic kidney disease

The three M's
PhD ceremony:Ms H.A. (Harmke) Polinder-Bos
When:January 09, 2019
Supervisors:prof. dr. C.A.J.M. Gaillard, prof. dr. R.T. (Ron) Gansevoort
Co-supervisor:dr. C.F.M. (Casper) Franssen
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
A geriatric perspective on chronic kidney disease

A geriatric perspective on chronic kidney disease - the three

The population of patients with advanced chronic kidney disease has largely become a geriatric population. Therefore, geriatric syndromes are often present in patients with advanced CKD. In this thesis we studied geriatric problems related to Muscle, Mobility and Mind in patients with chronic kidney disease who are not (yet) or already on dialysis therapy.First, we focused on muscle mass, measured by a creatinine in the urine. 38% of people with advanced chronic kidney disease had a very low creatinine excretion - i.e. a very low muscle mass - compared with healthy people. A very low creatinine excretion was also associated with the presence of frailty. In a study with dialysis patients, on the other hand, we observed that higher creatinine excretion was related to better muscle strength and better physical health.Next, we studied fall accidents in dialysis patients. This study showed that 55% of the patients fell at least once during 1 year of follow-up. This fall frequency is almost similar to the fall frequency in nursing home residents. 15% of the fall incidents resulted in a bone fracture. Finally, we focused on the brain. Vascular damage in the brain, and cognitive impairment are more often seen in hemodialysis patients than in healthy people. Perhaps the hemodialysis treatment itself has a negative effect on the brain. Our research showed that during hemodialysis the cerebral blood flow decreased by 10% in elderly patients. This might be one of the mechanisms underlying the high burden of cerebral vascular damage and of cognitive impairment in hemodialysis patients.