Reference Values for Lower-Limb Dynamometry in Patients With Chronic Kidney Disease (REHAD-CKD) (REHAD- CKD)
Patients with chronic kidney disease (CKD) undergoing hemodialysis present musculoskeletal complications, such as sarcopenia, which impair their functionality and are associated with an increased risk of mortality. Functional assessment in this population is complex due to the organization of hemodialysis schedules and patients' dependence on medical transportation, which hinders evaluation outside the dialysis setting.
The assessment of lower limb strength is of great relevance, as an adequate level of muscle strength in this region is essential for performing many activities of daily living, including walking, sit-to-stand and stand-to-sit movements, as well as ascending and descending stairs. Our research group has published a study demonstrating the safety and reliability of intradialytic measurement of hip flexion and abduction strength; however, reference values for the dialysis population and for individuals with CKD in general are currently unknown.
The primary aim of this study is to propose reference values for hip flexor and abductor muscle strength measured using a hand-held dynamometer in individuals with chronic kidney disease (CKD). Secondary objectives include assessing the association between lower limb muscle strength measured with a hand-held dynamometer and handgrip strength, physical activity level, frailty, gait speed, performance in the 10-repetition sit-to-stand-to-sit test, ultrasound assessment of the rectus femoris muscle, and health-related quality of life.
Panoramica dello studio
Stato
Condizioni
Tipo di studio
Iscrizione (Stimato)
Contatti e Sedi
Contatto studio
- Nome: Eva Ms Segura Ortí, Professor
- Numero di telefono: +34671580094
- Email: esegura@uchceu.es
Luoghi di studio
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Madrid, Spagna
- Reclutamento
- Diaverum Madrid
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Contatto:
- Eva Ms Segura Ortí, Professor
- Numero di telefono: +34671580094
- Email: esegura@uchceu.es
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Contatto:
- Shaira Ms Martínez Vaquera, Manager
- Numero di telefono: +34 683 236 547
- Email: shaira.martinez@diaverum.com
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Criteri di partecipazione
Criteri di ammissibilità
Età idonea allo studio
- Adulto
- Adulto più anziano
Accetta volontari sani
Metodo di campionamento
Popolazione di studio
Descrizione
Inclusion Criteria:
- ≥1 months on HD (3 weekly sessions of 4 hours)
Exclusion Criteria:
- Lower-limb amputation;
- Neurological, musculoskeletal or osteoarticular disorders;
- Severe/unstable comorbidities (e.g., decompensated heart failure or diabetes, unstable angina, recent MI, uncontrolled hypertension, severe lung disease, acute infection);
- <1 months on HD;
- <2 sessions/week,
- Inability to understand assessments.
Piano di studio
Come è strutturato lo studio?
Dettagli di progettazione
Coorti e interventi
Gruppo / Coorte |
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REHAB-CKD group
The target population of the present study consists of patients with chronic kidney disease undergoing hemodialysis in DIAVERUM centers in Spain.
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Cosa sta misurando lo studio?
Misure di risultato primarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Reference values for lower limb strengh
Lasso di tempo: Baseline
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Lower limb strengh will be evaluated using handheld dynamometer (Lafayette Manual Muscle Testing System Model-01165, Lafayette IN, USA) for hip flexors and hip abductors.Testing will follow a strict structured order: first hip flexors and then hip abductors.
Within each muscle group, legs will be alternated, starting with the dominant leg and then the nondominant leg, to allow specific rest periods between muscle groups (15 seconds).
Hip flexors will be assessed with the patients with both hips and knees bent.
The dynamometer will be placed on the anterior part of the thigh, 2 centimetres below of patella.
Hip abductors will be assessed with both legs extended at the hip and knee.
The dynamometer will be placed on the lateral part of the thigh, 2 centimetres below of the knee joint line.
During both measurements physiotherapist will apply force in the opposite direction of the movement.
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Baseline
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Misure di risultato secondarie
Misura del risultato |
Misura Descrizione |
Lasso di tempo |
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Muscle strength assessment Handgrip
Lasso di tempo: Baseline
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It will use a Jamar® Approved Hydraulic Hand Dynamometer.
The participant will be seated in a chair with their back straight and the arm flexed at 90°.
The test will be repeated three times for each hand (3-5 seconds), with rest periods between repetitions to avoid muscle fatigue.
The cut-off points for loss of muscle strength will be set greater than or equal to 27 kg for men and greater than or equal to 16 kg for women, based on values defined by Mathiowetz et al. and included in the European clinical nutrition guidelines as a phenotypic criterion for disease-related malnutrition.
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Baseline
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Human Activity Profile
Lasso di tempo: Baseline
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The HAP consist of 94 questions addressing different domains of daily activity and participation, with three possible answers for each item: 'still doing,' 'stopped doing,' or 'never did.'
For each item, the participant will have to choose one of these responses.
Based on each answer, two scores will be calculated: the Maximal Activity Score (MAS), which corresponds to the activity with the highest effort demand that the volunteer 'still performs'; and the Adjusted Activity Score (AAS), which will be calculated by subtracting the number of items the subject 'has stopped doing' below the MAS value from the MAS itself.
The AAS will provide the value of activity that the subject has ceased to perform compared to what they were doing before.
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Baseline
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Screening for sarcopenia risk
Lasso di tempo: Baseline
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Screening for sarcopenia risk will be performed using the SARC-F questionnaire, which consists of five self-reported questions based on the subjects' perception of their limitations regarding strength, walking ability, rising from a chair, climbing stairs, and their history and number of falls.
Each item will be scored from 0 to 2, where 0 = no difficulty, 1 = some difficulty, and 2 = great difficulty, or if the subject uses devices or cannot perform the task without personal assistance.
The total SARC-F score can range from 0 to 10, and subjects with a score ≥ 4 points will be considered at risk of sarcopenia, in accordance with the recommendations of the European consensus on sarcopenia.
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Baseline
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Frailty assessment using the FRAIL questionnaire
Lasso di tempo: Baseline
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Frailty will be assessed using the five questions (fatigue, climbing stairs, walking 100 m, comorbidity, and weight loss) that comprise the FRAIL questionnaire.
A score of 1 or higher suggests frailty
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Baseline
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Frailty assessment using the FRIED phenotype
Lasso di tempo: Baseline
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Frailty will be assessed using the five components (weight loss, handgrip weakness, fatigue, low physical activity, and gait speed) of the FRIED phenotype.
A score of 1 or higher suggests frailty
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Baseline
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4-metre gait speed assessment
Lasso di tempo: Baseline
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The 4-metre gait speed test will be performed preferably before the second haemodialysis (HD) session of the week, in a corridor of the unit.
Patients will be asked to walk between two marks at their usual pace, using walking aids if necessary.
A practice trial will be provided, and the times of two trials will be recorded in seconds and converted to m/s.
The best of the two trials will be used for analysis.
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Baseline
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Health-related quality of life (HRQoL)
Lasso di tempo: Baseline
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HRQoL will be assessed using the Spanish version of the Medical Outcomes Study Short Form-36 (SF-36) questionnaire .
Scores range from 0 to 100, with higher scores indicating better HRQoL.
Results are reported across eight subscales (physical functioning, vitality, role physical, general health, social functioning, mental health, role emotional, and bodily pain) and two summary components (physical and mental components).
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Baseline
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Sit-to-Stand-to-Sit tests (10 repetitions and 60 seconds)(STS-10)
Lasso di tempo: Baseline
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The Sit-to-Stand-to-Sit- 10 (STS-10) and Sit-to-Stand-to-Sit-60 (STS-60) tests will be performed preferably before the second or third HD session. Participants will be seated in a chair with their arms crossed over the chest, feet on the floor, and back supported against the backrest whenever possible. The chair must be stable and placed against a wall to minimize the risk of falls. Participants will be asked to keep their arms crossed to avoid using them for assistance and, with their feet on the ground, to stand up and sit down 10 consecutive times as quickly as possible. The time required to complete the test will be recorded in seconds. After a rest period following the STS-10, the same procedure will be performed for the STS-60, in which the number of repetitions completed in 60 seconds will be recorded. Both the number of repetitions and the Rating of Perceived Exertion (RPE) will be documented. |
Baseline
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Assessment of muscle characteristics
Lasso di tempo: Baseline
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Muscle quantity and quality will be evaluated using ultrasound measurement of the cross-sectional area of the rectus femoris muscle, performed 30 minutes after the start of HD, on a different day from the muscle strength assessments. The assessment will be conducted on the dominant lower limb, with the participant in the supine position, the limb fully extended, and the muscles relaxed. Muscle thickness and cross-sectional area will be measured. The rectus femoris muscle will be evaluated at the midpoint between the anterior superior iliac spine (ASIS) and the superior pole of the patella, corresponding to the site of maximal muscle volume. |
Baseline
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Collaboratori e investigatori
Sponsor
Collaboratori
Investigatori
- Cattedra di studio: Eva Ms Segura Ortí, Professor, Cardenal Herrera University
Pubblicazioni e link utili
Pubblicazioni generali
- Segura-Orti E, Gordon PL, Doyle JW, Johansen KL. Correlates of Physical Functioning and Performance Across the Spectrum of Kidney Function. Clin Nurs Res. 2018 Jun;27(5):579-596. doi: 10.1177/1054773816689282. Epub 2017 Jan 23.
- Sabatino A, Regolisti G, Delsante M, Di Motta T, Cantarelli C, Pioli S, Grassi G, Batini V, Gregorini M, Fiaccadori E. Noninvasive evaluation of muscle mass by ultrasonography of quadriceps femoris muscle in End-Stage Renal Disease patients on hemodialysis. Clin Nutr. 2019 Jun;38(3):1232-1239. doi: 10.1016/j.clnu.2018.05.004. Epub 2018 May 19.
- Johansen KL, Painter P, Kent-Braun JA, Ng AV, Carey S, Da Silva M, Chertow GM. Validation of questionnaires to estimate physical activity and functioning in end-stage renal disease. Kidney Int. 2001 Mar;59(3):1121-7. doi: 10.1046/j.1523-1755.2001.0590031121.x.
- Segura-Orti E, Junque-Jimenez A, Dubuis V, Reboredo MM, Benavent-Caballer V, Valtuena-Gimeno N, Barros FS, Silva DT, Martinez-Olmos FJ. Handheld Dynamometry Testing During Dialysis: Intrarater and Interrater Reliability Study. J Ren Nutr. 2025 May;35(3):433-442. doi: 10.1053/j.jrn.2025.01.002. Epub 2025 Jan 24.
- Junque Jimenez A, Esteve Simo V, Andreu Periz L, Segura Orti E. The Relationship between Physical Activity Levels and Functional Capacity in Patients with Advanced Chronic Kidney Disease. Clin Nurs Res. 2021 Mar;30(3):360-368. doi: 10.1177/1054773820907757. Epub 2020 Feb 19.
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Maggiori informazioni
Termini relativi a questo studio
Termini MeSH pertinenti aggiuntivi
- Malattie urogenitali
- Processi patologici
- Malattie urogenitali maschili
- Malattie renali
- Malattie urologiche
- Malattie urogenitali femminili
- Malattie urogenitali femminili e complicanze della gravidanza
- Malattia cronica
- Attributi della malattia
- Insufficienza renale
- Condizioni patologiche, segni e sintomi
- Insufficienza renale cronica
Altri numeri di identificazione dello studio
- CEEI26/84
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