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Frailty and risk of falling in patients with CKD (PhD bursary)

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  • Frailty and risk of falling in patients with CKD (PhD bursary)

    BACKGROUND: Frailty is a well defined syndrome in people aged over 65 years and is characterised by alteredphysiological mechanisms that lead to vulnerability, loss of physiologicalreserve, and a range of poor patient relevant outcomes such as falls,physical disability, social and mentaldysfunction and increased morbidity (1). Prominent risk factorsassociated with frailty in the elderly, include muscle weakness, gait andbalance deficits, physical inactivity, polypharmacy, multiple co-existing chronicdiseases, poor nutritional status (1). Frailtyis now an emerging prevalent syndrome in Chronic KidneyDisease (CKD) (2) and is characterised by accelerated rate ofdiminishing cardiovascular function and aging processes that affect almost allbody systems. Although some of the traditional frailty phenotype componentssuch as muscle weakness, slow gait speed and nutritional deficits, are welldescribed and highly prevalent in the dialysis population, emerging evidencesuggests that these frailty risk factors become apparent even in the early stagesof kidney function loss and also in younger patients (2).In addition, the impact of cardiovasculardisease (CVD) in CKD is such, thataffects all areas of function and patient relevant outcomes. A recentsystematic review in pre-dialysis CKD(3), discussesthe strong presence and associations betweentraditional frailty components and clinical outcomes such as mortality anddialysis initiation. It also highlights the lack of evidence regarding relationshipsbetweenfrailty and other clinical andpatient relevant outcomes such as falls, for which there is now emergingevidence(4).Peoplewith CKD, are commonly characterised as high risk multi-comorbid individualsand aretherefore primary targetsforeffective interventions to optimiseindependent living and Quality of Life.
    Examples of the research questions of proposedstudentship include:
    • Whatis the prevalence of established frailty components and theincidence/circumstances and consequences of new falls in pre-dialysis CKDstages (CKD3b-5)?
    • Towhat extent do conventional fall risk factors (e.g. physical functionperformance indicators, physical activity patterns, fatigue/exhaustion) andnewly proposed risk factors (neuromuscular control of balance, number of dailybody transfers and level of cardiovascular control during manipulations of bodyposture) mediate any relationships between CKD3b-5, frailty, and falls?
    • Whatis the falls risk profile of people with non-dialysis dependent CKD and whatmay be the best therapies to prioritise and manage risk factors?

      SUPERVISORY/ADVISORYTEAM:Dr Pelagia Koufaki, (exercise physiology and rehabilitation specialist withspecial emphasis at assessing and optimising cardiometabolic health and patientrelevant outcomes-lead supervisor), DrMarietta van der Linden (expertise in gait and balance analysis methods-secondsupervisor), Dr Jane Goddard (consultantnephrologist and clinical link-clinical supervisor), Dr Sara Smith (dieticianand expertise in nutritional assessment-advisor), Mrs Janet Thomas(Physiotherapist and links to community based falls services-advisor)

    1. BergmanH, Ferrucci L, Guralnik J, Hogan DB, Hummel S, Karunananthan S, Wolfson C.Frailty: an emerging research and clinical paradigm--issues and controversies.J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):731-7.
    2. DalrympleLS, Katz R, Rifkin DE, Siscovick D, Newman AB, Fried LF, Sarnak MJ, Odden MC,Shlipak MG. Kidney function and prevalent and incident frailty. Clin J Am SocNephrol. 2013 Dec;8(12):2091-9.
    3. WalkerSR, Gill K, Macdonald K, Komenda P, Rigatto C, Sood MM, Bohm CJ, Storsley LJ,Tangri N1. Association of frailty and physical function in patients withnon-dialysis CKD: a systematic review. BMC Nephrol. 2013; Oct 22;14:228.
    4. ZanottoT, Mercer TH, van der Linden ML, Traynor JP, Petrie CJ, Doyle A, Chalmers K,Allan N, Price J, Oun H, Shilliday I, Koufaki P. Baroreflex function,haemodynamic responses to an orthostatic challenge, and falls in haemodialysispatients. PLoS One. 2018 Dec 6;13(12)