Renal Cachexia Dr Joanne Reid School of Nursing and Midwifery - PowerPoint PPT Presentation

Renal Cachexia Dr Joanne Reid School of Nursing and Midwifery Queen’s University Belfast j.reid@qub.ac.uk

Cachexia • Cachexia is ‘a complex metabolic syndrome associated with underlying illness and characterised by muscle loss, with or without loss of fat ’ • Definition of cachexia in chronic illness – weight loss of at least 5% within ≤12 months or Body Mass Index (BMI) <20 kg/m 2 • plus three of the following five features: – decreased muscle strength; – fatigue; – anorexia; – low fat-free mass index; – abnormal biochemistry (increased inflammatory markers [CRP, IL-6], anaemia [Hb <120 g/L], low serum albumin [<32g/L] (Evans et al. 2008). Evans et al . (2008). Cachexia, a new definition. Clinical Nutrition 27,793 – 799 .

Pathogenesis of cachexia • Multifacorial Reduced food intake Accelerated Alterations muscle and in fat loss metabolism

Importance of the problem - cachexia  Cachexia is linked with poor outcomes for the patients  Presence of the cachectic syndrome, associated with any chronic disease trajectory, increases mortality  is responsible for about one quarter of cancer deaths.  Cachexia causes great morbidity, limits therapy  No standardised ‘best treatment’ for cachexia  Lack of guidelines / protocols in clinical practice

Importance of the problem – cachexia in renal disease  Between 30-60% of advanced CKD patients will have cachexia – Among potential candidates to explain the high rate of morbidity and mortality and cardiovascular disease in CKD patients, cachexia continues to top the list.  Limited attention has been devoted to cachexia in renal disease  For renal cachexia there are no standardised definitions or inclusion criteria to help inform practice or research

Management of cachexia in renal disease • Challenging – definition needs refinement for renal population • Discriminating cachexia from other causes of malnutrition • Clinically differentiate between cachexia and Protein energy wasting as each state may require distinct management strategies

Previous cachexia work: advanced cancer population Reid et al (2009). The experience of cancer cachexia: A qualitative study of advanced cancer patients and their family members. International Journal of Nursing Studies , 46 (5), 606-616.

Renal cachexia work completed by Reid and colleagues Belfast based working group established Review paper: Reid et al. (2013). A literature review of end-stage renal disease and cachexia: understanding experience to inform evidence-based healthcare. Journal of Renal Care 39(1), 47 – 51. Consensus of defining foci and forward planning Editorial: Reid et al (2015) Defining cachexia in a renal population. Workshops (funding secured Journal of Renal Care 41(2), 79-80 . through R&D Office) Includes colleagues from UK, USA and 1) Belfast to UK working group EU (BRS conference, 2014) Planned application for NI then UK - 2) UK to International working epidemiological study group (Belfast workshop, 2014)

Working group / collaborators Starting point for working group Current working group (first publication) (last publication and grant collaborators) • Joanne Reid - QUB • Joanne Reid - QUB • Helen Noble - QUB • Helen Noble - QUB • Sam Porter - QUB • Sam Porter - QUB • Joanne Shields - BHSCT • Joanne Shields - BHSCT • Peter Maxwell - BHSCT / QUB • • Peter Maxwell - BHSCT / QUB Ken Farrington – England • Mark wright – England • Adrian Slee - England • Andrew Davenport - England • Miles Whitman - Scotland • Denis Fouque - France • David Seres – USA

• Questions? • Please contact j.reid@qub.ac.uk