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Toxins 2018, 10(10), 403; https://doi.org/10.3390/toxins10100403

Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients

1
Faculty of Sport, University of Ljubljana, Gortanova 22, 1000 Ljubljana, Slovenia
2
Department of Nephrology, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia
3
Clinical Institute for Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia
*
Author to whom correspondence should be addressed.
Received: 26 August 2018 / Revised: 16 September 2018 / Accepted: 29 September 2018 / Published: 1 October 2018
(This article belongs to the Special Issue Disposition of Uremic Toxins: The Challenges in Uremia)
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Abstract

Association of higher serum levels of uremic toxins and inflammatory markers with poorer physical performance is understudied. We measured the six-minute walk test (6MWT), 10 repetition sit-to-stand test (STS-10), handgrip strength (HGS), and Human Activity Profile (HAP) questionnaire score in 90 prevalent hemodialysis patents, with low comorbidity to reduce the potential confounding of concomitant disease. Midweek pre-dialysis serum levels of asymmetric dimethyl-arginine (ADMA), β2-microglobulin (B2M), high-sensitivity C-reactive protein (hs-CRP), indoxyl sulfate (IS), insulin-like growth factor 1 (IGF-1), interleukin 6 (IL-6), myostatin, and urea were analyzed as predictor parameters of physical performance measures in adjusted models. Serum levels of most measured toxins were not significantly related to performance, except for ADMA, which was significantly related to poorer performance in the STS-10 test (B = 0.11 ± 0.03 s, p < 0.01). Higher hs-CRP was associated with poorer results in the 6MWT (B = −2.6 ± 0.97 m, p < 0.01) and a lower HAP score (B = −0.36 ± 0.14, p = 0.01). There were no other significant associations found. We conclude that inflammation may be a more important pathway to physical impediment than uremic toxemia. This suggests that there is a large physical rehabilitation potential in non-inflamed uremic patients. View Full-Text
Keywords: hemodialysis; 6-minute walk test; sit-to-stand test; handgrip strength; Human Activity Profile; sarcopenia; muscle; asymmetric dimethyl-arginine; C-reactive protein; motor ability hemodialysis; 6-minute walk test; sit-to-stand test; handgrip strength; Human Activity Profile; sarcopenia; muscle; asymmetric dimethyl-arginine; C-reactive protein; motor ability
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Pajek, M.; Jerman, A.; Osredkar, J.; Ponikvar, J.B.; Pajek, J. Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients. Toxins 2018, 10, 403.

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