Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan.
BMC Nephrol. 2020 Aug 20;21(1):357. doi: 10.1186/s12882-020-02019-w.
Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan.
This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3-5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis.
In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47-0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function.
We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.
慢性肾脏病（CKD）涉及许多可导致虚弱和口腔功能减退的因素。我们旨在研究日本 CKD 成人患者中虚弱和口腔功能减退的流行情况，并探讨肾功能、虚弱和口腔功能之间的关联。
这是一项在两家机构进行的横断面研究。参与者包括 109 名 CKD 3-5 期门诊就诊或住院治疗的患者。采用心血管健康研究虚弱标准的日本版评估虚弱。口腔功能通过评估口腔运动技能[口腔交替发音率（ODK）]、咀嚼能力和重复唾液吞咽试验来评估。肾小球滤过率估计值（eGFR）用于表示肾功能。我们使用二项逻辑回归分析检查肾功能、虚弱和口腔功能之间的关联。
共有 31 名参与者（28.4%）被归类为虚弱。单变量分析显示，年龄、体重指数、eGFR 和血红蛋白水平与虚弱显著相关。ODK 和吞咽功能与虚弱显著相关。多变量分析显示，虚弱与 eGFR 显著相关[比值比（OR）0.96，95%置信区间（CI）0.92-1.00，p=0.048]和 ODK 率（OR 0.68，CI 0.47-0.98，p=0.038）。然而，CKD 严重程度与咀嚼或吞咽功能之间没有显著关联。
我们发现 CKD 患者虚弱的患病率较高，且虚弱与口腔运动技能之间存在显著关联，这会影响非透析 CKD 患者的吞咽功能。CKD 患者虚弱的高患病率表明，有必要常规评估虚弱状况以预防严重并发症的发生。此外，应仔细评估口腔和肾脏功能，并为 CKD 患者提供口腔健康教育和干预措施。
