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Renal cachexia - Dansk Sygeplejeråd ... Maxwell, AP 2015, 'Defining cachexia in a renal population' Journal of Renal Care, DOI: 10.1111/jorc.12129 Slee A, Reid J (accepted) Wasting

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  • Renal cachexia

    Professor Joanne Reid

  • 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)

  • Pathogenesis of cachexia

    Evans et al. (2008). Cachexia, a new definition. Clinical Nutrition 27,793–799.

    https://www.semanticscholar.org/paper/Cachexia:-a-new-definition.-Evans-Morley/a171737aa2517cf16f63cacfae6bae05c4f1067a/figure/0

  • Why is it important to investigate cachexia?

    • Cachexia is linked with poor outcomes for the patients • Presence of the cachectic syndrome, associated with any chronic disease trajectory, increases

    mortality

    • Cachexia causes great morbidity, limits therapy

    • No standardised ‘best treatment’ for cachexia

    • Lack of guidelines / protocols in clinical practice

  • Living with cancer cachexia: Exploring the perspectives of patients and their significant others

  • QUB Heritage

    Summary findings Summary findings

  • Conclusions:

    •in-depth understanding for patients with cancer and their families

    •challenges that they face on a daily basis

    •new knowledge on our awareness and comprehension of the experience of

    cachexia

    Further research: develop interventions that have therapeutic impact for

    patients with cachexia and their families

    Conclusions

  • Practice and policy impact

    National level - (Royal College of Nursing) Getting it right every time: Nutrition and Hydration Care at end of life (http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/).

    https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/ https://owa.qub.ac.uk/owa/redir.aspx?C=HnkkQ1aitFl7nyiulTtL9NG0pJkabhfCIRQyKa3FKtZW-C82jxbWCA..&URL=http://rcneolnutritionhydration.org.uk/nutrition-and-hydration/starvation-and-cachexia/

  • Thalidomide For Managing Cancer Cachexia

    European level - European Society for Clinical Nutrition and Metabolism (ESPEN) ESPEN guidelines on nutrition in cancer patients

  • Practice and policy impact

    BRITISH COLUMBIA INTER-PROFESSIONAL PALLIATIVE SYMPTOM MANAGEMENT GUIDELINES (2017) http://www.bc-cpc.ca/cpc/wp- content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf

    http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf http://www.bc-cpc.ca/cpc/wp-content/uploads/2017/11/09.-SMG-Clinical-Best-Practices-print-col-anorexia.pdf

  • Health care professionals’ experience, understanding and perception of need of advanced cancer patients with cachexia and their families: The benefits of a dedicated clinic

  • Need to develop specialist communication skills training for healthcare professionals Care of patients with cachexia and their families should employ a multi- disciplinary approach

    Implications for practice: •A formal educational cancer cachexia programme for clinicians •A dedicated clinic can facilitate a learning environment that allowed best practice to develop across and between professional groups

    Study Findings

  • QUB Heritage Importance of the problem: renal disease

  • Importance of problem – renal cachexia?

    • Between 30-60% of advanced CKD patients will have cachexia

    • 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

    • 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

  • Renal cachexia work completed

    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.

    Workshops (funding secured through R&D Office) 1)Belfast to UK working group (BRS conference, 2014) 2)UK to International working group (Belfast workshop, 2014)

    Consensus of defining foci and forward planning Editorial: Reid et al (2015) Defining cachexia in a renal population. J of Renal Care 2016 (differentiating between cachexia, sarcopenia and PEW) JHPC. Includes colleagues from UK, USA and Europe

    Study funded (Public Health Agency / NI Kidney Research Fund) 1)Establishing a clinical phenotype for cachexia in ESRD – recruitment completed 04/2018 2)Protocol published BMC Nephrology 2018; 19: 38 3)Publish review prior to cross-sectional results JCSM 4)Cross-sectional papers – cachexia / LMM measurement / QoL

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