Explore the vast range of titles available.

Purpose The impact of mild hyponatremia on geriatric syndromes is not clear. Our aim was to determine associations between mild hyponatremia and results of comprehensive geriatric assessment tools in outpatient settings. Methods We reviewed medical records of 1255 consecutive outpatient elderly subjects and compared results of comprehensive geriatric assessment measures among patients with mild hyponatremia (serum Na +  130–135 mEq/L) versus normonatremia (serum Na +  136–145 mEq/L). The comprehensive geriatric assessment measures included the Basic and Instrumental Activities of Daily Living, Mini Mental State Examination, Geriatric Depression Score, Tinetti Mobility Test, the Timed Up&Go Test, the Mini Nutritional Assessment, the handgrip test, the Insomnia Severity Index, polypharmacy, recurrent falls, urinary incontinence, orthostatic hypotension, and nocturia. Results Of the 1255 patients, 855 were female (68.1%), and the mean age was 73.7 ± 8.3 years. Mild hyponatremia was detected in 108 patients (8.6%). The median serum sodium was 140.5 [interquartile range (IQR) 138.4–141.8] versus 133.8 [IQR, 132.3–134.2] in normonatremia and mild hyponatremia groups, respectively ( p  < 0.001). The only significant difference for comorbidities between normonatremia and mild hyponatremia groups was the frequency of hypertension (66.9% versus 76.7%, respectively ( p  = 0.041). None of the comprehensive geriatric assessment tools conferred a significant association with mild hyponatremia. Of the 1061 subjects with available survival data, 96 (9.0%) deceased within 3–4 years of follow-up ( p  = 0.742). Hyponatremia as an independent variable did not have a significant effect on mortality in univariate logistic regression analysis (OR 1.13, 95% CI 0.55–2.33, p  = 0.742). Conclusion Mild hyponatremia does not apparently affect results of geriatric assessments significantly. Whether particular causes of hyponatremia may have different impacts should be tested in further studies.

PurposePatients with chronic kidney disease (CKD) usually represent an aging population, and both older age and CKD are associated with a higher risk of falling. Studies on risk factors among subjects with CKD are lacking.MethodsRecords of outpatients from one geriatric clinic in Turkey were retrospectively reviewed. A result of ≥ 13.5 s on the timed up and go (TUG) test was accepted as a high risk of falls. Independent predictors of an increased risk of falls among subjects with CKD (estimated glomerular filtration rate of < 60 mL/min/1.73 m2) were identified using logistic regression models.ResultsPatients with CKD (n = 205), represented the 20.2% of the entire cohort and was identified as an independent predictor of increased fall risk (OR 2.59). Within the CKD cohort, serum folic acid levels and frailty were independent predictors of an increased risk of falls. The CKD/fall risk group was older, had a lower median years of education, lower vitamin D levels, and lower serum folic acid levels than the CKD/non-fall risk group. In addition to higher serum creatinine and potassium levels, the only significant difference between patients with CKD/fall risk and a matched non-CKD/fall risk was a lower median folic acid level in the former group.ConclusionsFrailty and low folic acid levels are independently associated with an increased risk of falls among elderly outpatients with CKD. Prevention of frailty may reduce the risk of falls in these subjects. Possible benefit of folic acid supplementation requires further studies.

Background Excessive daytime sleepiness (EDS) is common in older adults and may contribute to reduced oral intake, potentially increasing the risk of dehydration, which has been linked to adverse health outcomes. We aimed to investigate whether EDS is associated with elevated plasma osmolarity (Posm) in a geriatric population. Methods In this cross-sectional study, 1,335 adults aged ≥ 65 years attending a geriatric outpatient clinic were assessed. Participants were classified as having EDS (Epworth Sleepiness Scale ≥ 11) or non-EDS. Plasma osmolarity was estimated using a validated formula, with thresholds of > 295 mmol/L for dehydration and > 300 mmol/L for overt dehydration. Clinical, laboratory, and demographic data were collected. Associations between EDS and dehydration were analyzed using univariate and multivariate logistic regression, adjusting for age, sex, comorbidities, and medication use. Results EDS was present in 24% of participants. Plasma osmolarity exceeded 295 mmol/L in 56% and 300 mmol/L in 23% of participants. Patients with EDS were older and had higher prevalence of chronic kidney disease, dementia, and polypharmacy. In multivariate analysis, independent predictors of Posm > 300 mmol/L included diabetes mellitus (OR 4.41), chronic kidney disease (OR 5.32), serum sodium (OR 1.76), and EDS (OR 1.51, p  = 0.027). EDS was not independently associated with Posm > 295 mmol/L. Conclusions In older adults, EDS is independently associated with overt dehydration. Routine assessment of daytime sleepiness may serve as a simple, non-invasive marker to identify individuals potentially at risk, enabling timely hydration interventions and potentially improving health outcomes in aging populations.

Objectives To determine the association between hypomagnesemia and dynapenia in older women with different nutritional status. Methods This cross-sectional study included older women who attended one outpatient geriatric clinic. Undernutrition was defined according to the Mini Nutritional Assessment score (MNA) (< 23,5), and handgrip strength of < 16 kg on dynamometer was defined as dynapenia. The association between hypomagnesemia (serum magnesium < 1.7 mg/dL) and dynapenia was determined by logistic regression analysis. Results Among the 933 older women (mean age 81 ± 8), the prevalences of undernutrition and hypomagnesemia were 61% and 15%, respectively. The risk of hypomagnesemia increased with each step of decline in nutritional status, and undernutrition was associated with hypomagnesemia (OR 1.64, 95% CI 1.11–2.43, p  = 0.013) In the entire cohort, hypomagnesemia was associated with dynapenia (OR 2.01, 95% CI 1.35-3.00, p  = 0.001). In well-nourished patients, hypomagnesemia was not associated with dynapenia, even when unadjusted. However, in the undernourished group, hypomagnesemia was associated with dynapenia after adjusting for age, diabetes mellitus, hypertension, coronary heart disease, Barthel and Lawton scores, polypharmacy, glomerular filtration rate, serum albumin, hemoglobin, and MNA score (OR 2.95, 95% CI 1.04–8.32, p  = 0.040). The coexistence of hypomagnesemia and undernutrition (versus neither of them) was significantly associated with dynapenia (OR 4.44, 95% CI 2.67–7.41, p  < 0.001). Conclusion The prevalence of hypomagnesemia increases with worsening nutritional status. Hypomagnesemia is associated with dynapenia in older women who are undernourished, even after adjusting for nutritional status, but not in those who are well nourished. The coexistence of undernutrition and hypomagnesemia increase the risk of dynapenia substantially. Highligths The prevalence of hypomagnesemia increases with worsening of nutritional status. The relationship between hypomagnesemia and dynapenia varies according to nutritional status; hypomagnesemia is associated with an increased risk of dynapenia in undernourished patients but not in their well-nourished counterparts. In the presence of malnutrition, the level of magnesium should also be assessed, and both malnutrition and hypomagnesemia should be treated.

Background and Objectives: Anemia management in maintenance hemodialysis patients with erythropoiesis-stimulating agent (ESA) hyporesponsiveness remains challenging. Roxadustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, offers a mechanistically distinct alternative. Materials and Methods: This multicenter retrospective study analyzed 110 hemodialysis patients with persistent anemia (Hemoglobin (Hb) < 10 g/dL) despite ≥ 3 months of maximum-reimbursable-dose ESA therapy in Türkiye. Outcomes were evaluated between patients who switched to Roxadustat (n = 80) and those who continued ESA therapy (n = 30) over 6 months in a non-randomized, observational comparison. Results: At baseline, median Hb levels were significantly lower in the Roxadustat-group than in the ESA-group (8.70 vs. 9.50 g/dL; p < 0.001), while weight-adjusted ESA doses were comparable (p = 0.332). By Month 6, the Roxadustat group achieved a significant Hb increase (from 8.70 to 9.95 g/dL), whereas the ESA-group showed no significant change (9.50 to 9.65 g/dL), and end-of-treatment Hb did not differ significantly between groups. The unadjusted mean Hb rise was greater in the Roxadustat cohort than in the ESA cohort (+1.40 ± 1.55 vs. +0.65 ± 1.93 g/dL; p = 0.037). However, after adjustment for baseline Hb (ANCOVA), baseline Hb predicted final Hb, while treatment group was not independently associated with final Hb. Transfusion requirements declined over follow-up in both groups. No new short-term safety signal was identified based on available clinical documentation. Conclusions: Roxadustat improved Hb in ESA-hyporesponsive patients with lower baseline Hb, but adjusted analyses indicated that baseline severity influenced response. Targets were not consistently achieved; these findings are hypothesis-generating regarding dose optimization, treatment duration, and earlier initiation.

Key summary points Aim To determine prevalences of common geriatric syndromes in the setting of different normal ranges of serum sodium. Findings Upper normal levels of serum sodium were associated with lower prevalences of malnutrition and dependency. Borderline hypernatremia was associated with lower risks of polypharmacy, dependency, frailty, and malnutrition compared to borderline hyponatremia. Message An upper-normal level of sodium was associated with lower prevalences of some geriatric syndromes among geriatric outpatients in this single-center study. Purpose To determine prevalences of common geriatric syndromes in the setting of different normal ranges of serum sodium. Methods In this cross-sectional study, 2048 older adults (aged ≥ 60) who underwent comprehesive geriatric assessment between 2016 and 2023 in one geriatric outpatient clinic were evaluated. Patient groups included moderate hyponatremia (< 130 mEq/L, n  = 28, 1.6%), mild hyponatremia (130–134 mEq/L, n  = 130, 7.3%), lower-normal range (135–140 mEq/L, n  = 904, 50.4%), upper normal range (141–145 mEq/L, n  = 702, 39.2%), and hypernatremia (> 145 mEq/L, n  = 29, 1.6%). A separate analysis was also performed according to the following classification: borderline hyponatremia (133–137 mEq/L), normal (138–142 mEq/L), and borderline hypernatremia (143–147 mEq/L). Logistic regression analysis was performed to determine associations between serum sodium groups and geriatric syndromes. Results After applying the inclusion/ exclusion criteria a total of 1792 patients were included, with a mean age of 81 ± 8 years and 71% were female. With the exception of geriatric depression, all other syndromes were more prevalent in the lower-normal range than the upper normal range. After adjustments for age, sex, comorbidities, functional status, and drug exposures, upper normal range of serum sodium was associated with lower risks of dependency (OR 0.72, 95% CI 0.53–0.99, p  = 0.043) and malnutrition (OR 0.69, 95% CI 0.51–0.94, p  = 0.018). Compared to borderline hyponatremia, borderline hypernatremia was associated with lower risks of polypharmacy (OR 0.58, 95% CI 0.37–0.89, p  = 0.014), dependency based on basic activities of daily living (OR 0.55, 95% CI 0.31–0.98, p  = 0.042), malnutrition (OR 0.55 95% CI 0.33–0.91, p  = 0.020), and frailty (OR 0.65, 95% CI 0.44–0.96, p  = 0.031). Conclusions Compared to a lower normal level of sodium, an upper normal level of sodium was associated with a lower risks of dependency and malnutrition. Borderline hypernatremia was associated with lower prevalences of polypharmacy, dependency, frailty, and malnutrition compared to borderline hyponatremia among geriatric outpatients in this single-center study.

BackgroundExcessive daytime sleepiness (EDS) is prevalent in not only older adults, but also patients with chronic kidney disease (CKD), and is associated with higher risks of morbidity and mortality.AimsThe aim of the present study is to determine associations between EDS and nutritional status and serum nutrient levels in older patients with CKD.MethodsThis cross-sectional study included 367 patients (aged ≥ 65 years) with CKD (eGFR < 60 ml/min/1.73 m2 and/or > 30 mg/day of albuminuria for > 3 months). EDS was recorded using the Epworth Sleepiness Scale (a score of ≥ 11). Malnutrition was diagnosed according to the Mini Nutritional Assessment (MNA) tool (a score of < 17).ResultsThe mean age was 81 ± 7 years, and 248 (67%) were female. EDS was seen in 99 (26.9%) patients. Those with EDS had significantly lower MNA scores and more frequent malnutrition than those without EDS (p < 0.05). In multivariable analysis adjusted for age, sex, cerebrovascular disease, dementia, number of drugs, and number of urinations at night, and the Charlson Comorbidity Index the relationship between malnutrition and EDS persisted (OR 2.58, 95% CI 1.38–4.83, p = 0.003). There was no significant difference between the presence of EDS and serum levels or deficiencies of vitamin D, vitamin B12, and folate (p > 0.05).ConclusionsEDS is associated with malnutrition in older patients with CKD. Therefore, EDS and nutritional status should be evaluated together in clinical practice. However, future studies are needed to determine the direction of the association between malnutrition and EDS and to evaluate if dietary intervention can improve EDS.

Background Relationship between dysphagia and dehydration has not been studied widely. The aim of this study is to determine the frequency of dysphagia and dehydration in geriatric outpatient clinic, to evaluate the relationship between these two conditions. Methods The cross-sectional study included 1345 patients. Plasma osmolarity (Posm) was calculated using the following formula: [1.86 x (Na + K) + 1.15 x glucose + urea + 14]. Overt dehydration was defined as a calculated Posm of > 300 mmol/L. Eating Assessment Tool (EAT-10) score of ≥ 3 was accepted as dysphagia. Associations between dehydration and dysphagia was evaluated. Results Mean age was 78 ± 8 years, and 71% were females. Dysphagia was observed in 27% of patients. Dysphagia was associated with a higher number of drug exposure, dependency on basic activities of daily living and geriatric depression ( p  < 0.05). Overt dehydration was found in 29% of patients with dysphagia, and 21% of patients with no dysphagia ( p  = 0.002); and dysphagia was significantly associated with overt dehydration mmol/L (OR 1.49, 95% CI 1.13–1.96, p  = 0.005) after adjustments for age and sex. In another model, EAT-10 score was found as one of the independent predictors of overt dehydration (OR1.03, 95% CI 1.00-1.06, p  = 0.38), along with diabetes mellitus (OR 2.32, 95% CI 1.72–3.15, p  < 0.001), chronic kidney disease (OR 3.05, 95% CI 2.24–4.15, p  < 0.001), and MNA score (OR 0.97, 95% CI 0.94-1.00, p  = 0.031). Conclusion EAT-10 scale was independently associated with overt dehydration among older adults, as MNA score was. Correction of both dysphagia and malnutrition might improve overt dehydration to a better extent than correction either of these factors alone. Future studies are needed to test cause and effect relationships.

Background The aim of this study was to investigate the clinical implications of appetite loss in older adults with normal nutritional status, prior to the development of malnutrition. Methods This study included a total of 755 older outpatients with normal nutritional status as determined by the Mini Nutritional Assessment (MNA ≥ 24). Council on Nutrition Appetite Questionnaire was used to assess appetite status. Patients with a CNAQ score of ≤ 28/40 were identified as having a reduced appetite. Sociodemographic characteristics, anthropometric measurements, comorbidities, number of drugs, and laboratory data at the time of outpatient clinic admission were recorded. A comprehensive geriatric assessment was performed for all patients. Results The mean age was 78.6 ± 7.7 years, and 66.8% were female. A total of 192 patients (25.4%) were identified with appetite loss. Individuals with appetite loss were older, more likely to be female, and more likely to have chronic kidney disease than those without appetite loss were ( p  < 0.05), while their educational level was lower. In the multivariate logistic regression, after adjusting for age, sex, years of education, and chronic kidney disease, there was an association between lower Tinetti Balance and Gait Scale scores, higher Geriatric Depression Scale-15 scores, and the number of medications associated with appetite loss ( p  < 0.05). Conclusions Appetite loss was observed in one out of four older adults with normal nutritional status (MNA ≥ 24). Appetite loss was associated with advanced age, female sex, lower educational level, chronic kidney disease, and polypharmacy. Older patients with appetite loss had more balance and gait disturbances and depressive symptoms even if they were well nourished. Trial registration Not applicable. This study is observational and not a clinical trial.

Effective systemic therapies suppress toxic light chain production leading to an increased proportion of patients with light chain (AL) amyloidosis who survive longer albeit with end-stage renal disease. There is a critical need to identify patients in this population who benefit from renal transplantation. This multicenter, observational study from five countries includes 237 patients with AL amyloidosis who underwent renal transplantation between 1987 and 2020. With a median follow-up of 8.5 years, the median overall survival from renal transplantation was 8.6 years and was significantly longer in patients with complete and very good partial hematologic responses (CR + VGPR) compared to less than VGPR (9 versus 6.8 years; HR: 1.5, P = 0.04 [95% CI: 1–2.1]) at renal transplantation. Median graft survival was 7.8 years and was better in the CR + VGPR group (8.3 vs 5.7 years, HR: 1.4, P = 0.05 [95% CI: 1–2]). The frequency and time to amyloid recurrence in the graft was also lower (16% vs 37%, p = 0.01) and longer (median time not achieved vs 10 years, p = 0.001) in the CR + VGPR group. Comparing CR vs. VGPR there was no difference in overall or graft survival. Although 69 patients (29%) experienced hematologic relapse, treatment effectively prevented graft loss in the majority (87%). Renal transplantation in selected AL amyloidosis patients is associated with extended overall and renal graft survival. Patients with hematologic CR or VGPR have the most favorable outcomes, and these patients should be considered for renal transplantation.