Imperial College London

DrLinaJohansson

Faculty of MedicineDepartment of Metabolism, Digestion and Reproduction

Honorary Clinical Lecturer
 
 
 
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Contact

 

+44 (0)20 3313 3947l.johansson

 
 
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Location

 

Nutrition and Dietetics, C blockHammersmith HospitalHammersmith Campus

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Summary

 

Publications

Publication Type
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23 results found

Wade-Mcbane K, King A, Urch C, Johansson L, Wells Met al., 2023, Is personalised prehabilitation feasible to implement for patients undergoing oncological treatment for lung cancer at a London teaching hospital? Protocol of a feasibility trial, BMJ Open, Vol: 13, Pages: 1-9, ISSN: 2044-6055

Introduction:There is significant potential to improve outcomes for patients with lung cancer in terms of quality of life and survival. There is some evidence that prehabilitation can help, but, to date, this has only been tested in surgical populations, despite 70-80% of lung cancer patients in the UK receiving non-surgical treatment. The physiological and psychological benefits of prehabilitation seen in surgical patients could be extrapolated to those receiving non-surgical treatment, particularly in such a poor prognosis group. With patients and healthcare professionals, we have co-designed a personalised and evidence-based prehabilitation programme. This draws on a conceptual framework that aligns with patient values and needs as well as functional goals. We aim to investigate whether this programme is feasible to implement and evaluate in clinical practice.Methods and analysis:An open-label, single-group feasibility study incorporating quantitative assessments, a qualitative free text questionnaire and reflective field notes. Thirty participants will be recruited over an eight-month period from a single London teaching hospital. All recruited participants will receive a personalised prehabilitation programme during their oncological treatment. This includes a one-hour face-to-face appointment prior to, at week three and at week six of their treatment regimen as well as a weekly telephone call. Interventions including nutrition, physical activity and psychological wellbeing are stratified according to a patient’s priorities, level of readiness and expressed needs. The primary outcome will be feasibility of the personalised prehabilitation programme in clinical practice by investigating areas of uncertainty regarding patient recruitment, attrition, treatment fidelity, intervention adherence and acceptability of study outcome measures. Secondary outcomes will include quality of life, functional capacity and grip strength.Ethics and dissemination:Ethical app

Journal article

Dilloway T, Ashby DR, Hickson M, Temple A, Johansson LRet al., 2023, Handgrip Strength Index: A Novel Parameter Which Quantifies Clinical Weakness in People on Haemodialysis., J Ren Nutr, Vol: 33, Pages: 456-464

OBJECTIVE: The muscle strength in people on haemodialysis is associated with nutritional status, quality of life, functional independence, and survival. Handgrip Strength (HGS) is simple to measure, but clinical interpretation is limited by the lack of reference ranges for a haemodialysis population. This study aims to define a novel parameter, HGS index, which quantifies degree of clinical weakness specific to a haemodialysis population and to test if this predicts survival. METHODS: In a cross-sectional single center study HGS was measured in stable participants on haemodialysis. HGS in the well-nourished subgroup, was used to develop a predictive equation for "expected" HGS according to demographic variables. This then was compared to observed HGS resulting in HGS index (%), an individualized parameter indicating weakness due to clinical variables while accounting for demographic contributors to strength. The association between HGS index and survival was explored in all participants. RESULTS: Among 427 well-nourished individuals on haemodialysis, HGS was strongly associated with demographic variables and predicted in males by the equation: HGS (kg) = 0.38∗height (cm) - 0.31∗age (years) - 18, and in females by the equation: HGS (kg) = 0.25∗height (cm) - 0.11∗age (years) - 16. Among 547 participants (22% with protein energy wasting), lower HGS index was associated with diabetes (P = .004), lower body mass index (BMI) (P = .005), lower albumin (P = .033), and longer dialysis vintage (P = .007). Over a mean observation period of 2.8 years, quintile of HGS index was strongly associated with survival (P = .023), and in a Cox proportional hazards model, the independent predictors of mortality were age, albumin, BMI and HGS index. CONCLUSION: HGS index, defined as observed relative to expected HGS, is an individualized measure of clinical weakness. It is a no

Journal article

Wade-Mcbane K, Urch C, Johansson L, Wells Met al., 2023, Does prehabilitation provide a model for holistic long-term care? Early insights from a lung cancer feasibility study, Publisher: ELSEVIER IRELAND LTD, Pages: S40-S40, ISSN: 0169-5002

Conference paper

Thind A, Goodall D, Rule A, Levy S, Brice S, Dor F, Evans N, Ospalla D, Thomas N, Wellsted D, Johansson L, Willicombe M, Brown Eet al., 2022, Prevalence of frailty and cognitive impairment in older transplant candidates. A preview to the Kidney Transplantation in Older People (KTOP): impact of frailty on outcomes study, BMC Nephrology, Vol: 23, ISSN: 1471-2369

Background Kidney transplantation in older people has increased, however older transplant recipients experience mixed outcomes that invariably impacts on their quality of life. The increased vulnerability of older end stage kidney disease patients to frailty and cognitive impairment, may partially explain the differences in outcomes observed. The Kidney Transplantation in Older People (KTOP): impact of frailty on clinical outcomes study is an active clinical study aiming to explore the experience of older people waiting for and undergoing transplantation. In this manuscript we present the study protocol, the study cohort, and the prevalence of frailty and cognitive impairment identified at recruitment. Methods The KTOP study is a single centre, prospective, mixed methods, observational study. Recruitment began in October 2019. All patients aged 60 or above either active on the deceased donor waitlist or undergoing live donor transplantation were eligible for recruitment. Recruited participants completed a series of questionnaires assessing frailty, cognition, and quality of life, which are repeated at defined time points whilst on the waitlist and post transplant. Clinical data was concurrently collected. Any participants identified as frail or vulnerable were also eligible for enrolment into the qualitative sub-study. Results208 participants have been recruited (age 60-78). Baseline Montreal Cognitive Assessments were available for 173 participants, with 63 (36.4%) participants identified as having scores below normal (score <26). Edmonton Frail Scale assessments were available for 184 participants, with 29 participants (15.8%) identified as frail (score ³8), and a further 37 participants (20.1%) identified as being vulnerable (score 6-7). Conclusion In the KTOP study cohort we have identified a prevalence of 36.4% of participants with MoCA scores suggestive of cognitive impairment, and a prevalence of frailty of 15.8% at recruitment. A further 20.1% were v

Journal article

Ali M, Dosani D, Corbett R, Johansson L, Charif R, Kon OM, Duncan N, Ashby Det al., 2022, Diagnosis of tuberculosis in dialysis and kidney transplant patients, HEMODIALYSIS INTERNATIONAL, Vol: 26, Pages: 361-368, ISSN: 1492-7535

Journal article

Kourtellidou S, Ashby D, Johansson L, 2021, Oral sodium bicarbonate in haemodialysis patients: a randomised controlled trial, BMC Nephrology, Vol: 22, Pages: 1-11, ISSN: 1471-2369

Background: Adverse events and mortality tend to cluster around dialysis sessions, potentially due to the impact of the saw-toothed profile of uraemic toxins such as potassium, peaking pre-dialysis and rapidly dropping during dialysis. Acidosis could be contributing to this harm by exacerbating a rise in potassium. The objectives of this study were to investigate the effects of oral bicarbonate treatment on reducing inter-dialytic potassium gain as well as other clinical consequences of preserving muscle mass and function and reducing intradialytic arrhythmia risk in people on haemodialysis. Methods: Open-label randomised controlled trial in a single-centre (London, UK). Forty-three clinically stable adults on haemodialysis were recruited, with a 6 month average pre-dialysis serum bicarbonate level <22mmol/l and potassium >4mmol/l. Thirty-three participants completed the study. Oral sodium bicarbonate tablets titrated up to a maximum of 3g bd (6g total) in intervention group for 12 weeks versus no treatment in the control group. Outcomes compared intervention versus non-intervention phases in the treated group and equivalent time points in the control group: pre- and post-dialysis serum potassium; nutritional assessments: muscle mass and handgrip strength and electrocardiograms (ECGs) pre and post dialysis. Results: Participants took an average of 3.7±0.5g sodium bicarbonate a day. In the intervention group, inter-dialytic potassium gain was reduced from 1.90±0.60 to 1.69±0.49mmol/l (p=0.032) and pre-dialysis potassium was reduced from 4.96±0.62 to 4.79±0.49mmol/l without dietary change. Pre-dialysis bicarbonate increased from 18.15±1.35 to 20.27±1.88mmol/l, however with an increase in blood pressure. Nutritionally, lean tissue mass was reduced in the controls suggesting less catabolism in the intervention group. There was no change in ECGs. Limitations are small sample size and unblinded study design

Journal article

Brown TJ, Williams H, Mafrici B, Jackson HS, Johansson L, Willingham F, McIntosh A, MacLaughlin HLet al., 2021, Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review, JOURNAL OF HUMAN NUTRITION AND DIETETICS, Vol: 34, Pages: 747-757, ISSN: 0952-3871

Journal article

Judah G, Mullan B, Yee M, Johansson L, Allom V, Liddelow Cet al., 2020, A habit-based randomised controlled trial to reduce sugar-sweetened beverage consumption: the impact of the substituted beverage on behaviour and habit strength, International Journal of Behavioral Medicine, Vol: 27, Pages: 623-635, ISSN: 1070-5503

BackgroundExcess sugar consumption has been linked to numerous negative health outcomes, such as obesity and type II diabetes. Reducing sugar-sweetened beverage (SSB) consumption may reduce sugar intake and thus improve health. The aim of the study was to test the impact of the potentially different rewarding nature of water or diet drinks as replacements for SSB, using a habit and implementation intention–based intervention.MethodAn online randomised, two-arm parallel design was used. One hundred and fifty-eight participants (mainly from the UK and USA) who regularly consumed SSBs (Mage = 31.5, 51% female) were advised to create implementation intentions to substitute their SSB with either water or a diet drink. Measures of SSB consumption, habit strength and hedonic liking were taken at baseline and at 2 months. Water or diet drink consumption was only measured at 2 months.ResultsThere was a large and significant reduction in SSB consumption and self-reported SSB habits for both the water and diet drink groups, but no difference between groups. There were no differences in hedonic liking for the alternative drink, alternative drink consumption and alternative drink habit between the two groups. Reduction in SSB hedonic liking was associated with reduced SSB consumption and habit.ConclusionThis study demonstrates that an implementation intention–based intervention achieved substantial reductions in SSB consumption and habits. It also indicates that hedonic liking for SSBs and alternative drinks are associated with changes in consumption behaviour. Substituting SSBs with water or diet drinks was equally as effective in reducing SSB consumption.

Journal article

Iyasere O, Brown EA, Johansson L, Davenport A, Farrington K, Maxwell AP, Collinson H, Fan S, Habib A-M, Stoves J, Woodrow Get al., 2019, Quality of life with conservative care compared with assisted peritoneal dialysis and haemodialysis, Clinical Kidney Journal, Vol: 12, Pages: 262-268, ISSN: 2048-8505

BackgroundThere is little information about quality of life (QoL) for patients with end-stage kidney disease (ESKD) choosing conservative kidney management (CKM). The Frail and Elderly Patients on Dialysis (FEPOD) study demonstrated that frailty was associated with poorer QoL outcomes with little difference between dialysis modalities [assisted peritoneal dialysis (aPD) or haemodialysis (HD)]. We therefore extended the FEPOD study to include CKM patients with estimated glomerular filtration rate ≤10 mL/min/1.73 m2 (i.e. individuals with ESKD otherwise likely to be managed with dialysis).MethodsCKM patients were propensity matched to HD and aPD patients by age, gender, ethnicity, diabetes status and index of deprivation. QoL outcomes measured were Short Form-12 (SF12), Hospital Anxiety and Depression Scale depression score, symptom score, Illness Intrusiveness Rating Scale (IIRS) and Renal Treatment Satisfaction Questionnaire. Frailty was assessed using the Clinical Frailty Scale. Generalized linear modelling was used to assess the impact of treatment modality on QoL outcomes, adjusting for baseline characteristics.ResultsIn total, 84 (28 CKM, 28 HD and 28 PD) patients were included. Median age for the cohort was 82 (79–88) years. Compared with CKM, aPD was associated with higher SF12 physical component score (PCS) [Exp B (95% confidence interval) = 1.20 (1.00–1.45), P < 0.05] and lower symptom score [Exp B = 0.62 (0.43–0.90), P = 0.01]; depression score was lower in HD compared with CKM [Exp B = 0.70 (0.52–0.92), P = 0.01]. Worsening frailty was associated with higher depression scores [Exp B = 2.59 (1.45–4.62), P < 0.01], IIRS [Exp B = 1.20 (1.12–1.28), P < 0.01] and lower SF12 PCS [Exp B = 0.87 (0.83–0.93), P < 0.01].ConclusionTr

Journal article

Iyasere O, Brown E, Gordon F, Collinson H, Fielding R, Fluck R, Johansson L, Morgan N, Stoves J, Vardhan A, Woodrow G, Davenport Aet al., 2019, LONGITUDINAL TRENDS IN QUALITY OF LIFE AND PHYSICAL FUNCTION IN FRAIL OLDER DIALYSIS PATIENTS: A COMPARISON OF ASSISTED PERITONEAL DIALYSIS AND IN-CENTER HEMODIALYSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 39, Pages: 112-118, ISSN: 0896-8608

Journal article

van Loon IN, Joosten H, Iyasere O, Johansson L, Hamaker ME, Brown EAet al., 2019, The prevalence and impact of falls in elderly dialysis patients: Frail elderly Patient Outcomes on Dialysis (FEPOD) study., Arch Gerontol Geriatr, Vol: 83, Pages: 285-291

BACKGROUND: As the numbers of older patients on dialysis rise, geriatric problems such as falling become more prevalent. We aimed to assess the prevalence of falls and the impact on mortality and quality of life in frail elderly patients on assisted PD (aPD) and hemodialysis (HD) from the FEPOD Study. METHODS: Data on falls and quality of life were collected with questionnaires at baseline and every six months during 2-year follow-up. Multiple regression analysis was used to evaluate factors associated with falls. Additionally, we performed a review of literature concerning the relation between falls and poor outcome. RESULTS: Baseline fall data were available for 203 patients and follow-up data for 114 patients. Dialysis modality was equally distributed (49% HD and 51% aPD). Mean (SD) age was 75 ± 7 years. Fall rate was 1.00 falls/patient year, comparable in HD and aPD. Falls led to fear of falling, resulting in less activities in 68% vs 42% (p < 0.01) and leaving the house less in 59% vs 31% (p < 0.01) of patients. Patients with diabetes mellitus were twice as likely to report falls at baseline (OR 1.91 [95%CI 1.00-3.63], p = 0.05) and falls at baseline were associated with falls during follow-up (OR 2.53 [95%CI 1.06-6.04] p = 0.03). Literature revealed frailty was a strong risk factor for falling and falling results in a higher mortality and hospitalization rate. CONCLUSION: Falls were frequent in older dialysis patients and have a negative impact on quality of life. Fall incidence is comparable between aPD and HD.

Journal article

Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AYM, Xu H, Lu Y, Molnar MZ, Kovesdy CPet al., 2018, Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism, JOURNAL OF RENAL NUTRITION, Vol: 28, Pages: 380-392, ISSN: 1051-2276

Journal article

Chauveau P, Aparicio M, Bellizzi V, Campbell K, Hong X, Johansson L, Kolko A, Molina P, Sezer S, Wanner C, ter Wee PM, Teta D, Fouque D, Carrero JJet al., 2018, Mediterranean diet as the diet of choice for patients with chronic kidney disease, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 33, Pages: 725-735, ISSN: 0931-0509

Journal article

Lyasere OU, Brown EA, Johansson L, Huson L, Smee J, Maxwell AP, Farrington K, Davenport Aet al., 2016, Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis, CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, Vol: 11, Pages: 423-430, ISSN: 1555-9041

Journal article

Johansson L, Brown EA, 2015, How to choose the type of dialysis in the elderly patient, Dialysis in Older Adults: A Clinical Handbook, Pages: 9-19, ISBN: 9781493933181

Only a few patients over the age of 70 will be eligible for transplantation, so the older patient starting dialysis will remain on this treatment for the rest of their life. Choice of dialysis modality will not affect patient survival but will have a major impact on patient lifestyle and therefore quality of life. The decision about dialysis modality is therefore a crucially important one, and the choice should be made with the patient. This requires the clinician (nephrologist, dialysis educator, etc.) to have a realistic understanding about life on haemodialysis (HD) and peritoneal dialysis (PD) for older people in general and for the patient in particular. The patient (and family/carers) also needs appropriate unbiased education about the pros and cons of HD and PD and how both will affect their lifestyle and overall prognosis. This process is called “shared decision making”. To ensure that this happens with each patient about to start patient, it is useful to break the process down into a series of steps as shown in Table 2.1.

Book chapter

Muthalagappan S, Johansson L, Kong WM, Brown EAet al., 2013, Dialysis or conservative care for frail older patients: ethics of shared decision-making, NEPHROLOGY DIALYSIS TRANSPLANTATION, Vol: 28, Pages: 2717-2722, ISSN: 0931-0509

Journal article

Johansson L, Hickson M, Brown EA, 2013, Influence of Psychosocial Factors on the Energy and Protein Intake of Older People on Dialysis, JOURNAL OF RENAL NUTRITION, Vol: 23, Pages: 348-355, ISSN: 1051-2276

Journal article

El-Sherbini N, Duncan N, Hickson M, Johansson L, Brown EAet al., 2013, NUTRITION CHANGES IN CONSERVATIVELY TREATED PATIENTS WITH ENCAPSULATING PERITONEAL SCLEROSIS, PERITONEAL DIALYSIS INTERNATIONAL, Vol: 33, Pages: 538-543, ISSN: 0896-8608

Journal article

Brown EA, Johansson L, 2011, Epidemiology and management of end-stage renal disease in the elderly, NATURE REVIEWS NEPHROLOGY, Vol: 7, Pages: 591-598, ISSN: 1759-5061

Journal article

Brown EA, Johansson L, 2011, Dialysis Options for End-Stage Renal Disease in Older People, NEPHRON CLINICAL PRACTICE, Vol: 119, Pages: C10-C13, ISSN: 1660-2110

Journal article

Brown EA, Johansson L, Farrington K, Gallagher H, Sensky T, Gordon F, Da Silva-Gane M, Beckett N, Hickson Met al., 2010, Broadening Options for Long-term Dialysis in the Elderly (BOLDE): differences in quality of life on peritoneal dialysis compared to haemodialysis for older patients, Nephrology Dialysis Transplantation, Vol: 25, Pages: 3755-3763, ISSN: 1460-2385

Background. Health-related quality of life (QOL) is an importantoutcome for older people who are often on dialysisfor life. Little is, however, known about differences in QOLon haemodialysis (HD) and peritoneal dialysis (PD) in olderage groups. Randomising patients to either modality toassess outcomes is not feasible.Methods. In this cross-sectional, multi-centred study weconducted QOL assessments (Short Form-12 Mental andPhysical Component Summary scales, Hospital Anxietyand Depression Scale and Illness Intrusiveness RatingsScale) in 140 people (aged 65 years or older) on PDand HD.Results. The groups were similar in age, gender, time ondialysis, ethnicity, Index of Deprivation (based on postcode),dialysis adequacy, cognitive function (Mini-MentalState Exam and Trail-Making Test B), nutritional status(Subjective Global Assessment) and social networks.There was a higher comorbidity score in the HD group.Regression analyses were undertaken to ascertain whichvariables significantly influence each QOL assessment.All were influenced by symptom count highlighting thatthe patient’s perception of their symptoms is a criticaldeterminant of their mental and physical well being.Modality was found to be an independent predictorof illness intrusion with greater intrusion felt in thoseon HD.Conclusions. Overall, in two closely matched demographicgroups of older dialysis patients, QOL was similar, if notbetter, in those on PD. This study strongly supports offeringPD to all suitable older people.

Journal article

Brown EA, Johansson L, 2009, Old age and frailty in the dialysis population, JOURNAL OF NEPHROLOGY, Vol: 23, Pages: 502-507, ISSN: 1121-8428

Journal article

Johansson L, Brown EA, 2009, Peritoneal Dialysis, SEMINARS IN DIALYSIS, Vol: 22, Pages: 27-29, ISSN: 0894-0959

Journal article

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