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Lobo JC, Farage NE, Abdalla DSP, Velarde LGC, Torres JPM, Mafra D. Association between circulating electronegative low-density lipoproteins and serum ferritin in hemodialysis patients: a pilot study. J Ren Nutr 2012; 22:350-6. [PMID: 21741859 DOI: 10.1053/j.jrn.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Iron supplementation is a common recommendation to chronic kidney disease patients undergoing hemodialysis (HD). However, iron excess is closely associated with lipid peroxidation and, it is well known that electronegative low-density lipoproteins (LDL[-]) are present at higher plasma concentrations in diseases with high cardiovascular risk such as chronic kidney disease. Thus, the aim of this study was to investigate whether ferritin levels are associated with LDL(-) levels in HD patients. DESIGN This was a cross-sectional study. SETTING This study was conducted from a private clinic in Rio de Janeiro, Brazil. PATIENTS The study included 27 HD patients and 15 healthy subjects. METHODS AND PROCEDURES Twenty-seven HD patients (14 men, 58.6 ± 10 years, 62.2 ± 51.4 months on dialysis, and body mass index: 24.4 ± 4.2 kg/m(2)) were studied and compared with 15 healthy individuals (6 men, 53.8 ± 15.4 years, body mass index: 24.5 ± 4.3 kg/m(2)). Serum LDL(-) levels were measured using the enzyme-linked immunosorbent assay method; ferritin levels by commercially available kits, and tumor necrosis factor-α, interleukin-6, monocyte chemoattractant protein-1, and plasminogen activator inhibitor-1 were determined with a multiplex assay kit manufactured by R&D Systems. RESULTS The HD patients presented higher LDL(-) and tumor necrosis factor-α levels (0.15 ± 0.13 U/L and 5.9 ± 2.3 pg/mL, respectively) than healthy subjects (0.07 ± 0.05 U/L and 2.3 ± 1.3 pg/mL, respectively) (P = .0001). The mean ferritin level in HD patients was 1,117.5 ± 610.4 ng/mL, and 90% of patients showed ferritin levels exceeding 500 ng/mL. We found a positive correlation between LDL(-) and ferritin in the patients (r = 0.48; P = .01), and ferritin was a significant contributor to LDL(-) concentrations independent of inflammation. CONCLUSIONS Excess body iron stores for HD patients was associated with signs of increased oxidative stress, as reflected by increased LDL(-) levels in HD patients.
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Lobo JC, Aranha LN, Moraes C, Brito LC, Mafra D. Linking zinc and leptin in chronic kidney disease: future directions. Biol Trace Elem Res 2012; 146:1-5. [PMID: 21947794 DOI: 10.1007/s12011-011-9211-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/12/2011] [Indexed: 02/05/2023]
Abstract
Anorexia is a common complication in patients with chronic kidney disease (CKD) and is associated with the development of malnutrition and an increased risk of mortality. Several compounds are linked to anorexia in these patients; however, the mechanisms are unknown. Zinc (Zn) deficiency is associated with decreased food intake and has been observed in CKD patients. In addition, leptin is an anorexigenic peptide, and patients with CKD present generally high levels of this hormone. Studies have suggested an association between Zn and leptin status in human and rats; however, the results are inconsistent. Some claimed that Zn supplementation does not change leptin release or that there is no significant relationship between Zn and leptin. Others have reported that Zn might be a mediator of leptin production. CKD patients have hyperleptinemia and hypozincemia, but the relationship between Zn deficiency and leptin levels in CKD patients has been poorly understood until now. The aim of this review is to integrate knowledge on leptin and Zn actions to provide a cohesive clinical perspective regarding their interactions in CKD patients.
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Calixto A, Geloneze B, Mafra D. Apelin: A Peptide Involved in Cardiovascular Risk in Hemodialysis Patients? Ren Fail 2012; 34:577-81. [DOI: 10.3109/0886022x.2012.668490] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Mafra D, Moraes C, Leal VO, Farage NE, Stockler-Pinto MB, Fouque D. Underreporting of energy intake in maintenance hemodialysis patients: a cross-sectional study. J Ren Nutr 2012; 22:578-83. [PMID: 22227181 DOI: 10.1053/j.jrn.2011.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/29/2011] [Accepted: 10/09/2011] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To analyze the reported energy intake (EI(rep)) in hemodialysis (HD) patients by total energy expenditure (TEE) measured by a dedicated device. DESIGN Cross-sectional study. SETTING RenalCor and RenalVida Clinics (Rio de Janeiro, Brazil). PATIENTS AND OTHERS PARTICIPANTS Forty-eight HD patients (51.4 ± 12.2 years, 62% men, body mass index [BMI], 23.8 ± 4.5 kg/m(2)) were studied. MAIN OUTCOME MEASURE EI(rep) was evaluated using a 3-day food record. TEE was measured over a 2-day period by SWA (SenseWear Pro2 Armband, BodyMedia Inc., Pittsburgh, PA). Subjects were identified as underreporters (URs), acceptable reporters (ARs), or overreporters (ORs) from their EI(rep)/TEE ratio. ARs were defined as having the EI(rep)/TEE ratio in the range of 0.76 to 1.24, URs as EI(rep)/TEE <0.76, ORs as EI(rep)/TEE >1.24 according to Goldberg index. RESULTS The mean TEE and EI(rep) were 34.7 ± 9.4 kcal/kg/day and 22.8 ± 10.6 kcal/kg/day, respectively, and 37.5% of patients presented overweight or obesity. Thirty-one patients (65%) were identified as URs, and the mean of Goldberg index was 0.54 ± 0.12 (0.23 to 0.75), versus 0.95 ± 0.12 (0.79 to 1.2) for ARs. There were no ORs among the patients studied. There were negative correlations between Goldberg index and BMI (r = -0.35, P < .01) and % body fat (r = -0.4, P < .01) and between EI(rep) and BMI (r = -0.58, P < .001). CONCLUSION These results confirm a high prevalence of underreporting of EI in HD patients, particularly in patients with high BMI.
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Avesani CM, Trolonge S, Deleaval P, Baria F, Mafra D, Faxen-Irving G, Chauveau P, Teta D, Kamimura MA, Cuppari L, Chan M, Heimburger O, Fouque D. Physical activity and energy expenditure in haemodialysis patients: an international survey. Nephrol Dial Transplant 2011; 27:2430-4. [DOI: 10.1093/ndt/gfr692] [Citation(s) in RCA: 108] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Abdalla DSP, Leite M, Mafra D. Is zinc-α2-glycoprotein a cardiovascular protective factor for patients undergoing hemodialysis? Clin Chim Acta 2011; 413:616-9. [PMID: 22178218 DOI: 10.1016/j.cca.2011.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Zinc-α2-glycoprotein (ZAG) is a lipid mobilizing factor. Its anti-inflammatory action and expression pattern suggest that ZAG could act by protecting against the obesity-associated disorders. In hemodialysis (HD) patients, ZAG levels were described to be elevated but its effects on markers of inflammation and LDL oxidation are still unclear. We investigated the relationship between ZAG and markers of systemic inflammation and LDL atherogenic modification profile in HD patients. METHODS Forty-three patients regularly on HD were studied and compared to 20 healthy subjects. Plasma ZAG, adiponectin, electronegative LDL [LDL(-)], an atherosclerotic negatively charged LDL subfraction, and anti-LDL(-) autoantibodies levels were measured by ELISA. Markers of inflammation and atherogenic cell recruitment (TNF-α, interleukin-6, VCAM-1, ICAM-1, MCP-1 and PAI-1) were also determined. RESULTS Inflammatory markers and atherogenic cell recruitment were higher in HD patients when compared to healthy subjects. ZAG levels were also higher in HD patients (151.5 ± 50.1 mg/l vs 54.6 ± 23.0 mg/l; p<0.0001) and its levels were negatively correlated with TNF-α (r=-0.39; p=0.001) and VCAM-1 (r=-0.52; p<0.0001) and, positively correlated with anti-LDL(-) autoantibodies (r=0.38; p=0.016). On multivariate analyses, plasma ZAG levels were independently associated with VCAM-1 (p=0.01). CONCLUSION ZAG is inversely associated with markers of pro-atherogenic factors linked to systemic inflammation and oxidative stress. Thus, this adipokine may constitute a novel marker of a favorable metabolic profile regarding cardiovascular risk factors in HD population.
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Leal VO, Stockler-Pinto MB, Farage NE, Aranha LN, Fouque D, Anjos LA, Mafra D. Handgrip strength and its dialysis determinants in hemodialysis patients. Nutrition 2011; 27:1125-9. [DOI: 10.1016/j.nut.2010.12.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Revised: 11/25/2010] [Accepted: 12/13/2010] [Indexed: 01/04/2023]
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Saldanha JF, Carrero JJ, Lobo JC, Stockler-Pinto MB, Leal VO, Calixto A, Geloneze B, Mafra D. The newly identified anorexigenic adipokine nesfatin-1 in hemodialysis patients: Are there associations with food intake, body composition and inflammation? ACTA ACUST UNITED AC 2011; 173:82-5. [PMID: 22036920 DOI: 10.1016/j.regpep.2011.09.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/06/2011] [Accepted: 09/29/2011] [Indexed: 10/15/2022]
Abstract
Nesfatin-1 is a recently identified anorexigenic peptide that has been implicated in appetite regulation, weight loss and/or malnutrition. Anorexia and malnutrition are common features of chronic kidney disease (CKD) that predispose patients to worse outcomes. However, the reasons for the occurrence of anorexia in CKD patients are not fully elucidated. The aim of this study was to investigate the association between nesfatin-1 and protein intake and body composition in patients undergoing hemodialysis (HD). Twenty five HD patients from a private Clinic in Rio de Janeiro, Brazil were studied and compared with 15 healthy subjects that were matched for body mass index (BMI), % body fat mass (by anthropometrics) and age. Appetite was measured using a specific questionnaire, and food intake was evaluated based on 3-day food records. Nesfatin-1 levels were measured by ELISA and leptin, TNF-α and IL-6 levels were determined by a multiplex assay kit. Serum nesfatin-1 levels did not differ between HD patients (0.16±0.07ng/mL) and healthy subjects (0.17±0.10ng/mL). Nesfatin-1 levels showed significant negative correlations with protein intake (r=-0.42; p=0.03), but did not associate with inflammatory markers or appetite scores. Combining patients and controls, we observed positive correlations with BMI (r=0.33; p=0.03), % body fat (r=0.35; p=0.03), leptin (r=0.45; p=0.006) and the triceps skinfold thickness (r=0.36; p=0.02). In multivariate analysis % body fat was the main determinant of nesfatin-1 variance. In conclusion, nesfatin-1 levels did not differ between HD patients and healthy subjects and negatively correlated with protein intake. This pathway is likely not dysregulated in uremia.
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Saldanha J, Carrero J, Mafra D. The possible role of nesfatin-1 on appetite regulation in hemodialysis patients. Med Hypotheses 2011; 77:654-7. [DOI: 10.1016/j.mehy.2011.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 06/01/2011] [Accepted: 07/01/2011] [Indexed: 11/26/2022]
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Mafra D, Fouque D. Dog walk: a simple way to improve chronic kidney disease patients' inactivity. Clin Kidney J 2011; 4:362-3. [PMID: 25984193 PMCID: PMC4421717 DOI: 10.1093/ndtplus/sfr073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lobo JC, Mafra D, Farage NE, Faulin TDES, Abdalla DSP, de Nóbrega ACL, Torres JPM. Increased electronegative LDL and decreased antibodies against electronegative LDL levels correlate with inflammatory markers and adhesion molecules in hemodialysed patients. Clin Chim Acta 2011; 412:1788-92. [DOI: 10.1016/j.cca.2011.05.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/31/2011] [Accepted: 05/31/2011] [Indexed: 10/18/2022]
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Rosales L, Vega O, Usvyat L, Thijssen S, Levin N, Kotanko P, Miyamoto T, Witasp A, Rashid Qureshi A, Heimburger O, Barany P, Nordfors L, Lindholm B, Stenvinkel P, Jesus Carrero J, Kalousova M, Benakova H, Kubena AA, Dusilova-Sulkova S, Tesar V, Zima T, Lee YJ, Kim MS, Song BG, Cho S, Kim SR, Stockler-Pinto M, Lobo J, Moraes C, Barros A, Farage N, Boaventura G, Mafra D, Malm O, Matsuda S, Akaike N, Kajiwara K, Tovbin D, Kesari S, Sola-Del Valle D, Barasch J, Douvdevani A, Zlotnik M, Abd Elkadir A, Storch S, Sarikaya M, Sari F, Gunes J, Eren M, Cetinkaya R, Hwang JC, Ma TL, Wang CT, Ogawa H, Nagaya T, Ota Y, Sarai M, Oda O, Biavo B, Uezima C, Costa ME, Barros C, Martins JP, Ribeiro Jr E, Tzanno-Martins C, Honda H, Kimata N, Wakai K, Akizawa T, Droulias J, Filliponi V, Argyropoulos C, Fischer R, Papakonstantinou C, Papadopoulos C, Kouvelis A, Zervas G, Dampolia E, Zerefos N, Valis D, Sarcina C, Baragetti I, Uboldi P, Buzzi L, Garlaschelli K, Ferrario F, Terraneo V, Norata GD, Catapano AL, Pozzi C, Conti G, Santoro D, Caccamo D, Condello S, Pazzano D, Savica V, Jentile R, Fede C, Bellinghieri G, Zortcheva R, Ikonomov V, Galunska B, Paskalev D, Dobreva D, Ivanova D, Tsunoda M, Ikee R, Sasaki N, Sato N, Hashimoto N, Korol L, Dudar I, Migal L, Gonchar Y, Seleznova I, Ischenko V, Erkmen Uyar M, Tutal E, Bal Z, Ahmed N, Sezer S, Fedak D, Kuzniewski M, Pawlica D, Kusnierz-Cabala B, Solnica B, Drozdz M, Janda K, Sulowicz W, Kopec J, Banach M, Sulowicz W, Leal V, Lobo J, Stockler-Pinto M, Farage N, Mafra D. Protein-energy wasting, inflammation and oxidative stress in CKD 5D. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mafra D, Farage NE, Lobo JC, Stockler-Pinto MB, Leal VO, Carvalho DP, Leite M. Relationship between total ghrelin and inflammation in hemodialysis patients. Peptides 2011; 32:358-61. [PMID: 21129426 DOI: 10.1016/j.peptides.2010.11.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/23/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
Abstract
In hemodialysis (HD) patients studies have shown that plasma ghrelin is increased and it has been speculated that ghrelin levels might be related to systemic inflammation. The present study attempted to correlate the serum levels of total ghrelin with serum TNF-α and IL-6, and with nutritional status and body composition in HD patients. Forty-seven HD patients from a single dialysis unit (18 women, mean age 55.3±12.2 yr; BMI 24.4±4.2kg/m(2); % body fat 29.4±7.4%) were studied and compared to 21 healthy subjects (12 women, 50.7±15.7 yr and BMI 25.6±4.0kg/m(2); % body fat 30.0±5.7%). Biochemical data, serum total ghrelin, TNF-α and IL-6 levels were measured. The body composition was evaluated by dual energy X-ray absortiometry (DEXA) and energy and protein intake were evaluated. Patients showed elevated plasma ghrelin levels when compared to healthy subjects (1.14±1.0ng/mL vs 0.58±0.4; p<0.001). There was a positive correlation between ghrelin levels and TNF-α (r=0.25; p<0.04), IL-6 (r=0.42; p<0.02), and a negative correlation between TNF-α and protein intake (r=-0.28; p<0.03), and energy intake (r=-0.34; p<0.01). No correlation was observed with any aspect of body composition. Plasma ghrelin levels are elevated in HD patients and associated with the state of systemic inflammation. We suggest that the inflammatory state may affect ghrelin bioactivity and metabolism in hemodialysis patients.
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Mafra D, Deleaval P, Teta D, Cleaud C, Arkouche W, Jolivot A, Fouque D. Influence of inflammation on total energy expenditure in hemodialysis patients. J Ren Nutr 2011; 21:387-93. [PMID: 21239181 DOI: 10.1053/j.jrn.2010.09.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 09/06/2010] [Accepted: 09/11/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Studies show that inflammation can contribute to an increase in resting energy expenditure in patients with chronic kidney disease; however, findings about total energy expenditure (TEE) have not been reported. The aim of this study was to evaluate the effects of inflammation on TEE and physical activity energy expenditure in hemodialysis (HD) patients. DESIGN This was a cross-sectional study. SETTING This study was conducted from Hôpital Edouard Herriot, Lyon, France. PATIENTS This study included 24 HD patients and 18 healthy subjects. MAIN OUTCOME MEASURE TEE and step counts were measured over a 7-day period by the SenseWear Pro2 Armband in 24 HD patients (15 patients with C-reactive protein <5 mg/L, aged 67.0 ± 14.7 years, and 9 with C-reactive protein >5 mg/L, aged 69.0 ± 18.0 years) and compared with 18 healthy subjects (62.3 ± 15.3 years). RESULTS Mean estimated TEE measured with SenseWear Pro2 Armband was significantly lower (25.5 ± 4.1 kcal/kg/day) in patients with inflammation when compared with those without inflammation (32.0 ± 6.7 kcal/kg/day) and with healthy subjects (31.8 ± 7.0 kcal/kg/day) (P = .012). There was a difference in the physical activity (step counts) between patient groups (P < .05). Healthy subjects and patients without inflammation walked more (8,107 ± 5,419 and 6,016 ± 3,752 steps/day, respectively) as compared with patients with inflammation (2,801 ± 2,754 steps/day, P = .001). CONCLUSION Our findings suggest that patients with inflammation have a lower TEE when compared with healthy subjects and patients without inflammation. TEE is influenced by physical activity because patients with inflammation appear to be less active.
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Stockler-Pinto M, Mafra D, Farage N, Boaventura G, Cozzolino S. Effect of Brazil nut supplementation on the blood levels of selenium and glutathione peroxidase in hemodialysis patients. Nutrition 2010; 26:1065-9. [DOI: 10.1016/j.nut.2009.08.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/29/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
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Leal VO, Mafra D, Fouque D, Anjos LA. Use of handgrip strength in the assessment of the muscle function of chronic kidney disease patients on dialysis: a systematic review. Nephrol Dial Transplant 2010; 26:1354-60. [PMID: 20709742 DOI: 10.1093/ndt/gfq487] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Even though handgrip strength (HGS) is considered a simple and reliable method to evaluate muscle function and, indirectly, the nutritional status in clinical settings, there is still no consensus concerning its use in patients with chronic kidney disease (CKD) undergoing dialysis. This study presents a systematic review of the literature on the use of HGS as a parameter for nutritional assessment and a prognostic marker in patients on dialysis. METHODS The MEDLINE database (1966 to October 2009) was consulted for this systematic review by using the search terms hand strength or muscle strength dynamometer and dialysis. Eighteen articles were identified and included in the analysis. RESULTS Similar to the general population, HGS values were associated with age and gender. The analysed studies showed correlation between muscle function estimated by HGS and variables used in the assessment of muscle mass and nutritional status, as well as the prediction of clinical complications. CONCLUSIONS The analysis indicates that HGS is a useful tool for continuous and systematic assessment of muscle mass related to nutritional status in patients on dialysis. However, it is still necessary to standardize the techniques used for HGS, especially with respect to the position of measurement, the evaluation period, the choice of arm side and the diagnostic criterion.
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Lobo JC, Torres JPM, Fouque D, Mafra D. Zinc deficiency in chronic kidney disease: is there a relationship with adipose tissue and atherosclerosis? Biol Trace Elem Res 2010; 135:16-21. [PMID: 19760368 DOI: 10.1007/s12011-009-8504-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
Abstract
Cardiovascular complications caused by an accelerated atherosclerotic disease consist the major cause of morbidity and mortality in patients with chronic kidney disease (CKD). These patients present multiple atherosclerotic risk factors, considered traditional, as well as nontraditional risk factors such as inflammation and oxidative stress. These complications are also seen in obesity, in which endothelial dysfunction is one of the early stages of atherosclerosis. The impact of trace metal deficiencies on this process is not well studied in patients with CKD and in obese people, although the influence of trace elements depletion, particularly zinc (Zn), may have significant clinical implications. This brief review describes the functions of Zn as well as the respective role of this trace element in atherosclerosis processes, with a particular emphasis on obese patients with chronic kidney disease.
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Mafra D, Guebre-Egziabher F, Fouque D. Endocrine Role of Stomach in Appetite Regulation in Chronic Kidney Disease: About Ghrelin and Obestatin. J Ren Nutr 2010; 20:68-73. [DOI: 10.1053/j.jrn.2009.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Indexed: 12/24/2022] Open
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Mafra D, Jolivot A, Chauveau P, Drai J, Azar R, Michel C, Fouque D. Are ghrelin and leptin involved in food intake and body mass index in maintenance hemodialysis? J Ren Nutr 2009; 20:151-7. [PMID: 19913442 DOI: 10.1053/j.jrn.2009.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Both leptin and ghrelin (in the forms of acyl ghrelin and des-acyl ghrelin) are involved in food intake, and appear to be dysregulated in chronic kidney disease. This study describes plasma leptin, acyl, and des-acyl ghrelin concentrations in relation to protein intake and body mass index (BMI) in hemodialysis (HD) patients. DESIGN This was a cross-sectional study. SETTING This study was conducted during the baseline phase of the French multicenter Influence of a High-Flux Dialyzer on Long-Term Leptin Levels Study. PATIENTS We studied 125 HD patients (aged 72.5+/-11.7 years; 59% males). MAIN OUTCOME MEASURE Blood samples were collected during fasting, and before a regular HD session. Plasma ghrelin and leptin were evaluated. The protein equivalents of total nitrogen appearance and BMI were calculated. RESULTS Patients demonstrated elevated serum leptin (48.0+/-49.0 ng/mL) and des-acyl ghrelin (646.6+/-489.5 pg/mL) levels, and low acyl ghrelin levels (29.8+/-58.5 pg/mL), according to normal values. Acyl ghrelin was negatively correlated with C-reactive protein (r=-0.34, P < .001). The des-acyl to acyl ghrelin ratio was negatively correlated with protein intake, as estimated by normalized Protein Nitrogen Appearance (r=-0.22, P=.01). Serum leptin exhibited its well-described positive correlation with BMI and waist circumference, but the other hormones did not. CONCLUSIONS This study reports high des-acyl ghrelin and leptin levels and low acyl ghrelin levels in HD patients, a finding potentially associated with inflammation and food intake.
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Leal VO, Delgado AG, Leite M, Mitch WE, Mafra D. Influence of renal function and diet on acid-base status in chronic kidney disease patients. J Ren Nutr 2009; 19:178-82. [PMID: 19218046 DOI: 10.1053/j.jrn.2008.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE We investigated the influence of potential renal acid load (PRAL) and renal function on the degree of metabolic acidosis in patients with chronic kidney disease (CKD). DESIGN This was a cross-sectional study. SETTING This study was conducted at the Nephrology Outpatient Division of the Hospital Universitário Clementino Fraga Filho (Rio de Janeiro, Brazil). PATIENTS Thirty CKD patients undergoing conservative treatment were divided according to plasma HCO(3)(-) values into acidotic (HCO(3)(-) <or=22 mM, n = 15) and nonacidotic (HCO(3)(-) >22 mM, n = 15). MAIN OUTCOME MEASURE Biochemical, nutritional, and anthropometric parameters and PRAL were measured. RESULTS The mean of plasma HCO(3)(-) values was 17.7 +/- 2.8 mM in the acidotic group, and 25.1 +/- 2.2 mM in the nonacidotic group. There was no significant difference in mean PRAL values between the acidotic (9.8 +/- 6.4 mEq/day) and nonacidotic (12.7 +/- 10.0 mEq/day) groups, but there was a significant correlation between plasma HCO(3)(-) and creatinine clearance (r = 0.78, P < .0001). Based on the receiver operating characteristic curve, the level of creatinine clearance to begin detection of acidosis was 31.8 mL/min, with a sensitivity and specificity of 86.7%. CONCLUSION The acid-base status of this group of CKD patients undergoing conservative treatment was mainly determined by degree of renal insufficiency rather than diet.
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Mafra D, Santos FR, Lobo JC, de Mattos Grosso D, Barreira AL, Velarde LGC, Abdalla DSP, Leite M. Alpha-tocopherol supplementation decreases electronegative low-density lipoprotein concentration [LDL(-)] in haemodialysis patients. Nephrol Dial Transplant 2009; 24:1587-92. [PMID: 19176686 DOI: 10.1093/ndt/gfn760] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Oxidative stress is a significant contributor to cardiovascular diseases (CVD) in haemodialysis (HD) patients, predisposing to the generation of oxidized low-density lipoprotein (oxLDL) or electronegatively charged LDL subfraction. Antioxidant therapy such as alpha-tocopherol acts as a scavenger of lipid peroxyl radicals attenuating the oxidative stress, which decreases the formation of oxLDL. The present study was designed to investigate the influence of the alpha-tocopherol supplementation on the concentration of electronegative low-density lipoprotein [LDL(-)], a minimally oxidized LDL, which we have previously described to be high in HD patients. METHODS Blood samples were collected before and after 120 days of supplementation by alpha-tocopherol (400 UI/day) in 19 stable HD patients (50 +/- 7.8 years; 9 males). The concentrations of LDL(-) in blood plasma [using an anti-LDL- human monoclonal antibody (mAb)] and the anti-LDL(-) IgG auto-antibodies were determined by ELISA. Calculation of body mass index (BMI) and measurements of waist circumference (WC), triceps skin folds (TSF) and arm muscle area (AMA) were performed. RESULTS The plasma alpha-tocopherol levels increased from 7.9 microM (0.32-18.4) to 14.2 microM (1.22-23.8) after the supplementation (P = 0.02). The mean concentration of LDL(-) was reduced from 570.9 microg/mL (225.6-1241.0) to 169.1 microg/mL (63.6-621.1) (P < 0.001). The anti-LDL(-) IgG auto-antibodies did not change significantly after the supplementation. The alpha-tocopherol supplementation also reduced the total cholesterol and LDL-C levels in these patients, from 176 +/- 42.3 mg/dL to 120 +/- 35.7 mg/dL (P < 0.05) and 115.5 +/- 21.4 mg/dL to 98.5 +/- 23.01 mg/dL (P < 0.001), respectively. CONCLUSION The oral administration of alpha-tocopherol in HD patients resulted in a significant decrease in the LDL(-), total cholesterol and LDL-C levels. This effect may favour a reduction in cardiovascular risk in these patients, but a larger study is required to confirm an effect in this clinical setting.
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Mafra D, Deleaval P, Teta D, Cleaud C, Perrot MJ, Rognon S, Thevenet M, Arkouche W, Jolivot A, Fouque D. New Measurements of Energy Expenditure and Physical Activity in Chronic Kidney Disease. J Ren Nutr 2009; 19:16-9. [DOI: 10.1053/j.jrn.2008.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Mafra D, Fouque D. How Is Body Mass Index Protective in Maintenance Dialysis? J Ren Nutr 2008; 18:255. [DOI: 10.1053/j.jrn.2008.03.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lobo J, Santos F, Grosso D, Lima R, Barreira A, Leite, Jr. M, Mafra D, Abdalla D. Electronegative LDL and Lipid Abnormalities in Patients Undergoing Hemodialysis and Peritoneal Dialysis. ACTA ACUST UNITED AC 2008; 108:c298-304. [DOI: 10.1159/000127982] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 12/28/2007] [Indexed: 11/19/2022]
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Mafra D, Guebre-Egziabher F, Fouque D. Body mass index, muscle and fat in chronic kidney disease: questions about survival. Nephrol Dial Transplant 2008; 23:2461-6. [DOI: 10.1093/ndt/gfn053] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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