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Okamura K, Tanaka S, Kitamura H, Hiyamuta H, Tsuruya K, Nakano T, Kitazono T. Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2024; 31:1072-1086. [PMID: 38267049 PMCID: PMC11224694 DOI: 10.5551/jat.64571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS Weight changes from a young age are known to be associated with poor life outcomes in the general population. However, little is known about the association between weight change from a young age and life expectancy in patients with chronic kidney disease (CKD). METHODS Data of 2,806 nondialysis CKD patients who participated in the Fukuoka Kidney Disease Registry (FKR) Study, a multicenter observational study, were analyzed. The primary outcome was all-cause death, whereas the secondary outcome was cardiovascular mortality. The covariate of interest was weight change, defined as the difference between body weight at study enrollment and at 20 years old. Cox proportional-hazards models were used to estimate the risks of mortality for participants with weight changes of ≥ 5 or <5 kg compared with those with stable weights. RESULTS During the 5-year observation period, 243 participants died from all causes and 62 from cardiovascular disease. The risk of all-cause mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.11; 95% confidence interval [CI], 1.52-2.93). Conversely, the risk of cardiovascular mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.48; 95% CI, 1.32-4.64). However, no significant association was observed between weight gain and the risks of all-cause and cardiovascular mortalities. CONCLUSION Weight loss from 20 years of age was found to be associated with higher risks of all-cause and cardiovascular mortalities in patients with CKD.
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Affiliation(s)
- Kazuhiro Okamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, Japan
| | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - for the Fukuoka Kidney Disease Registry (FKR) Study Collaboration Group
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
- Department of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, Japan
- Department of Nephrology, Nara Medical University, Nara, Japan
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Sato Y, Yoshihisa A, Nozaki Y, Ohara H, Sugawara Y, Abe S, Misaka T, Sato T, Oikawa M, Kobayashi A, Yamaki T, Nakazato K, Takeishi Y. Geriatric Nutritional Risk Index predicts bleeding event in patients with heart failure. ESC Heart Fail 2024; 11:702-708. [PMID: 38115750 DOI: 10.1002/ehf2.14631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS We aimed to elucidate the association between malnutrition and the occurrence of bleeding events in patients with heart failure. METHODS AND RESULTS We evaluated the nutritional status of patients with heart failure [n = 2044, median (inter-quartile range) age 69.0 (59.0-78.0) years, 1209 (59.1%) males] using the Geriatric Nutritional Risk Index (GNRI). The primary endpoint was a composite of bleeding events such as haemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut-off point of GNRI for predicting the primary endpoint was 106.2. We divided the patients into two groups based on GNRI levels: high GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and low GNRI group (GNRI < 106.2, n = 1438, 70.4%). We compared the patients' characteristics and prognosis between the two groups. The low GNRI group was older [72.0 (63.0-79.0) vs. 63.0 (53.0-73.0) years, P < 0.001] and had a lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001). There were no differences in the use of antiplatelet agents and anticoagulants between the two groups. Levels of B-type natriuretic peptide were higher [321.1 (123.3-667.4) vs. 111.6 (42.6-235.4) pg/mL, P < 0.001] and levels of haemoglobin were lower [12.4 (10.8-13.7) vs. 14.2 (12.9-15.4) g/dL, P < 0.001] in the low GNRI group. The Kaplan-Meier analysis demonstrated that bleeding event rates were higher in the low GNRI group (log-rank P < 0.001). The multivariable Cox proportional hazard analysis revealed that low GNRI (hazard ratio 1.952, 95% confidence interval 1.002-3.805, P = 0.049) was associated with bleeding events. CONCLUSIONS Heart failure patients with poor nutritional status, determined by GNRI under 106.2, experienced high bleeding event rates. Comprehensive management is required to avoid bleeding event in those populations.
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Affiliation(s)
- Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
- Department of Clinical Laboratory Sciences, Fukushima Medical University, Fukushima, Japan
| | - Yuji Nozaki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Himika Ohara
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yukiko Sugawara
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Abe
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan
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Zhou D, Yang H, Zeng L, Yang W, Guo F, Cui W, Chen C, Zhao J, Wu S, Yang N, Lin H, Yin A, Li L. Calculated inflammatory markers derived from complete blood count results, along with routine laboratory and clinical data, predict treatment failure of acute peritonitis in chronic peritoneal dialysis patients. Ren Fail 2023; 45:2179856. [PMID: 36908218 PMCID: PMC10013372 DOI: 10.1080/0886022x.2023.2179856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND & AIMS Complete blood count (CBC)-derived inflammatory markers are predictive biomarkers for the prognosis of many diseases. However, there was no study on patients with peritoneal dialysis-associated peritonitis (PDAP). We aimed to investigate the value of these markers in predicting treatment failure of acute peritonitis in chronic PD patients. METHODS The records of 138 peritonitis episodes were reviewed and divided into treatment success or failure groups in a single center for 10 years. CBC-derived markers and other routine data were recorded before peritonitis treatment was initiated. Univariate and multivariate regression analyses and the receiver operating characteristic (ROC) curve about the predictors of treatment outcomes were performed. RESULTS Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and derived NLR were significantly higher in the failure group. Univariate logistic regression results showed that NLR and PLR were risk factors of treatment outcomes. The backward stepwise multivariate logistic regression results demonstrated that NLR [adjusted odds ratio (aOR), 1.376; 95% confidence intervals (CI), 1.105-1.713; p = .004], PLR (aOR, 1.010; 95%CI, 1.004-1.017; p = .002) were risk factors, but hemoglobin-to-lymphocyte ratio (HLR) (aOR, 0.977; 95%CI, 0.963-0.991; p = .001), and SII (aOR, 0.999; 95%CI, 0.998-1.000; p = .040) were protective factors. A combination of age, PD vintage, Gram-positive peritonitis, staphylococcus aureus, culture-negative, NLR, PLR, HLR, and SII would improve prognostic performance. The area under this ROC curve was 0.85, higher than other factors. CONCLUSIONS NLR, PLR, HLR, and SII were associated with PDAP outcomes. Age, PD vintage, NLR, and PLR were significant risk factors in PDAP patients.
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Affiliation(s)
- Dan Zhou
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China.,College of Integrative Medicine, Dalian Medical University, Dalian, China.,Graduate School, Dalian Medical University, Dalian, China
| | - Huibin Yang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Li Zeng
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Wei Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Wenting Cui
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Chen
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jiayao Zhao
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ning Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Anchun Yin
- College of Integrative Medicine, Dalian Medical University, Dalian, China.,Graduate School, Dalian Medical University, Dalian, China.,First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Longkai Li
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Dou Y, Li A, Liu G, Wang P, Zhang B. Comparison of bioimpedance equations and dual-energy X-ray for assessment of fat free mass in a Chinese dialysis population. Ren Fail 2023; 45:2182131. [PMID: 36856322 PMCID: PMC10108741 DOI: 10.1080/0886022x.2023.2182131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Bioelectrical impedance analysis (BIA) is simple, noninvasive, inexpensive and frequently used for estimating fat free mass (FFM). The aims of this study were to evaluate the applicability of different BIA equations on FFM in Chinese subjects, and to compare the difference in hemodialysis and peritoneal dialysis patients with healthy controls respectively. METHODS Dialysis patients and healthy adults were enrolled in this study, and the subjects were matched by age, gender, and the minimum sample size in each group was calculated using PASS. FFM estimated by BIA was calculated using equations of Kyle, Sun SS and Segal, and TBW/0.73. Dual-energy X-ray absorptiometry (DXA) method was set as reference method. Pearson's correlation and Bland-Altman analysis were used to test the validity of the BIA equations. RESULTS 50 hemodialysis (HD) patients, 52 peritoneal dialysis (PD) patients and 30 healthy adults aged 22-67 y were included in this study. Age, height, weight, BMI and gender did not differ significantly among HD, PD patients, and healthy controls (p > 0.05), but BIA parameters were quite different (p<0.01). Bland-Altman analysis showed that in healthy volunteers, all equations showed good agreement with DXA measured. For dialysis patients, the FFM predictions of different equations showed differences between HD and PD patients, and the equations seemed more applicable for HD patients. CONCLUSION The equations developed by healthy subjects might be not appropriate for dialysis patients, especially peritoneal dialysis patients. It is recommended to develop a specific BIA equation from dialysis population.
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Affiliation(s)
- Yanna Dou
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Afang Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Gangrong Liu
- Department of Bone Mineral Density, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peipei Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bei Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Demirbaş S, Demirbaş ZA, Beyazal M, Kara E. The predictive value of temporal muscle thickness measured by ultrasonography for detecting moderate to severe malnutrition in chronic hemodialysis patients. Int Urol Nephrol 2023; 55:2877-2885. [PMID: 36995555 DOI: 10.1007/s11255-023-03577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION AND AIM To determine the predictive value of temporal muscle thickness (TMT) measured by ultrasonography in the diagnosing of moderate to severe malnutrition in chronic hemodialysis (CHD) patients. MATERIALS AND METHODS Adult patients (> 18 years) who had been on CHD for at least 3 months were included in this cross-sectional study. Patients with infection or inflammatory disease, malignancy, malabsorption syndrome, history of surgery within the last 3 months excluded. Demographic, anthropometric, laboratory parameters, and Malnutrition Inflammation Score (MIS) test results recorded. RESULTS A total of 60 chronic hemodialysis (CHD) patients (median age: 66 years, 46.7% female) and 30 healthy individuals (median age: 59.5 years, 55% female) were examined. While there were no significant difference between the dry weight (70 vs 71 kg) and body mass index (BMI) (25.8 vs 26 kg/m2) of the CHD patients and healthy control group, we found that triceps skinfold thickness (TST) (16 vs 19 mm) and left and right TMT (9.6 vs 10.7 and 9.8 vs 10.9 mm) values were significantly lower in the CHD patients (p < 0.001). CHD patients were divided into two groups according to their MIS values as mild (MIS < 6) and moderate/severe malnutrition (MIS ≥ 6). Patients with moderate/severe malnutrition were older, predominantly female and with longer HD vintage. Left (8.8 vs 11 mm) and right TMT (9.1 vs 11.2 mm) values were lower in moderate/severe malnutrition group. In the correlation analysis, a negative correlation was found between TMT and age and MIS, and a positive correlation determined with dry weight, BMI, TST and serum uric acid. In the ROC curve analysis, we found that the optimal cut-off value of left and right TMT for predicting moderate/severe malnutrition were 10.05 and 10.45 mm, respectively. Multivariate regression analysis showed that HD vintage, URR, and TMT values were independently associated with moderate/severe malnutrition. CONCLUSION TMT value measured by ultrasonography in CHD patients can be used as a reliable, easily accessible and non-invasive diagnostic method for predicting moderate/severe malnutrition.
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Affiliation(s)
- Sibel Demirbaş
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Zengin Aydın Demirbaş
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehmet Beyazal
- Faculty of Medicine, Department of Radiology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Ekrem Kara
- Faculty of Medicine, Department of Internal Medicine, Division of Nephrology, Recep Tayyip Erdogan University, Rize, Turkey.
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Ayer A, Banerjee U, Mills C, Donovan C, Nelson L, Shah SJ, Dubin RF. Left atrial strain is associated with adverse cardiovascular events in patients with end-stage renal disease: Findings from the Cardiac, Endothelial Function and Arterial Stiffness in ESRD (CERES) study. Hemodial Int 2022; 26:323-334. [PMID: 35388570 PMCID: PMC9262816 DOI: 10.1111/hdi.13008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 01/09/2023]
Abstract
Introduction We lack cardiovascular (CV) markers for patients with end‐stage renal disease (ESRD), and left atrial (LA) strain has not been studied definitively in this population. We examined associations of LA reservoir, conduit, and booster strain with major adverse cardiovascular events (MACE) among stable patients with ESRD on dialysis. Methods One hundred and ninety patients in the Cardiac, Endothelial and Arterial Stiffness in ESRD study underwent echocardiography, including strain imaging. The primary outcome was 2‐year composite non‐fatal MACE or CV death. We performed Cox proportional hazards regression for LA strain measures, adjusting for demographics, comorbidities, left ventricular global longitudinal strain (LV GLS), E/e′ and LA volume index. Findings Mean ± SD LA reservoir strain was 24.1 ± 7.0%, and LA conduit strain 11.9 ± 5.1%. In age‐adjusted analyses, lower LA reservoir strain and LA conduit strain were associated with the primary outcome (HR per 1‐SD worsening LA strain parameter = 1.57 [95% CI 1.2–2.1], p = 0.003 and 1.68 [95% CI 1.2–2.3], p = 0.002, respectively). After adjusting for comorbidities, LA reservoir strain remained associated with the primary outcome and with deaths alone, and LA conduit strain with the primary outcome and hospitalizations alone (p < 0.05 for all). Associations of LA conduit strain were independent of LV GLS. Associations were stronger in participants with serum albumin <3.6 mg/dl (p for interaction 0.008). Discussion Left atrial reservoir strain and conduit strain were independently associated with MACE among patients with ESRD. Our study provides unique ascertainment of CV hospitalizations not attributed to missed dialysis, and LA conduit strain was a strong marker for this outcome.
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Affiliation(s)
- Amrita Ayer
- Division of Nephrology, San Francisco VA Medical Center/University of California, San Francisco, California, USA
| | - Upasana Banerjee
- Division of Nephrology, San Francisco VA Medical Center/University of California, San Francisco, California, USA
| | - Claire Mills
- Center for Vascular Excellence, Division of Cardiology, San Francisco General Hospital/University of California, San Francisco, California, USA
| | - Catherine Donovan
- Center for Vascular Excellence, Division of Cardiology, San Francisco General Hospital/University of California, San Francisco, California, USA
| | - Lauren Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ruth F Dubin
- Division of Nephrology, San Francisco VA Medical Center/University of California, San Francisco, California, USA
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Cueto-Manzano AM, Romero-García AR, Cortés-Sanabria L, Márquez-Herrera RM, Martin-del-Campo F, Jacobo-Arias F, Pazarín-Villaseñor HL, Rojas-Campos E. Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis. Clin Nutr ESPEN 2022; 49:307-313. [DOI: 10.1016/j.clnesp.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/27/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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Fujioka H, Koike T, Imamura T, Tomoda F, Kakeshita K, Yamazaki H, Kinugawa K. Impact of Geriatric Nutritional Risk Index and Modified Creatinine Index Combination on Mortality in Hemodialysis Patients. Nutrients 2022; 14:nu14040801. [PMID: 35215451 PMCID: PMC8878210 DOI: 10.3390/nu14040801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/04/2022] Open
Abstract
The prognostic impact of the combination of a geriatric nutritional risk index (GRNI) and modified creatinine index, both of which assess nutritious status in hemodialysis patients, has not yet been well investigated thus far. Patients receiving maintenance hemodialysis in our institutes between February 2011 and January 2017 were retrospectively included. The baseline GRNI and modified Creatinine index were calculated and the impact of their combination on 5-year all-cause mortality following the index hemodialysis was investigated. A total of 183 patients (68.3 ± 12.4 years, 98 men, hemodialysis duration 97 ± 89 months) were followed from the index hemodialysis for 5.5 years. Mean GNRI was 91.2 and mean modified Creatinine index was 22.2 in men and 19.6 in women. The 5-year survival was significantly stratified by the median values of GNRI and modified Creatinine index (p < 0.05 for both). Patients with low GNRI and a low modified Creatinine index had lower 5-year survival than those with the other three combination patterns (p < 0.05). A combination of GNRI and modified Creatinine index may be a promising tool to risk stratify mortality in dialysis patients.
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Affiliation(s)
- Hayato Fujioka
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
| | - Tsutomu Koike
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
- Correspondence: ; Tel.: +81-76-434-2246
| | - Fumihiro Tomoda
- Faculty of Health Science, Fukui Health Science University, Fukui 910-3190, Japan;
| | - Kota Kakeshita
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
| | - Hidenori Yamazaki
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, Toyama University, Toyama 930-0194, Japan; (H.F.); (T.K.); (K.K.); (H.Y.); (K.K.)
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Yasar E, Tek NA, Tekbudak MY, Yurtdaş G, Gülbahar Ö, Uyar GÖ, Ural Z, Çelik ÖM, Erten Y. THE RELATIONSHIP BETWEEN MYOSTATIN, INFLAMMATORY MARKERS AND SARCOPENIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Ren Nutr 2022; 32:677-684. [PMID: 35122995 DOI: 10.1053/j.jrn.2022.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/20/2021] [Accepted: 01/01/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine the prevalence of sarcopenia in patients with chronic kidney disease (CKD), investigate the relationship of the serum myostatin level with sarcopenia and inflammatory markers. METHODS The study was conducted with four patient groups: renal transplantation (TX), stage 3-5 non-dialysis-dependent CKD (NDD-CKD), hemodialysis (HD), and peritoneal dialysis (PD). Laboratory parameters, serum myostatin, C-reactive protein, and interleukin-6 (IL-6) levels were studied. Body composition was estimated using a multifrequency bioimpedance analysis. Handgrip strength (HGS) was evaluated with a handgrip dynamometer. The HGS and appendicular skeletal muscle index (ASMI) measurements were used to determine sarcopenia presence. RESULTS The study included 130 patients [72(55%) males]. The patient distribution in groups was as follows: 37 in HD, 28 in PD, 37 in renal TX, and 28 in NDD-CKD. The highest level of myostatin was measured in the HD group and the lowest in the TX group (p<0.001). The HGS measurement was significantly lower only in the PD group compared to the TX group (p=0.025). The myostatin was negatively correlated with HGS, albumin, estimated glomerular filtration rate, and Kt/Vurea. However, myostatin had no correlation with inflammatory markers or ASMI. Sarcopenia was present in 37 (29%) of all patients: 15 (40%) in the HD group, nine (32%) in NDD-CKD, seven (25%) in PD, and six (16%) in TX. When the patients with and without sarcopenia were compared, only myostatin was higher in the former (p=0.045). As a result of multivariate analysis, myostatin was the only independent factor which predict sarcopenia (OR: 1.002, 95% CI:1.001-1.005, p=0.048). CONCLUSION To prevent devastating events associated with sarcopenia in patients with CKD, renal transplantation seems to be the best treatment solution. For the early recognition of sarcopenia, the measurement of the serum myostatin level may be a promising diagnostic approach.
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Affiliation(s)
- Emre Yasar
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey.
| | - Nilüfer Acar Tek
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | | | - Gamze Yurtdaş
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey; Izmir Katip Celebi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Izmir, Turkey
| | - Özlem Gülbahar
- Gazi University Faculty of Medicine, Department of Medical Biochemistry, Ankara, Turkey
| | - Gizem Özata Uyar
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Zeynep Ural
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey
| | - Özge Mengi Çelik
- Gazi University, Faculty of Health Sciences, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Yasemin Erten
- Gazi University, Faculty of Medicine, Department of Nephrology, Ankara, Turkey
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Elezi B, Topi S, Abazaj E. Profile of Obesity and Comorbidities and their Correlation among Hemodialysis Patients, Elbasan. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Nowadays, obesity is an enormous problem in the public health of undeveloped countries and developing countries. Being overweight, especially obesity in internal organs contributes to increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. There is no complete data available in our country on the correlation between obesity and comorbidity diseases among persons undergoing dialysis. So we do not know how BMI affects Diabetic or Cardio Vascular Disease (CVD) patients among dialysis patients. We, therefore, undertook this study to evaluate the association of obesity with mobility in hemodialysis patients at the Elbasan dialysis center.
METHODOLOGY: This cross-sectional study was performed in 160 patients who have undergone the dialysis process at Elbasan Dialysis Center for three years (2016-2018). A standardized questionnaire was adopted to obtain data from all patients. The subjects were divided a priory into 4 categories based on the body mass index (BMI) (underweight <19, normal 19-25, pre-obese 25-30 and obese ≥30 kg/m2). Software SPSS version 20.0 is used to analyze and evaluate the data. Kaplan-Meier estimate were used to find the correlation between BMI with their prognostic abilities like cardiovascular disease and Diabetes Mellitus Type 2. We have considered statistically significant every p value less than 0.05.
RESULT: Over all 160 patients, the men presented the highest number of cases compared to female 73.1% and 26.9% respectively. The mean age resulted 52.7 ± 15.6 years and age groups 50-59 years old and 60-69 years old with 29.4% and 34.3% respectively were the most frequent in this study. About the category of BMI index 8.8% patients resulted underweight, 45% were in normal weight, 28.2% were pre-obese and 6.6% were obese. We observed significant correlations between BMI and some of the demographic data such as: gender, age, place of residence, educational level, smoking and alcohol consumption for p <0.05. Changes in patient survival rates between BMI with DMT2 and cardiovascular disease are not statistically significant (long range p> 0.05). In terms of mortality, a strong significant correlation was observed with the age of 50-69 years and with the index of hemoglobin, urea and creatinine after dialysis with p value <0.05.
CONCLUSION: In the paradoxical epidemiology, the overweight becomes chronic on hemodialysis patients and serves as a protective factor which is associated with better survival, but we weren`t found significant association between the BMI and some of the variables analyzed. This study presents a small number of chronic patients on hemodialysis center in Elbasan city. There is a need to better understand the reverse epidemiological causes in individuals on dialysis, which can help us improve the poor outcome in this population.
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Wang J, Luo P, Yang Y, Lin Z, Wen Z, Li Y, Huang Y, Yang S, Lu Y, Kong Y, Zhao Y, Wan Q, Wang Q, Huang S, Liu Y, Liu A, Liu F, Hou F, Qin X, Liang M. Dietary protein intake and the risk of all-cause and cardiovascular mortality in maintenance hemodialysis patients: A multicenter, prospective cohort study. Nutrition 2021; 95:111564. [PMID: 35032733 DOI: 10.1016/j.nut.2021.111564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The association between dietary protein intake (DPI) and mortality in people receiving maintenance hemodialysis (MHD) remains uncertain. We aimed to explore the relationship of DPI with all-cause and cardiovascular (CV) mortality, and to examine the possible modifiers for the associations, in Chinese MHD patients. METHODS This multicenter prospective cohort study was conducted in eight outpatient dialysis centers in South China. We enrolled 1044 MHD patients in 2014 and 2015. The DPI was assessed using a 3-d 24-h dietary recall. Using Cox proportional hazard models, we estimated the hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) for all analyzed end points. RESULTS During a median follow-up of 45 mo, there were 354 (33.9%) deaths, 210 of which were CV related. Compared with patients with a DPI of 1.0 to < 1.4 g/kg ideal body weight (IBW)/d, a significantly higher risk of all-cause mortality was found in those with a DPI < 1.0 g/kg IBW/d (adjusted HR, 1.84; 95% CI, 1.42-2.38) or ≥ 1.4 g/kg IBW/d (adjusted HR, 1.49; 95% CI, 1.00-2.22). Similar trends were found for CV mortality. Moreover, we found a significantly stronger positive association between DPI (≥ 1.4 versus 1.0 to < 1.4 g/kg IBW/d) and all-cause mortality in women (adjusted HR, 2.05; 95% CI, 1.00-4.22) than in men (adjusted HR, 0.89; 95% CI, 0.49-1.63; P for interaction = 0.0487). CONCLUSION In Chinese MHD patients, a DPI of 1.0 to < 1.4 g/kg IBW/d was associated with lower risks of all-cause and CV mortality.
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Affiliation(s)
- Jieyu Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pei Luo
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaya Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Wen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenglin Yang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongxin Lu
- People's Hospital of Yuxi City, Yuxi, China
| | - Yaozhong Kong
- The First People's Hospital of Foshan, Foshan, China
| | | | - Qijun Wan
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Wang
- Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Sheng Huang
- Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yan Liu
- Nephrology Department, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, China
| | - Aiqun Liu
- The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fanna Liu
- Jinan University First Affiliated Hospital, Guangzhou, China
| | - FanFan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Renal Division, Guangdong Provincial Key Laboratory of Renal Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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12
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Yang Y, Xu Y, Zhang P, Zhou H, Yang M, Xiang L. Predictive Value of Objective Nutritional Indexes in Technique Failure in Peritoneal Dialysis Patients. J Ren Nutr 2021; 32:605-612. [PMID: 34776339 DOI: 10.1053/j.jrn.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Patients undergoing peritoneal dialysis (PD) will encounter with a well-recognized challenge of technique failure (TF). We aimed to explore the predictive value of objective nutritional indexes in PD TF. METHODS This retrospective observational study included PD patients from August 2010 to March 2019. The Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI) were calculated at baseline. TF was defined as a permanent switch from PD to hemodialysis. Univariate and multivariate Cox regression was performed to investigate the association between confounding factors and outcomes. The optimal cut-off values were determined using receiver operating characteristic curve analysis. We used the Kaplan-Meier curve to compare the outcomes according to the cut-off values. The area under the curve (AUC) was used to test discriminative power of these objective nutritional indexes. RESULTS We analyzed 276 PD patients, 84 (30.43%) experienced TF during 2.5 (1.4, 4.0) years of follow-up. In the Kaplan-Meier analysis, patients with a higher CONUT score (>3), lower GNRI (≤85.77), and lower PNI (≤40.2) had significantly higher risk of TF (38.2% vs. 18.9%, P = .011; 39.6% vs. 25.1%, P = .043; 35.9% vs. 17.9%, P = .022; respectively). After adjusting confounding factors, a high CONUT score and low PNI were independently and significantly associated with TF analyzed by a multivariate Cox regression model (hazard ratio 2.284, 95% confidence interval [CI] 1.248-4.179, P = .007; hazard ratio 2.070, 95% CI 1.233-3.475, P = .006; respectively). The largest AUC to predict TF was PNI (AUC 0.600, 95% CI 0.539-0.658), followed by CONUT score (AUC 0.596, 95% CI 0.535-0.654) and GNRI (AUC 0.572, 95% CI 0.511-0.631). CONCLUSIONS The CONUT score and PNI are independently associated with TF in PD patients. Moreover, assessment of PNI and the CONUT score may provide more useful predictive values than GNRI.
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Affiliation(s)
- Yan Yang
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yuanyuan Xu
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Pei Zhang
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hua Zhou
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Min Yang
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Li Xiang
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Betzler BK, Sultana R, Banu R, Tham YC, Lim CC, Wang YX, Nangia V, Tai ES, Rim TH, Bikbov MM, Jonas JB, Cheng CY, Sabanayagam C. Association between Body Mass Index and Chronic Kidney Disease in Asian Populations: A Participant-level Meta-Analysis. Maturitas 2021; 154:46-54. [PMID: 34736579 DOI: 10.1016/j.maturitas.2021.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 12/31/2022]
Abstract
Obesity and chronic kidney disease (CKD) are major public health problems worldwide. However, the association between body mass index (BMI) and CKD is inconclusive in Asians. In this meta-analysis, eight population-based studies, from China, India, Russia (Asian), Singapore and South Korea, provided individual-level data (n=50037). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. BMI was analyzed both as a continuous variable and in three categories: <25kg/m2, normal; 25-29.9kg/m2, overweight; and ≥30kg/m2, obese. The association between BMI and CKD was evaluated in each study using multivariable logistic regression models and individual estimates were pooled using random-effect meta-analysis to obtain the pooled odds ratio (OR) and 95% confidence interval (CI). Associations were also evaluated in subgroups of age, gender, smoking, diabetes, and hypertension status. Of 50037 adults, 4258 (8.5%) had CKD. 13328 (26.6%) individuals were overweight while 4440 (8.9%) were obese. The prevalence of any CKD ranged from 3.5% to 29.1% across studies. In pooled analysis, both overweight and obesity were associated with increased odds of CKD, with pooled OR (95% CI) of 1.15 (1.03-1.29) and 1.23 (1.06-1.42), respectively. In subgroup analyses, significant associations between BMI and CKD were observed in adult males, non-smokers, and those with diabetes and arterial hypertension (all p<0.05). When evaluated as a continuous variable, BMI was not significantly associated with CKD. If confirmed in longitudinal studies, these results may have clinical implications in risk stratification and preventive measures, given that obesity and CKD are two major chronic diseases with substantial public health burden worldwide.
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Affiliation(s)
- Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Riswana Banu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | | | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Jost B Jonas
- Beijing Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Ufa Eye Research Institute, Ufa, Russia; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Switzerland
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.
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ALATAŞ H, YILDIRAN H, YALÇIN A. Hemodiyaliz tedavisi alan hastalarda besin alımı ile malnütrisyon inflamasyon skoru arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.794910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Ieiri N, Hotta O. A case of autosomal dominant polycystic kidney disease with amelioration of refractory cyst infections following prolonged hemodialysis time. CEN Case Rep 2021; 10:598-602. [PMID: 34138451 PMCID: PMC8494846 DOI: 10.1007/s13730-021-00614-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/08/2021] [Indexed: 11/30/2022] Open
Abstract
Renal cyst infection is a frequent and serious problem in patients with autosomal dominant polycystic kidney disease (ADPKD). Cyst infection is often a refractory complication of treatment that leads to sepsis and death in patients with ADPKD. It was previously reported that a higher dose of dialysis demonstrated clearly better survival than shorten-time dialysis. The relationship between the frequency of cyst infection episodes in hemodialysis (HD) patients with ADPKD and the dialysis dose has not yet been fully elucidated. In this report, we describe a case of an HD patient with ADPKD that was provided elongation of HD time from 4-h twice weekly HD to 8-h thrice weekly nocturnal HD. As a result, the frequency of cyst infection episodes decreased from 10.0 to 1.5 days a month. Our findings suggest that prolonged HD time might contribute to amelioration of refractory cyst infections in patients with ADPKD.
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Affiliation(s)
- Norio Ieiri
- Division of Internal Medicine, Hotta Osamu Clinic, Rokuchounomeminamimach 2-39, Wakabayashi-ku, Sendai, Miyagi, 984-0013, Japan.
| | - Osamu Hotta
- Division of Internal Medicine, Hotta Osamu Clinic, Rokuchounomeminamimach 2-39, Wakabayashi-ku, Sendai, Miyagi, 984-0013, Japan.,Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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16
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Tinti F, Lai S, Noce A, Rotondi S, Marrone G, Mazzaferro S, Di Daniele N, Mitterhofer AP. Chronic Kidney Disease as a Systemic Inflammatory Syndrome: Update on Mechanisms Involved and Potential Treatment. Life (Basel) 2021; 11:419. [PMID: 34063052 PMCID: PMC8147921 DOI: 10.3390/life11050419] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is characterized by manifestations and symptoms involving systemic organs and apparatus, associated with elevated cardiovascular morbidity and mortality, bone disease, and other tissue involvement. Arterial hypertension (AH), diabetes mellitus (DM), and dyslipidemia, with glomerular or congenital diseases, are the traditional risk factors recognized as the main causes of progressive kidney dysfunction evolving into uremia. Acute kidney injury (AKI) has recently been considered an additional risk factor for the worsening of CKD or the development of CKD de novo. Evidence underlies the role of systemic inflammation as a linking factor between AKI and CKD, recognizing the role of inflammation in AKI evolution to CKD. Moreover, abnormal increases in oxidative stress (OS) and inflammatory status in CKD seem to exert an important pathogenetic role, with significant involvement in the clinical management of this condition. With our revision, we want to focus on and update the inflammatory mechanisms responsible for the pathologic conditions associated with CKD, with particular attention on the development of AKI and AKI-CKD de novo, the alteration of calcium-phosphorus metabolism with bone disease and CKD-MBD syndrome, the status of malnutrition and malnutrition-inflammation complex syndrome (MICS) and protein-energy wasting (PEW), uremic sarcopenia, the status of OS, and the different inflammatory pathways, highlighting a new approach to CKD. The depth comprehension of the mechanisms underlying the development of inflammation in CKD may present new possible therapeutic approaches in CKD and hopefully improve the management of correlated morbidities and provide a reduction in associated mortality.
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Affiliation(s)
- Francesca Tinti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy; (S.L.); (S.R.); (S.M.)
| | - Silvia Lai
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy; (S.L.); (S.R.); (S.M.)
| | - Annalisa Noce
- Department of Systems Medicine, Nephrology and Dialysis Unit, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (A.N.); (G.M.); (N.D.D.)
| | - Silverio Rotondi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy; (S.L.); (S.R.); (S.M.)
| | - Giulia Marrone
- Department of Systems Medicine, Nephrology and Dialysis Unit, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (A.N.); (G.M.); (N.D.D.)
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy
| | - Sandro Mazzaferro
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale dell’Università 37, 00185 Rome, Italy; (S.L.); (S.R.); (S.M.)
| | - Nicola Di Daniele
- Department of Systems Medicine, Nephrology and Dialysis Unit, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (A.N.); (G.M.); (N.D.D.)
| | - Anna Paola Mitterhofer
- Department of Systems Medicine, Nephrology and Dialysis Unit, University of Rome Tor Vergata, via Montpellier 1, 00133 Rome, Italy; (A.N.); (G.M.); (N.D.D.)
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Zhang J, Lu X, Li H, Wang S. Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis. Ren Fail 2021; 43:743-753. [PMID: 33913381 PMCID: PMC8901278 DOI: 10.1080/0886022x.2021.1918558] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim Inconsistent investigations of the risk factors for all-cause mortality in patients undergoing peritoneal dialysis (PD) were reported. The present meta-analysis aimed to assess the impact of some clinical characteristics on the risk of mortality in PD patients. Methods PubMed and Embase were systematically searched for studies evaluating the risk factors for all-cause mortality in PD patients. Hazard ratio (HR) and 95% confidence interval (CI) were derived using a random-effect or fixed-effect model considering the heterogeneity across studies. Result A total of 26 studies were included in this meta-analysis in accordance with the inclusion and exclusion criteria. Age, primary cardiovascular diseases, diabetes mellitus, and high level of alkaline phosphatase showed significant positive associations with elevated risk of all-cause and cardiovascular mortality in PD patients, while hemoglobin acted as a benefit factor. Furthermore, early onset of peritonitis, high peritoneal transport status, elevated body mass index and high-sensitivity C-reactive protein could also considerably increase the risk of all-cause mortality. The absolute serum level of magnesium, potassium, and uric acid required to improve survival in PD patients should be verified further. Conclusions Multiple factors could affect the risk of mortality in PD patients.
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Affiliation(s)
- Jialing Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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18
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Tsuneyoshi S, Matsukuma Y, Kawai Y, Hiyamuta H, Yamada S, Kitamura H, Tanaka S, Taniguchi M, Tsuruya K, Nakano T, Kitazono T. Association between geriatric nutritional risk index and stroke risk in hemodialysis patients: 10-Years outcome of the Q-Cohort study. Atherosclerosis 2021; 323:30-36. [PMID: 33773162 DOI: 10.1016/j.atherosclerosis.2021.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUNDS AND AIMS The geriatric nutritional risk index (GNRI), which is calculated using the serum albumin level and body mass index, is a nutritional marker associated with an increased risk of cardiovascular events in patients who are receiving hemodialysis. However, no studies have examined the association between the GNRI level and the incidence of stroke in this population. METHODS Three thousand forty-five patients were registered in the Q-Cohort Study, which is a multicenter, observational cohort of hemodialysis patients. The main outcomes were brain infarction and brain hemorrhage. The main exposure was GNRI levels at baseline. Patients were divided into quartiles on the basis of baseline GNRI levels: Q1, <90.7; Q2, 90.7-95.5; Q3, 95.6-99.8; Q4, >99.8. The risk of brain infarction or hemorrhage was estimated using the multivariable-adjusted Cox proportional hazard risk models and restricted cubic spline analyses. RESULTS During the 10-year follow-up period, 326 patients developed brain infarction and 149 patients developed brain hemorrhage. Cox proportional hazard risk models showed that the risk of brain infarction and hemorrhage in Q1 was significantly higher than that in Q4 group. The hazard ratios [95% confidence intervals] were 1.49 [1.05-2.12] and 1.89 [1.11-3.20], respectively. Restricted cubic spline curves showed that a lower GNRI was incrementally associated with an increased risk for both brain infarction and brain hemorrhage. CONCLUSIONS Our results suggest that a lower GNRI is an independent risk factor for both brain infarction and hemorrhage in patients who are receiving maintenance hemodialysis.
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Affiliation(s)
- Shoji Tsuneyoshi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Kawai
- Department of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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19
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Boonyakrai C, Kanjanabuch T, Puapatanakul P, Halue G, Johnson DW, Lorvinitnun P, Tangjittrong K, Kittiskulnam P, Pongpirul K, Bieber B, Tungsanga K. Association between self-reported appetite and clinical outcomes of peritoneal dialysis patients: Findings from a low middle-income country. Nephrology (Carlton) 2021; 26:454-462. [PMID: 33550668 DOI: 10.1111/nep.13859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/29/2020] [Accepted: 01/28/2021] [Indexed: 11/26/2022]
Abstract
AIM Patient-reported outcome measures (PROM) has gained international recognition as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand the associations between patient-reported appetite and clinical outcomes. METHODS In the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS), 690 of 848 randomly selected PD patients from 22 facilities reported their appetite by using the short form (three items) of the Appetite and Diet Assessment Tool (ADAT), between 2016 and 2018. In this questionnaire, the patients rated their appetite as well as a change in appetite over time. Cox proportional hazards model regression was used to estimating associations between self-reported appetite and clinical outcomes, including mortality, haemodialysis (HD) transfer and peritonitis. RESULTS Half of the PD patients reported a good appetite, whereas 34% and 16% reported fair and poor appetites, respectively. Poor appetite was more prevalent among female, diabetic, congestive heart failure, older age and patients who had worse nutritional indicators, including lower time-averaged serum albumin and serum creatinine concentrations, as well as a higher proportions of hypokalaemia and severe hypoalbuminemia (serum albumin <3 g/dl). After adjusting for age, sex, comorbidities, and PD vintage, poor appetite was associated with increased risks of peritonitis (adjusted hazard ratio [HR] 1.73, 95% confidence interval [CI] 1.14-2.62), HD transfer (adjusted HR 2.25, 95% CI 1.24-4.10) and all-cause mortality (adjusted HR 1.60, 95% CI 1.08-2.39) compared to patients with good appetite. CONCLUSION Patient-reported poor appetite was independently associated with higher risks of peritonitis, HD transfer and all-cause mortality. This warrants further investigation to identify effective interventions.
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Affiliation(s)
- Chanchana Boonyakrai
- Department of Medicine, Taksin Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pongpratch Puapatanakul
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.,Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Guttiga Halue
- Department of Medicine, Phayao Hospital, Phayao, Thailand
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Pichet Lorvinitnun
- Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Kittisak Tangjittrong
- Division of Nephrology, Department of Internal Medicine, Pranangklao Hospital, Nonthaburi, Thailand
| | - Piyawan Kittiskulnam
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
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20
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Kalantar-Zadeh K, Ficociello LH, Bazzanella J, Mullon C, Anger MS. Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis. Int J Nephrol Renovasc Dis 2021; 14:11-21. [PMID: 33505168 PMCID: PMC7829597 DOI: 10.2147/ijnrd.s291348] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
Hypoalbuminemia results when compensatory mechanisms are unable to keep pace with derangements in catabolism/loss and/or decreased synthesis of albumin. Across many disease states, including chronic kidney disease (CKD), hypoalbuminemia is a well-established, independent risk factor for adverse outcomes, including mortality. In the setting of CKD, reduced serum albumin concentrations are often a manifestation of protein-energy wasting, a state of metabolic and nutritional alterations resulting in reduced protein and energy stores. The progression of CKD to kidney failure and the initiation of maintenance hemodialysis (HD) further predisposes an already at-risk population toward hypoalbuminemia such that approximately 60% of HD patients have albumin concentrations <4.0 g/dl. Albumin loss into the dialysate through the dialyzer appears to be a potentially modifiable cause of hypoalbuminemia in some patients. A group of newer dialyzers for maintenance HD-sometimes termed protein-leaking or medium cut-off membranes-aim to improve clearance of middle molecules (vs high flux dialyzers) but are associated with increased albumin losses. In this article, we will examine the impact of dialyzer selection on albumin losses during conventional HD, including the clinical relevance of such losses on serum albumin levels. Data on the clinical relevance of albumin losses during dialysis and current gaps in the evidence base are also discussed.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California, Irvine, School of Medicine, Orange, CA, USA
- Department of Epidemiology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Los Angeles Biomedical Research Institute at Harbor–UCLA, Torrance, CA, USA
| | | | | | - Claudy Mullon
- Fresenius Medical Care Renal Therapies Group, Waltham, MA, USA
| | - Michael S Anger
- Fresenius Medical Care Renal Therapies Group, Waltham, MA, USA
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21
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Alcalde-Estévez E, Sosa P, Asenjo-Bueno A, Plaza P, Olmos G, Naves-Díaz M, Rodríguez-Puyol D, López-Ongil S, Ruiz-Torres MP. Uraemic toxins impair skeletal muscle regeneration by inhibiting myoblast proliferation, reducing myogenic differentiation, and promoting muscular fibrosis. Sci Rep 2021; 11:512. [PMID: 33436654 PMCID: PMC7804102 DOI: 10.1038/s41598-020-79186-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/04/2020] [Indexed: 01/29/2023] Open
Abstract
Uraemic toxins increase in serum parallel to a decline in the glomerular filtration rate and the development of sarcopenia in patients with chronic kidney disease (CKD). This study analyses the role of uraemic toxins in sarcopenia at different stages of CKD, evaluating changes in the muscular regeneration process. Cultured C2C12 cells were incubated with a combination of indoxyl sulphate and p-cresol at high doses (100 µg/mL) or low doses (25 µg/mL and 10 µg/mL) resembling late or early CKD stages, respectively. Cell proliferation (analysed by scratch assays and flow cytometry) was inhibited only by high doses of uraemic toxins, which inactivated the cdc2-cyclin B complex, inhibiting mitosis and inducing apoptosis (analysed by annexin V staining). By contrast, low doses of uraemic toxins did not affect proliferation, but reduced myogenic differentiation, primed with 2% horse serum, by inhibiting myogenin expression and promoting fibro-adipogenic differentiation. Finally, to assess the in vivo relevance of these results, studies were performed in gastrocnemii from uraemic rats, which showed higher collagen expression and lower myosin heavy chain expression than those from healthy rats. In conclusion, uraemic toxins impair the skeletal muscular regeneration process, even at low concentrations, suggesting that sarcopenia can progress from the early stages of CKD.
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Affiliation(s)
- Elena Alcalde-Estévez
- grid.7159.a0000 0004 1937 0239Departamento de Biología de Sistemas, Facultad de Medicina Y Ciencias de La Salud, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid, Spain
| | - Patricia Sosa
- grid.7159.a0000 0004 1937 0239Departamento de Biología de Sistemas, Facultad de Medicina Y Ciencias de La Salud, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid, Spain
| | - Ana Asenjo-Bueno
- grid.411336.20000 0004 1765 5855Unidad de Investigación de La Fundación Para La Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Patricia Plaza
- grid.411336.20000 0004 1765 5855Unidad de Investigación de La Fundación Para La Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Gemma Olmos
- grid.7159.a0000 0004 1937 0239Departamento de Biología de Sistemas, Facultad de Medicina Y Ciencias de La Salud, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid, Spain ,Instituto Reina Sofía de Investigación Nefrológica, IRSIN, Madrid, Spain ,grid.420232.50000 0004 7643 3507Area 3-Fisiología y Fisiopatología Renal Y Vascular del IRYCIS, Madrid, Spain
| | - Manuel Naves-Díaz
- Unidad de Gestión Clínica de Metabolismo Óseo. Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Diego Rodríguez-Puyol
- Instituto Reina Sofía de Investigación Nefrológica, IRSIN, Madrid, Spain ,grid.420232.50000 0004 7643 3507Area 3-Fisiología y Fisiopatología Renal Y Vascular del IRYCIS, Madrid, Spain ,grid.411336.20000 0004 1765 5855Departamento de Medicina Y Especialidades Médicas, Universidad de Alcalá Y Servicio de Nefrología del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Susana López-Ongil
- grid.411336.20000 0004 1765 5855Unidad de Investigación de La Fundación Para La Investigación Biomédica del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain ,Instituto Reina Sofía de Investigación Nefrológica, IRSIN, Madrid, Spain ,grid.420232.50000 0004 7643 3507Area 3-Fisiología y Fisiopatología Renal Y Vascular del IRYCIS, Madrid, Spain
| | - María P. Ruiz-Torres
- grid.7159.a0000 0004 1937 0239Departamento de Biología de Sistemas, Facultad de Medicina Y Ciencias de La Salud, Universidad de Alcalá, 28871 Alcalá de Henares, Madrid, Spain ,Instituto Reina Sofía de Investigación Nefrológica, IRSIN, Madrid, Spain ,grid.420232.50000 0004 7643 3507Area 3-Fisiología y Fisiopatología Renal Y Vascular del IRYCIS, Madrid, Spain
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22
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Onishi T, Nakano Y, Hirano KI, Nagasawa Y, Niwa T, Tajima A, Ishii H, Takahashi H, Sakurai S, Ando H, Takashima H, Amano T. Prevalence and clinical outcomes of triglyceride deposit cardiomyovasculopathy among haemodialysis patients. Heart 2021; 107:127-134. [PMID: 32998957 PMCID: PMC7788260 DOI: 10.1136/heartjnl-2020-317672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the effect of triglyceride deposit cardiomyovasculopathy (TGCV) on the cardiovascular outcomes in haemodialysis (HD) patients with suspected coronary artery disease (CAD). METHODS This retrospective single-centre observational study included data from the cardiac catheter database of Narita Memorial Hospital between April 2011 and March 2017. Among 654 consecutive patients on HD, the data for 83 patients with suspected CAD who underwent both [123I]-β-methyl-iodophenyl-pentadecanoic acid scintigraphy and coronary angiography were analysed. Patients were divided into three groups: definite TGCV (17 patients), probable TGCV (22 patients) and non-TGCV control group (44 patients). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke assessed for up to 5 years of follow-up. RESULTS The prevalence of definite TGCV was approximately 20% and 2.6% among consecutive HD patients with suspected CAD and among all HD patients, respectively. At the end of the median follow-up period of 4.7 years, the primary endpoint was achieved in 52.9% of the definite TGCV patients (HR, 7.45; 95% CI: 2.28 to 24.3; p<0.001) and 27.3% of the probable TGCV patients (HR, 3.28; 95% CI: 0.93 to 11.6; p=0.066), compared with that in 9.1% of the non-TGCV control patients. Definite TGCV was significantly and independently associated with cardiovascular mortality and outcomes among HD patients in all multivariate models. CONCLUSIONS TGCV is not uncommon in HD patients and is associated with an increased risk of cardiovascular events including cardiovascular death. Thus, TGCV might be a potential therapeutic target.
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Affiliation(s)
- Tomohiro Onishi
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Ken-Ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yasuyuki Nagasawa
- Department of Internal Medicine, Division of Cardiology, Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toru Niwa
- Narita Memorial Hospital, Toyohashi, Japan
| | | | - Hideki Ishii
- Department of Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | | | | | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
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23
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Arhuidese IJ, Holscher CM, Elemuo C, Parkerson GR, Johnson BL, Malas MB. Impact of Body Mass Index on Outcomes of Autogenous Fistulas for Hemodialysis Access. Ann Vasc Surg 2020; 68:192-200. [DOI: 10.1016/j.avsg.2020.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
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24
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Srivastava A, Bodnar J, Osman F, Jorgenson MR, Astor BC, Mandelbrot DA, Parajuli S. Serum Albumin Level Before Kidney Transplant Predicts Post-transplant BK and Possibly Cytomegalovirus Infection. Kidney Int Rep 2020; 5:2228-2237. [PMID: 33305116 PMCID: PMC7710825 DOI: 10.1016/j.ekir.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Opportunistic viral infections cause extensive morbidity and mortality in kidney transplant recipients (KTRs). Low serum albumin levels before and after transplant have been associated with negative outcomes. However, it is uncertain whether serum albumin levels before transplantation are associated with the risk for post-transplantation opportunistic BK polyomavirus (BKV) or cytomegalovirus (CMV). Methods We reviewed all KTRs transplanted at our institution between 1 January 2005 and 31 December 2015 with serum albumin measured within 45 days before transplantation in a retrospective observational cohort study. Selected patients were stratified into 3 groups: normal albuminemia (≥3.5 g/dl), moderate hypoalbuminemia (3.49–2.5 g/dl), and severe hypoalbuminemia (<2.5 g/dl). Patients were observed for post-transplantation BKV or CMV according to standard of care. Results We included 1717 patients in this study; 72.3% had normal serum albumin, 26.3% had moderate hypoalbuminemia, and 1.5% had severe hypoalbuminemia. Moderate and severe hypoalbuminemia incurred a higher risk for BKV compared with normal serum albumin levels in univariable analysis (moderate hypoalbuminemia: hazard ratio [HR] = 1.5; 95% confidence interval [CI], 1.14–1.90; P = .003); severe hypoalbuminemia: HR = 2.15; 95% CI, 1.01–4.56; P = 0.05). Although not significant after multivariable adjustment, there was still 18% increased risk in moderate hypoalbuminemia and 64% in severe hypoalbuminemia for BKV compared with the normal albumin group. Moderate hypoalbuminemia was associated with a higher risk for CMV infection than normal serum albumin levels in multivariable analysis, although it was not statistically significant (HR = 1.15; 95% CI, 0.36–3.64; P = 0.81). Conclusions These findings suggest that pretransplantation hypoalbuminemia is associated with a higher risk for post-transplantation BKV and possibly CMV. More intense screening is warranted for these viruses in recipients with pretransplant hypoalbuminemia.
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Affiliation(s)
- Aniruddha Srivastava
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Joshua Bodnar
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fauzia Osman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Margaret R Jorgenson
- Department of Pharmacy, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Brad C Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,Department of Population Health Sciences Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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25
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Vanden Wyngaert K, Celie B, Calders P, Eloot S, Holvoet E, Van Biesen W, Van Craenenbroeck AH. Markers of protein-energy wasting and physical performance in haemodialysis patients: A cross-sectional study. PLoS One 2020; 15:e0236816. [PMID: 32730305 PMCID: PMC7392314 DOI: 10.1371/journal.pone.0236816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Bert Celie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
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26
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Kumada Y, Ishii H, Oshima S, Ito R, Umemoto N, Takahashi H, Murohara T. Association of protein-energy wasting and inflammation status with mortality after coronary revascularisation in patients on haemodialysis. Open Heart 2020; 7:e001276. [PMID: 32709700 PMCID: PMC7380732 DOI: 10.1136/openhrt-2020-001276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Protein-energy wasting is associated with chronic inflammation and advanced atherosclerosis in haemodialysis (HD) patients. We investigated association of geriatric nutritional risk index (GNRI), C reactive protein (CRP) with prediction of mortality after coronary revascularisation in chronic HD patients. METHODS We enrolled 721 HD patients electively undergoing coronary revascularisation. They were divided into tertiles according to preprocedural GNRI levels (tertile 1 (T1):<91.5, T2: 91.5-98.1 and T3:>98.1) and CRP levels (T1:≤1.4 mg/L, T2: 1.5-7.0 mg/L and T3:≥7.1 mg/L). RESULTS Kaplan-Meier 10 years survival rates were 32.3%, 44.8% and 72.5% in T1, T2 and T3 of GNRI and 60.9%, 49.2% and 23.5% in T1, T2 and T3 of CRP, respectively (p<0.0001 in both). Declined GNRI (HR 2.40, 95% CI 1.58 to 3.74, p<0.0001 for T1 vs T3) and elevated CRP (HR 2.31, 95% CI 1.58 to 3.43, p<0.0001 for T3 vs T1) were identified as independent predictors of mortality. In combined setting of both variables, risk of mortality was 5.55 times higher (95% CI 2.64 to 13.6, p<0.0001) in T1 of GNRI with T3 of CRP than in T3 of GNRI with T1 of CRP. Addition of GNRI and CRP in a model with established risk factors improved C-statistics (0.648 to 0.724, p<0.0001) greater than that of each alone. CONCLUSION Preprocedural declined GNRI and elevated CRP were closely associated with mortality after coronary revascularisation in chronic HD patients. Furthermore, combination of both variables not only stratified risk of mortality but also improved the predictability.
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Affiliation(s)
- Yoshitaka Kumada
- Cardiovascular Surgery, Matsunami General Hospital, Hashima-gun, Gifu, Japan
| | - Hideki Ishii
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Cardiology, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Satoru Oshima
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Ryuta Ito
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Norio Umemoto
- Cardiology, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | | | - Toyoaki Murohara
- Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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27
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Zhang Q, Zhang J, Zhang W, Wang M, Huang B, Zhang M, Chen J. Risk factors for decreased upper-limb muscle strength and its impact on survival in maintenance hemodialysis patients. Int Urol Nephrol 2020; 52:1143-1153. [PMID: 32367337 DOI: 10.1007/s11255-020-02468-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Protein-energy wasting, characterized by decreased muscle mass, is one of the strongest predictors of mortality in patients on maintenance hemodialysis (MHD). As people get older, their muscle strength usually declines faster than muscle mass. However, the association between lower-limb muscle strength and all-cause mortality remains unclear. We aimed to evaluate risk factors for decreased upper-limb muscle strength in MHD patients and its impact on patient survival. METHODS The cross-sectional part of the study included 174 MHD patients. Subsequently, they were followed up for 52 weeks. Biceps muscle strength, anthropometry, body composition, dietary intake, daily steps, and biochemical indicators of malnutrition and inflammation were evaluated. Risk factors for muscle weakness were screened by multiple linear regression analysis, and patient survival was analyzed by Kaplan-Merier and Cox multivariate analysis. RESULTS The 174 MHD patients (93 men; 63.05 ± 12.29 years) were classified as a young (< 65 years, n = 97) group and an elderly group (≥ 65 years, n = 77). Gender, daily steps, muscle mass, 25(OH)D level and IL-6 in young group, and muscle mass, 25(OH)D, daily steps, and NT-proBNP in elderly group were associated with the decreased biceps muscle strength. The survival rate in high muscle strength group was significantly higher than that in low muscle strength group (P = 0.002). The association between low muscle strength and high mortality risk remained strong in the fully adjusted model. CONCLUSION Risk factors of muscle weakness were different between young and elderly MHD patients. There was a strong correlation between strong biceps muscle strength and high patient survival.
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Affiliation(s)
- Qian Zhang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Jiaying Zhang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Weichen Zhang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Mengjing Wang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Bihong Huang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Minmin Zhang
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China
| | - Jing Chen
- Division of Nephrology, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Road, Shanghai, 200040, China.
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28
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Lee YL, Jin H, Lim JY, Lee SY. Relationship Between Low Handgrip Strength and Chronic Kidney Disease: KNHANES 2014-2017. J Ren Nutr 2020; 31:57-63. [PMID: 32381354 DOI: 10.1053/j.jrn.2020.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/16/2020] [Accepted: 03/12/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Accelerated loss of muscle mass is common in patients with chronic kidney disease (CKD). Various factors associated with CKD, such as nutritional deficiencies, metabolic acidosis, and chronic inflammation, contribute to muscle wasting. This study aimed to investigate the relationship between CKD and handgrip strength (HGS) in the Korean population. DESIGN AND METHODS This is a population-based, cross-sectional study of a nationally representative sample of 18,765 patients aged ≥19 years from the Korea National Health and Nutrition Examination Survey in 2014-2017. We measured HGS using a digital hand dynamometer and determined the cutoff for low HGS by deriving -2 standard deviation values of sex-matched healthy young adults (19-39 years old). We defined CKD as eGFR <60 mL/min/1.73 m2 or the presence of CKD based on a self-reported questionnaire. RESULTS The prevalence of CKD was 4.0% in the total population. The cutoff values for the low HGS were 29.5 kg for men and 16.8 kg for women. The prevalence of low HGS was 6.2% in patients without CKD, and 25.2% in patients with CKD. There was a significant correlation between HGS and eGFR in both men and women. In multivariate logistic regression adjusted by age group, diabetes, hypertension, and obesity, CKD showed an independent relationship with low HGS in both men (odds ratio [OR] 1.910, 95% confidence interval [CI] 1.468-2.485) and women (OR 1.570, 95% CI 1.202-2.052). CONCLUSIONS The prevalence of low HGS was higher in patients with CKD. We suggest that the sarcopenia should be evaluated in patients with CKD.
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Affiliation(s)
- Yae Lim Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heejin Jin
- Medical Research Collaborating Center, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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Afşar B, Sezer S, Ozdemir FN, Celik H, Elsurer R, Haberal M. Malnutrition–Inflammation Score is a Useful Tool in Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080602600616] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundMalnutrition–Inflammation Score (MIS) is a quantitative assessment tool based on Subjective Global Assessment (SGA) and predicts mortality and morbidity in maintenance hemodialysis patients. However, there are not enough data about the use of MIS in peritoneal dialysis (PD). In this study, relationships between MIS and prospective hospitalization indices, risk of developing peritonitis, anemia indices, and laboratory and anthropometric parameters were analyzed and compared with SGA in PD.Methods50 PD patients (M/F 26/24, age 45.2 ± 14.9 years, mean PD duration 30.8 ± 23.1 months) were included. The same physician performed the SGA and MIS evaluations. Clinical, laboratory, and anthropometric parameters were measured.Results18 patients were classified as SGA-A (without malnutrition), 24 as SGA-B (with moderate malnutrition), and 8 as SGA-C (with severe malnutrition). Increment in MIS was concordant with SGA groups A to C ( p < 0.0001). Peritonitis rate, number of hospitalizations, total number of hospitalization days, erythropoietin requirements, C-reactive protein (CRP), and ferritin levels were positively correlated with MIS ( p < 0.0001). Midarm muscle circumference ( p = 0.04), albumin ( p < 0.0001), prealbumin ( p = 0.001), creatinine ( p = 0.04), hemoglobin ( p = 0.003), transferrin ( p < 0.0001), and cholesterol ( p = 0.009) were negatively correlated with MIS. Correlation coefficients of hospitalization indices, peritonitis rate, anemia indices, erythropoietin requirements, albumin, prealbumin, CRP, and anthropometric parameters were higher with MIS than with SGA. In logistic regression analysis, a higher MIS was independently associated with a higher risk of future hospitalization ( p = 0.029, odds ratio 2.14, confidence interval 1.082 – 4.146).ConclusionsThis study demonstrated that MIS significantly correlated with clinical, nutritional, inflammatory, and anthropometric parameters and anemia indices in PD patients, and that those correlations were stronger than those with SGA.
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Affiliation(s)
- Bariş Afşar
- Department of Nephrology Baskent University Hospital, Ankara, Turkey
| | - Siren Sezer
- Department of Nephrology Baskent University Hospital, Ankara, Turkey
| | | | - Huseyin Celik
- Department of Nephrology Baskent University Hospital, Ankara, Turkey
| | - Rengin Elsurer
- Department of Nephrology Baskent University Hospital, Ankara, Turkey
| | - Mehmet Haberal
- Department of General Surgery, Baskent University Hospital, Ankara, Turkey
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Arase H, Yamada S, Hiyamuta H, Taniguchi M, Tokumoto M, Tsuruya K, Nakano T, Kitazono T. Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-Cohort Study. Sci Rep 2020; 10:1241. [PMID: 31988325 PMCID: PMC6985259 DOI: 10.1038/s41598-020-58181-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/13/2020] [Indexed: 12/23/2022] Open
Abstract
Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients. It remains unknown whether the modified Cr index predicts infection-related mortality in this population. We investigated the association between the modified Cr index and infection-related mortality. A total of 3046 patients registered in the Q-Cohort Study, a multicenter, observational study of HD patients, were analyzed. Associations between sex-specific quartiles (Q1–Q4) of the modified Cr index and the risk for infection-related mortality were analyzed by Cox proportional hazard model. During a median follow-up of 8.8 years, 387 patients died of infection. The estimated risk for infection-related mortality was significantly higher in the lower quartiles (Q1, Q2, and Q3) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals [CI]: Q1, 2.89 [1.70–5.06], Q2, 2.76 [1.72–4.62], and Q3, 1.79 [1.12–2.99]). The hazard ratio (95% CI) for a 1 mg/kg/day decrease in the modified Cr index was 1.18 (1.09–1.27, P < 0.01) for infection-related mortality. In conclusion, a lower modified Cr index is associated with an increased risk for long-term infection-related mortality in the HD population.
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Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Safety of radiotherapy for hemodialysis patients with cancer. Int J Clin Oncol 2020; 25:978-983. [PMID: 31965416 DOI: 10.1007/s10147-020-01621-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The number of hemodialysis (HD) patients is increasing worldwide, and they are at a higher risk of cancer than the general population. Because HD patients are more likely to have inflammation, radiotherapy (RT)-induced adverse effects (AEs) are theoretically expected to be worse for HD patients. Since only a few reports have been published on this subject, we aimed to evaluate the tolerability of RT in HD patients. METHODS We retrospectively analyzed AEs related to RT for HD patients. Our study included patients from three institutions treated between January 2007 and July 2017. The patient eligibility criteria were (i) receipt of maintenance HD 2-3 times per week for end-stage renal disease prior to the start of RT and (ii) pathologically confirmed malignancies. The endpoints were acute and late non-hematologic AEs. RESULTS The study included 56 patients. The most common histology was head and neck cancer (23%), followed by lung cancer (14%) and prostate cancer (11%). The median radiation dose was 60 (range, 12-93.8) Gy at an equivalent dose in 2-Gy fractions (EQD2). The RT completion rate was 96%. Patients had a median follow-up period after RT of 9.1 (range 0.5-98.1) months. Grade 3 or worse acute and late AEs were noted in 6 (11%) and 3 (7%) patients, respectively. In the acute phase, 2 patients had grade 5 AEs, both of which were infections. CONCLUSION Our results suggest that RT for HD patients is clinically tolerable. However, some patients can experience severe infections related to treatment.
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Fatonah S, Sulchan M, Sofro MAU. Macronutrients, micronutrients intake and inflammation in hemodialysis patients. POTRAVINARSTVO 2019. [DOI: 10.5219/1193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Inflammation in hemodialysis patients occurs since before undergoing hemodialysis. Inflammation is associated with an increase in oxidative stress. Hemodialysis patients are at risk for macronutrients and micronutrients deficiencies which can influence the increase in oxidative stress and inflammation. The purpose of this study was to evaluate the intake of micronutrients and inflammatory status in hemodialysis patients. This study was a cross-sectional study with 76 hemodialysis patients (40 male and 36 female) who attended in two hemodialysis centers of Kendal, Indonesia. After obtaining the written consent, then patients were interviewed food intake consisting of macronutrient and micronutrient intake. Macronutrient and micronutrient intake are obtained by the semi quantitative food frequency method and classified as a deficit (<100% adequacy level) and normal/ more (≥100% adequacy level), according to specific recommendations for individuals undergoing dialysis. Serum albumin was examined using the Brom Cresol Purple (BCP) method with a low category (<3.5 mg.dL-1) and normal (3.5 – 4.5 mg.dL-1). The hs-CRP serum was examined using the ELISA method and categorized as low (<1 mg.L-1), moderate (1 – 3 mg.L-1) and high (> 3 mg.L-1). A descriptive analysis was performed. The results of this study showed that 88.2% deficit energy intake, 84.2% deficit protein intake, 85.5% deficit of vitamin A intake, 85.5% deficit of vitamin C intake, 100% deficit of vitamin E intake, 98, 7% deficit zinc intake , 92.1% deficit copper intake. 63.2% subjects are low level of serum albumin and 61.8% subjects is high level of hs-CRP serum. Macronutrient and micronutrient intake in most hemodialysis patients shows deficit. The serum albumin of most hemodialysis patients shows low level. Serum hs-CRP most hemodialysis patients show high level.
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Yuan Y, Hu JW, Wang Y, Wang KK, Zheng WL, Chu C, Ma Q, Yan Y, Liao YY, Mu JJ. Association between atherogenic index of plasma and subclinical renal damage over a 12-year follow-up: Hanzhong adolescent hypertension study. Eur J Clin Nutr 2019; 74:278-284. [DOI: 10.1038/s41430-019-0530-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
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Hishida M, Imaizumi T, Nishiyama T, Okazaki M, Kaihan AB, Kato S, Kubo Y, Ando M, Kaneda H, Maruyama S. Survival Benefit of Maintained or Increased Body Mass Index in Patients Undergoing Extended-Hours Hemodialysis Without Dietary Restrictions. J Ren Nutr 2019; 30:154-162. [PMID: 31401040 DOI: 10.1053/j.jrn.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/16/2019] [Accepted: 06/02/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Low body mass index (BMI) is a potential risk factor for mortality in patients on maintenance hemodialysis. This suggests the usefulness of BMI as a prognostic factor and implies the importance of nutritional status, inflammation, and oxidative stress, all of which affect BMI. We aimed to evaluate BMI changes over time and the mortality risk in patients undergoing a novel combination therapy consisting of an extended-hours hemodialysis protocol without dietary restrictions, which enabled sufficient nutrition. DESIGN AND METHODS This is a retrospective cohort study. Patients were divided into 2 groups based on BMI change (ΔBMI < 0, ΔBMI ≥ 0) between the 3rd and 12th month after transfer to the clinic. We studied the associations of BMI changes with all-cause mortality. Further subgroup analyses were performed using Cox models. We finally studied 187 patients who were receiving the combined therapy. The main outcome measure was all-cause mortality of the study group. RESULTS The median (interquartile range) follow-up time was 4.9 (3.0-8.6) years. Overall, 138 patients were in the ΔBMI ≥ 0 group. As per unadjusted and adjusted Cox models, maintained or increased BMI during this period was associated with hazard ratios of 0.45 (confidence interval 0.23-0.87, P < .05) and 0.35 (confidence interval 0.17-0.75, P < .01) for all-cause mortality, respectively. In the same group, maintained or increased BMI was found to be significantly associated with decreased mortality in female, older, and nondiabetic patients. The data indicated that diabetic status could have a modifying effect on the association between variation in BMI and mortality (P = .006). CONCLUSIONS Extended-hours hemodialysis without dietary restrictions led to a beneficial effect of maintenance or increase in BMI, especially in females, patients aged ≥65 years, and those without diabetic nephropathy, which could lead to prolonged survival.
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Affiliation(s)
- Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Takahiro Imaizumi
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Toshiro Nishiyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Masaki Okazaki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Ahmad Baseer Kaihan
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Yoko Kubo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Masahiko Ando
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Hiroshi Kaneda
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Kamome Clinic, Ibaraki, Japan.
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Zhang H, Tao Y, Wang Z, Lu J. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore) 2019; 98:e16713. [PMID: 31441844 PMCID: PMC6716681 DOI: 10.1097/md.0000000000016713] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the nutritional status of children with chronic kidney disease (CKD) before dialysis via a series of indexes, and investigate the prognostic impact of nutritional status in these patients assessed by the Prognostic Nutritional Index (PNI).Fifty-four children with CKD before dialysis were enrolled in this study. The nutritional status was evaluated by different indexes, including dietary intake, anthropometry data and biochemical parameters. Additionally, PNI is calculated as 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (/mm). Glomerular filtration rate (GFR) of patients with different PNI scores was followed up.Thirty-four patients (63.0%) experienced unreasonable dietary intake, and the patients with CKD stage 4 were characterized by lower energy intake. The height was the most affected anthropometry parameter. Additionally, 46 patients (85.2%) suffered from anemia. The serum albumin of 42 patients (77.8%) was <35 g/L, while 34 cases (63.0%) had increased cholesterol and triglyceride. According to the PNI scores, the patients were divided into 3 groups: high-PNI (PNI ≥ 38), middle-PNI (35 ≤ PNI < 38), and low-PNI (PNI < 35). Of the 54 patients, the PNI was <35 in 29 (53.7%) and ≥38 in 13 (24.1%). The patients with CKD stage 4 were belonged to the low-PNI group. At follow-up, GFR decreased significantly in patients with low-PNI scores compared with the high-PNI group (P < .05).Malnutrition, as a common complication of CKD, has a prognostic impact in children with CKD before dialysis, as assessed by the PNI score.
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Affiliation(s)
- Hui Zhang
- Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yuhong Tao
- Department of Pediatrics, West China Second University Hospital of Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Zheng Wang
- Department of Pediatrics, West China Second University Hospital of Sichuan University
| | - Jing Lu
- Department of Pediatrics, West China Second University Hospital of Sichuan University
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Kim JK, Kim SG, Oh JE, Lee YK, Noh JW, Kim HJ, Song YR. Impact of sarcopenia on long-term mortality and cardiovascular events in patients undergoing hemodialysis. Korean J Intern Med 2019; 34:599-607. [PMID: 29161801 PMCID: PMC6506738 DOI: 10.3904/kjim.2017.083] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS A high body mass index (BMI) is known to correlate with better survival in patients on hemodialysis (HD). However, the impacts of body composition and sarcopenia on survival have not been well studied in this population. METHODS One hundred and forty-two prevalent HD patients were recruited and followed prospectively for up to 4.5 years. Low muscle mass (measured using a portable, whole-body, bioimpedance spectroscopic device) was defined as a lean tissue index (LTI) two standard deviations (SD) or more below the normal gender-specific mean for young people. Low muscle strength was a handgrip strength (HGS) of less than 30 kg in males and less than 20 kg in females. Sarcopenia was considered present when both LTI and HGS were reduced. RESULTS The mean age was 59.8 ± 13.1 years; 57.0% were male and 47.2% had diabetes. Forty-seven patients (33.1%) had sarcopenia. During follow-up, 28 patients (19.7%) died, and low LTI (adjusted hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.10 to 6.97) and low HGS (HR 5.65; 95% CI, 1.99 to 16.04) were independently associated with mortality. Sarcopenia was a significant predictor for death (HR, 6.99; 95% CI, 1.84 to 26.58; p = 0.004) and cardiovascular events (HR, 4.33; 95% CI, 1.51 to 12.43; p = 0.006). CONCLUSION Sarcopenia was strongly associated with long-term mortality and cardiovascular events in HD patients. Assessment of muscle strength and muscle mass may provide additional prognostic information to survival in patients with end-stage renal disease.
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Affiliation(s)
- Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Young Rim Song, M.D. Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-3720 Fax: +82-31-386-2269 E-mail:
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Demir NA, Sumer S, Celik G, Afsar RE, Demir LS, Ural O. How should procalcitonin and C-reactive protein levels be interpreted in haemodialysis patients? Intern Med J 2019; 48:1222-1228. [PMID: 29717808 DOI: 10.1111/imj.13952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Procalcitonin (PCT) and C-reactive protein (CRP) are used most widely in the diagnosis/treatment of bacterial infections. These are not infection-specific and may also show increases in other inflammation-causing cases. AIM To establish a new cut-off value for PCT and CRP to eliminate confusion in the diagnosis and treatment of bacterial infections in haemodialysis (HD) patients. METHODS A total of 1110 patients, 802 with undocumented infection and 308 with documented infection, was included in the study. RESULTS A total of 802 patients with undocumented infection had a mean CRP value of 12.2 ± 9.6 mg/dL and a mean PCT value of 0.51 ± 0.96 ng/mL and the 308 patients with documented infection had a mean CRP value of 125.9 ± 83.3 mg/dL and a mean PCT value of 13.9 ± 26.9 ng/mL at the time of admittance. In HD patients, the cut-off values for CRP was determined as 19.15 mg/dL and for PCT as 0.685 ng/mL in the presence of infection. The use of these two parameters in combination (CRP ≥19.15 mg/dL and PCT ≥ 0.685 ng/mL) was found to have 95% positive predictive value (PPV) and 93% negative predictive value (NPV) for the diagnosis of infectious diseases in HD patients. When CRP ≥100 mg/dL and PCT ≥5 ng/mL, this was found to have 100% PPV and 94% NPV for the diagnosis of sepsis in HD patients. CONCLUSION We specified PCT and CRP cut-off values with high PPV and NPV for revealing the presence of bacterial infection and sepsis in HD patients.
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Affiliation(s)
- Nazlim A Demir
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Sua Sumer
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Gulperi Celik
- Department of Internal Medicine, Division of Nephrology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Rengin E Afsar
- Department of Internal Medicine, Division of Nephrology, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey
| | - Lutfi S Demir
- Department of Public Health, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Onur Ural
- Department of Infectious Disease and Clinical Microbiology, Selcuk University Faculty of Medicine, Konya, Turkey
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Katalinic L, Premuzic V, Basic-Jukic N, Barisic I, Jelakovic B. Hypoproteinemia as a factor in assessing malnutrition and predicting survival on hemodialysis. J Artif Organs 2019; 22:230-236. [PMID: 30852693 DOI: 10.1007/s10047-019-01098-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 02/20/2019] [Indexed: 10/27/2022]
Abstract
Series of studies have described malnutrition as one of the main non-traditional risk factors associated with poor prognosis and treatment outcome in patients on hemodialysis (HD). The aims of this study were to evaluate the link between HD treatment quality and the nutritional status and to additionally investigate the association of malnutrition and overall survival. A total of 134 adult out-patients (56.4% male, mean age 60.8 ± 16.15 years) were enrolled in the study. Clinical and laboratory data were obtained from the medical records. Anthropometric measurements were performed prior to HD. Malnutrition-Inflammation Score (MIS) was used as a scoring system representing the severity of protein-energy wasting (PEW). Malnourished patients were significantly older when compared to non-malnourished patients. They had significantly longer dialysis vintage and lower residual diuresis, BMI, serum proteins, and albumins and lean tissue index (LTI). Malnourished patients survived significantly shorter than non-malnourished patients. Hypoproteinemic patients had significantly lower values of serum albumins and LTI and survived shorter than normoproteinemic patients. Only malnourishment and age were associated with higher overall mortality in all groups of patients. By focusing on MIS and serum protein status rather than dialysis-related factors and different treatment techniques, we could accomplish better nutrition status and improved overall outcomes. While anticipating new and more effective measures for preventing malnutrition, our results clearly demonstrate that striving for the highest possible nutrition status should be one of the key strategies in improving the outcomes in this specific group of patients.
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Affiliation(s)
- Lea Katalinic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | - Vedran Premuzic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia.
| | - Nikolina Basic-Jukic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | - Ivan Barisic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
| | - Bojan Jelakovic
- Department of Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Kispaticeva 12, 10 000, Zagreb, Croatia
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Hsiung JT, Kleine CE, Naderi N, Park C, Soohoo M, Moradi H, Rhee CM, Obi Y, Kopple JD, Kovesdy CP, Kalantar-Zadeh K, Streja E. Association of Pre-End-Stage Renal Disease Serum Albumin With Post-End-Stage Renal Disease Outcomes Among Patients Transitioning to Dialysis. J Ren Nutr 2019; 29:310-321. [PMID: 30642656 DOI: 10.1053/j.jrn.2018.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/23/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Serum albumin is a marker of malnutrition and inflammation and has been demonstrated as a strong predictor of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. Yet, whether serum albumin levels in late-stage CKD are associated with adverse outcomes after the transition to ESRD is unknown. We hypothesize that lower levels and a decline in serum albumin in late-stage CKD are associated with higher risk of mortality and hospitalization rates 1 year after transition to ESRD. DESIGN AND METHODS This retrospective cohort study included 29,124 US veterans with advanced CKD transitioning to ESRD between 2007 and 2015. We evaluated the association of pre-ESRD (91 days before transition) serum albumin with 12-month post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates as well as the association of 1-year pre-ESRD albumin slope and 12-month post-ESRD mortality using hierarchical multivariable adjustments. RESULTS There was a negative linear association between serum albumin and all-cause mortality, such that risk doubled (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.87, 2.28) for patients with the lowest serum albumin <2.8 g/dL (ref: ≥4.0 g/dL) after full adjustment. A consistent relationship was observed between serum albumin and cardiovascular and infection-related mortality, and hospitalization outcomes. An increase in serum albumin of >0.25 g/dL/year was associated with reduced mortality risk (HR: 0.76, 95% CI: 0.63, 0.91) compared with a slight decline in albumin (ref: >-0.25 to 0 g/dL/year), whereas a decline more than 0.5 g/dL/year was associated with a 55% higher risk in mortality (HR: 1.55, 95% CI: 1.43, 1.68) in fully adjusted models. CONCLUSIONS Lower pre-ESRD serum albumin was associated with higher post-ESRD all-cause, cardiovascular, and infection-related mortalities and hospitalization rates. Declining serum albumin levels in the pre-ESRD period were also associated with worse 12-month post-ESRD mortality.
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Affiliation(s)
- Jui-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California
| | - Carola-Ellen Kleine
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California
| | - Neda Naderi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Department of Internal Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Christina Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California
| | - Joel D Kopple
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California; UCLA Fielding School of Public Health, Los Angeles, California
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine, School of Medicine, Orange, California; Nephrology Section, Tibor Rubin VA Medical Center, Long Beach, California.
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Ko YE, Yun T, Lee HA, Kim SJ, Kang DH, Choi KB, Kim YS, Kim YL, Oh HJ, Ryu DR. Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients. Sci Rep 2018; 8:17846. [PMID: 30552374 PMCID: PMC6294808 DOI: 10.1038/s41598-018-35967-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 11/09/2018] [Indexed: 01/03/2023] Open
Abstract
Although subjective global assessment (SGA) is a widely used representative tool for nutritional investigations even among dialysis patients, no studies have examined gender-specific differences in the ability of SGA to predict mortality in hemodialysis (HD) patients. A total of 2,798 dialysis patients were enrolled from clinical research center for end-stage renal disease (CRC for ESRD) between 2009 and 2015. The cohort was divided into two groups based on nutritional status as evaluated by SGA: 'good nutrition' and 'mild to severe malnutrition'. Multivariate Cox proportional regression analyses were performed to investigate gender-specific differences in SGA for mortality among incident and prevalent HD patients. 'Mild to severe malnutrition' was significantly correlated with increased mortality compared with 'good nutrition' for all HD, incident and prevalent HD patients. Compared with 'good nutrition', 'mild to severe malnutrition' was also more significantly associated with increased mortality in male patients in the incident and prevalent HD groups. However, no significant associations between nutritional status evaluated by SGA and mortality were observed for female patients. SGA of HD patients can be useful for predicting mortality, especially in male HD patients. However, SGA alone might not reflect adverse outcomes in female patients.
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Affiliation(s)
- Ye Eun Ko
- Ewha Womans University, College of Medicine, Seoul, Korea
| | - Taeyoung Yun
- Ewha Womans University, College of Medicine, Seoul, Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Duk-Hee Kang
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University of Medicine, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyung Jung Oh
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea. .,Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Korea. .,Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea. .,Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea. .,Research Institute for Human Health Information, Ewha Womans University Mokdong Hospital, Seoul, Korea. .,Tissue Injury Defense Research Center, Ewha Womans University, Seoul, Korea.
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Jagdale A, Cooper DKC, Iwase H, Gaston RS. Chronic dialysis in patients with end-stage renal disease: Relevance to kidney xenotransplantation. Xenotransplantation 2018; 26:e12471. [PMID: 30456901 DOI: 10.1111/xen.12471] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
Abstract
Renal allotransplantation clearly offers better survival and quality of life for end-stage renal disease (ESRD) patients than chronic dialysis. The median waiting time for a deceased donor kidney in a suitable ESRD patient is 3.9 years. The initial candidates for pig kidney xenotransplantation will be those with ESRD unlikely to receive an allograft within a reasonable period of time. It is thus reasonable to ascertain whether clinical trials of xenotransplantation might likewise offer superior outcomes. Chronic dialysis in patients with ESRD is associated with poor quality of life, significant morbidity, and relatively high mortality, with only 56% surviving 3 years and 42% at 5 years. However, a significant number of these patients, because of comorbidities, frailty, etc, would not be considered for renal allotransplantation and likely not for xenotransplantation. As genetically engineered pig kidneys have satisfactorily supported life in immunosuppressed nonhuman primates for many months or even more than a year, consideration in carefully selected patients could be given to pig kidney xenotransplantation. We suggest that, in order to give a patient the best possible outcome, the pig kidney could be transplanted pre-emptively (before dialysis is initiated). If it fails at any stage, the patient would then begin chronic dialysis and continue to await an allograft. The present (limited) evidence is that failure of a pig graft would not be detrimental to a subsequent allograft.
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Affiliation(s)
- Abhijit Jagdale
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - David K C Cooper
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hayato Iwase
- Department of Surgery, Xenotransplantation Program, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert S Gaston
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Leptin and ghrelin in chronic kidney disease: their associations with protein-energy wasting. Pediatr Nephrol 2018; 33:2113-2122. [PMID: 29980850 DOI: 10.1007/s00467-018-4002-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/22/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study aimed to evaluate plasma concentrations of leptin and total ghrelin in children with chronic kidney disease (CKD) and assess their roles in protein-energy wasting (PEW). METHODS This study consisted of three different CKD populations [CKD group (20 patients with non-dialysis CKD), dialysis group (39 patients on dialysis), and kidney transplant (KTx) group (35 KTx recipients)] and control group (18 healthy children). Plasma leptin and total ghrelin levels were measured. Multi-frequency bioimpedance analysis was used for the assessment of fat and lean mass. PEW was defined using criteria including body mass, muscle mass, growth, serum albumin level, and protein intake. RESULTS While plasma leptin levels did not differ among the study groups, total ghrelin levels were significantly higher in the dialysis group (P < 0.001). Seven dialysis patients (18%) and one CKD patient (5%) but none of the KTx recipients met the criteria of PEW. Dialysis patients with PEW had lower plasma leptin levels compared to their counterparts (P = 0.018); however, total ghrelin levels did not differ between the two groups (P = 0.10). Low leptin level in dialysis patients was independently associated with lower fat mass index (P < 0.001) and lower height-specific SD scores of BMI (P = 0.019). CONCLUSIONS PEW is prevalent in dialysis patients. Low levels of leptin seem to be associated with PEW. Our result suggests that low leptin levels may be a consequence rather than a cause of PEW. Longitudinal studies are required to investigate this complex relationship between leptin and PEW in pediatric dialysis patients.
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Golestaneh L, Bellin E, Neugarten J, Lo Y. Avoidable visits to the emergency department(ED) and their association with sex, age and race in a cohort of low socio-economic status patients on hemodialysis in the Bronx. PLoS One 2018; 13:e0202697. [PMID: 30142175 PMCID: PMC6108498 DOI: 10.1371/journal.pone.0202697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/06/2018] [Indexed: 12/26/2022] Open
Abstract
Background In national samples drawn from the USRDS, female patients utilize the hospital ED and inpatient services at a higher rate than their male counterparts and have a higher rate of re-hospitalization. We wanted to explore the association of sex with avoidable ED visits made by a cohort of patients on hemodialysis in a mostly minority, lower socioeconomic status (SES), population in the Bronx to test the applicability of the USRDS findings. Methods We used Montefiore’s clinical database to build a cohort of patients on hemodialysis with a first ED visit between 2013 and 2017. All ED visits after the index ED visit and those within one year prior to the index visit were recorded. None of the ED visits resulted in a hospitalization and were thus labeled “avoidable”. Bivariate analysis tested the association of demographic and clinical variables with sex. We used negative binomial regression to test the association of each variable with avoidable ED visit count. The multivariate model used negative binomial regression with avoidable ED visit count as outcome and sex as the exposure variable and included ancestral variables age and race. Potential mediators were added to the model to measure their effects on the association of sex with avoidable ED visits. Results Four thousand six hundred and seventy three subjects on hemodialysis were identified as having at least one avoidable ED visit, in the period of 2013–2017 at one of four ED sites affiliated with Montefiore Medical Center in the Bronx. Over 5 years (2012–2017), the median number of ED visits made by the study sample was 4 (25–75% IQR: 2–8). Female patients on hemodialysis in our cohort were older, more commonly black, had lower SES scores, less commonly had commercial insurance and were less commonly married than their male counterparts. Female sex was not significantly associated with a higher rate of avoidable ED visits in the total cohort.(1.053(0.99–1.12) Female sex was significantly associated with outcome in non-Hispanic whites only and in those subjects younger than 44 years old.(IRR 1.30(1.06–1.69), 1.17(1.00–1.38) in non-Hispanic White and younger age group, respectively.) Marital status, SES and hemoglobin levels possibly mediated the association of sex and outcome in our population. (>25% change in the coefficient for sex with respect to outcome when variable added to the model). Conclusion In this single center study of a lower-socioeconomic status, mostly minority dialysis population, the association of female sex with avoidable ED visits was not significant. These results suggest the association of sex with hospitalization outcomes, described by national datasets that determine quality indicators, are not consistent across different types of populations with some mediation possible by SES and marital status in poorer neighborhoods.
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Affiliation(s)
- Ladan Golestaneh
- Department of Medicine, Renal Division, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
- * E-mail:
| | - Eran Bellin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Joel Neugarten
- Department of Medicine, Renal Division, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
| | - Yungtai Lo
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, United States of America
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Uchiumi N, Sakuma K, Sato S, Matsumoto Y, Kobayashi H, Toriyabe K, Hayashi K, Kawasaki T, Watanabe T, Itohisa A, Yokota M, Okazawa K, Murotani N. The clinical evaluation of novel polymethyl methacrylate membrane with a modified membrane surface: a multicenter pilot study. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0170-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Choi MS, Kistler B, Wiese GN, Stremke ER, Wright AJ, Moorthi RN, Moe SM, Hill Gallant KM. Pilot Study of the Effects of High-Protein Meals During Hemodialysis on Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis. J Ren Nutr 2018; 29:102-111. [PMID: 30107974 DOI: 10.1053/j.jrn.2018.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/11/2018] [Accepted: 06/08/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Patients undergoing hemodialysis (HD) have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of HD treatment; but eating during HD may be discouraged because of concerns of postprandial hypotension. However, little data are available to support this practice. In this study, we hypothesized that high-protein meals during HD do not lead to symptomatic intradialytic hypotension events. DESIGN A 9-week, nonrandomized, parallel-arm study. SETTING A single in-center HD clinic. SUBJECTS Eighteen patients undergoing HD from 2 shifts completed the study. Patients were aged 62 ± 16 years with dialysis vintage of 3.4 ± 2.6 years. INTERVENTION Patients in the intervention group (n = 9) undergoing HD received meals of ∼30 g protein and ∼1/3 daily recommended intakes of sodium, potassium, phosphorus, and fluid during dialysis for 25 consecutive HD sessions. The control group (n = 9) completed all aspects of the study including a visit by study personnel but were not given meals. The 25 consecutive sessions before the start of the intervention/control phase were used as a baseline comparison for each patient. MAIN OUTCOME MEASURE Symptomatic hypotension event frequency. RESULTS In the intervention arm, there were 19 symptomatic hypotension events in 5 patients prestudy and 18 events in 6 patients during the study. In the control arm, there were 16 events in 7 patients prestudy and 13 events in 7 patients during the study. Change in the frequency of symptomatic hypotension events from prestudy to during study was not different between groups (P = .71). There was no effect of meals on nutritional status, but patients reported positive attitudes toward receiving meals during dialysis. CONCLUSION High-protein meals during HD did not increase symptomatic hypotension events. Larger, longer term studies are needed to confirm these results and evaluate whether high-protein meals on dialysis benefit nutritional status and clinical outcomes.
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Affiliation(s)
- Mun Sun Choi
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Brandon Kistler
- Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
| | - Gretchen N Wiese
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | | | - Amy J Wright
- Indiana Clinical and Translational Science Institute, Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Ranjani N Moorthi
- Department of Medicine/Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sharon M Moe
- Department of Medicine/Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana; Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
| | - Kathleen M Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana; Department of Medicine/Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana.
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Abd El Basset Bakr AM, Hasaneen BM, AbdelRasoul Helal Bassiouni D. Assessment of Nutritional Status in Children With Chronic Kidney Disease Using Hand Grip Strength Tool. J Ren Nutr 2018; 28:265-269. [DOI: 10.1053/j.jrn.2017.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 01/04/2023] Open
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Arase H, Yamada S, Yotsueda R, Taniguchi M, Yoshida H, Tokumoto M, Nakano T, Tsuruya K, Kitazono T. Modified creatinine index and risk for cardiovascular events and all-cause mortality in patients undergoing hemodialysis: The Q-Cohort study. Atherosclerosis 2018; 275:115-123. [PMID: 29890446 DOI: 10.1016/j.atherosclerosis.2018.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr levels, and Kt/V for urea, reflects skeletal muscle mass in patients on hemodialysis. Whether the modified Cr index is associated with cardiovascular events and all-cause mortality remains unknown. METHODS A total of 3027 patients registered in the Q-Cohort Study, a multicenter, prospective study of patients on hemodialysis in Japan, were analyzed. The main outcomes were cardiovascular events and all-cause mortality. Associations between sex-specific quartiles of the modified Cr index and outcomes were analyzed by the Cox proportional hazard models and the Fine-Gray proportional subdistribution hazards model. RESULTS The modified Cr index was correlated with known nutritional and inflammatory markers. During a 4-year follow-up, 499 patients died of any cause, 372 experienced heart disease, and 194 developed stroke. The risk for all-cause mortality was significantly higher in the lower quartiles (Q1 and Q2) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals: Q1, 2.65 [1.69-4.25], Q2, 1.92 [1.27-2.94], and Q3, 1.31 [0.87-2.02]). The risk of heart disease was significantly higher in Q1 than in Q4 (hazard ratios and 95% confidence intervals: Q1, 1.64 [1.04-2.61], Q2, 1.34 [0.91-2.00], and Q3, 1.04 [0.71-1.52]). The risk of stroke was not associated with the modified Cr index. CONCLUSIONS A lower modified Cr index is associated with an increased risk for heart disease and all-cause mortality, but not with the risk for stroke in patients on hemodialysis.
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Affiliation(s)
- Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ryusuke Yotsueda
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masatomo Taniguchi
- Fukuoka Renal Clinic, 4-6-20 Watanabe-dori, Chuo-ku, Fukuoka, 810-0004, Japan
| | - Hisako Yoshida
- Saga University Hospital, Clinical Research Center, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka, 814-0193, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Ku E, Kopple JD, Johansen KL, McCulloch CE, Go AS, Xie D, Lin F, Hamm LL, He J, Kusek JW, Navaneethan SD, Ricardo AC, Rincon-Choles H, Smogorzewski M, Hsu CY. Longitudinal Weight Change During CKD Progression and Its Association With Subsequent Mortality. Am J Kidney Dis 2018; 71:657-665. [PMID: 29217305 PMCID: PMC5915916 DOI: 10.1053/j.ajkd.2017.09.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/12/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Few studies have investigated the changes in weight that may occur over time among adults with the progression of chronic kidney disease (CKD). Whether such weight changes are independently associated with death after the onset of end-stage renal disease has also not been rigorously examined. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS We studied 3,933 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a longitudinal cohort of patients with CKD. We also performed similar analyses among 1,067 participants of the African American Study of Kidney Disease and Hypertension (AASK). PREDICTORS Estimated glomerular filtration rate (eGFR) and weight change during CKD. OUTCOME Weight and all-cause mortality after dialysis therapy initiation. RESULTS During a median follow-up of 5.7 years in CRIC, weight change was not linear. Weight was stable until cystatin C-based eGFR (eGFRcys) decreased to <35mL/min/1.73m2; thereafter, weight declined at a mean rate of 1.45 kg (95% CI, 1.19-1.70) for every 10 mL/min/1.73m2 decline in eGFRcys. Among the 770 CRIC participants who began hemodialysis or peritoneal dialysis therapy during follow-up, a >5% annualized weight loss after eGFR decreased to <35mL/min/1.73m2 was associated with a 54% higher risk for death after dialysis therapy initiation (95% CI, 1.17-2.03) compared with those with more stable weight (annualized weight changes within 5% of baseline) in adjusted analysis. Similar findings were observed in the AASK. LIMITATIONS Inclusion of research participants only; inability to distinguish intentional versus unintentional weight loss. CONCLUSIONS Significant weight loss began relatively early during the course of CKD and was associated with a substantially higher risk for death after dialysis therapy initiation. Further studies are needed to determine whether interventions to optimize weight and nutritional status before the initiation of dialysis therapy will improve outcomes after end-stage renal disease.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA.
| | - Joel D Kopple
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, and University of California, Los Angeles Schools of Medicine and Public Health, Los Angeles, CA
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Nephrology Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - L Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - John W Kusek
- National Institute of Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, IL
| | - Hernan Rincon-Choles
- Glickman Urological and Kidney Institute, Department of Nephrology, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, CA
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Muscle wasting in chronic kidney disease. Pediatr Nephrol 2018; 33:789-798. [PMID: 28508131 DOI: 10.1007/s00467-017-3684-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
Loss of lean body mass is a relevant component of the cachexia, or protein energy wasting (PEW), syndrome. Reduced muscle mass seems to be the most solid criterion for the presence of cachexia/PEW in patients with chronic kidney disease (CKD), and those with greater muscle mass loss have a higher risk of death. Children with CKD have many risk factors for lean mass and muscle wasting, including poor appetite, inflammation, growth hormone resistance, and metabolic acidosis. Mortality risks in patients with CKD increases as body mass index (BMI) and weight decreases. However, data regarding cachexia/PEW and muscle wasting in children with CKD is scarce due to lack of consensus in diagnostic criteria and an appropriate investigative methodology. Further research is urgently needed to address this important complication in the pediatric CKD setting, which may have fundamental impact on clinical outcomes.
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Golestaneh L. Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift. Semin Dial 2018; 31:278-288. [DOI: 10.1111/sdi.12675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ladan Golestaneh
- Nephrology Division; Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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