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Vongsanim S, Salame C, Eaton S, Grimble G, Davenport A. Differences between Measured Total Nitrogen Losses in Spent Peritoneal Dialysate Effluent and Estimated Nitrogen Losses. J Ren Nutr 2019; 29:243-247. [DOI: 10.1053/j.jrn.2018.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/12/2018] [Accepted: 08/12/2018] [Indexed: 11/11/2022] Open
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Abstract
Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/Vurea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra-dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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Comparison of multifrequency bioimpedance measured lean mass to that calculated from anthropomometric measurements in patients with chronic kidney disease. Eur J Clin Nutr 2019; 73:1200-1202. [DOI: 10.1038/s41430-019-0415-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 11/09/2022]
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Krediet RT, Yoowannakul S, Harris LS, Davenport A. Relationships between Peritoneal Protein Clearance and Parameters of Fluid Status Agree with Clinical Observations in other Diseases that Venous Congestion Increases Microvascular Protein Escape. Perit Dial Int 2019; 39:155-162. [DOI: 10.3747/pdi.2018.00016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 10/06/2018] [Indexed: 11/15/2022] Open
Abstract
Background Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal micro-vessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements. Methods A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram. Results Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, p = 0.007) and right atrial area (β 0.01, p = 0.03) were significant independent predictors of peritoneal protein clearance. Conclusion Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality.
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Affiliation(s)
- Raymond T. Krediet
- Department of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Suree Yoowannakul
- UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom
| | - Lauren S. Harris
- UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom
| | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom
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Fan J, Ye H, Zhang X, Cao P, Guo Q, Mao H, Yu X, Yang X. Association of Lean Body Mass Index and Peritoneal Protein Clearance in Peritoneal Dialysis Patients. Kidney Blood Press Res 2019; 44:94-102. [PMID: 30808849 DOI: 10.1159/000498841] [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] [Accepted: 02/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The relationship between peritoneal protein clearance (PPCl) and nutritional status in peritoneal dialysis (PD) population have not been clarified. This study aims to investigate the relationship between PPCl and nutritional status in PD population. METHODS Prevalent PD patients were enrolled in the cross-sectional survey in a single center from April to November 2013. The total amount of protein loss in the dialysate was calculated. PPCl reflects the individual differences of peritoneal protein loss, and is calculated by the formula, that PPCl (ml/day)=24-h dialysate protein loss / (albumin/0.4783). Nutritional status measured by lean body mass index (LBMI) was assessed by multi-frequency bioelectrical impedance analysis (BIA). RESULTS Totally 351 PD patients (55% male, 17.1% with diabetes, mean age 47.7±14.3 years) were included. The median PPC l was 58 ml/day. Patients were divided into four groups for comparison according to the PPC quartiles. Compared with lower PPCl quartiles, patients with higher PPCl had higher body mass index (BMI) (P< 0.001), body surface area (BSA) (P < 0 .001), LBMI (P<0.001), 4-hour D/P creatinine ratio (P< 0.001), and lower residual renal CCl (P<0.001). Compared with conventional body index (BMI and BSA) in ROC analysis, LBMI (area under curve: 0.71, 95% confidence interval [CI]: 0.66-0.77) had better performance in predicting higher PPCl. After adjustment in logistic regression models, each 1 kg/m2 increase of LBMI (odd ratio[OR] =1.37; 95% CI: 1.17-1.60), each 0.1 increase of 4-hour D/P creatinine ratio (OR =1.47; 95% CI: 1.11-1.93), and every 1 L/week/1.73m2 decrease of residual renal CCl (OR =0.98; 95% CI: 0.96-0.99) were independently associated with higher PPCl (> 58 ml/day). CONCLUSION Higher LBMI was independently associated with higher , indicating that better nutritional status dominates peritoneal protein metabolism in PD patients.
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Affiliation(s)
- Jinjin Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiaodan Zhang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Peiyi Cao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China, .,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, China,
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Kim DI, Taylor JA, Tan CO, Park H, Kim JY, Park SY, Chung KM, Lee YH, Lee BS, Jeon JY. A pilot randomized controlled trial of 6-week combined exercise program on fasting insulin and fitness levels in individuals with spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1082-1091. [DOI: 10.1007/s00586-019-05885-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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Tangvoraphonkchai K, Davenport A. Aortic pulse wave velocity is greater in peritoneal dialysis patients with lower dual energy X-ray absorptiometry (DXA) femoral neck bone mineral density. J Nephrol 2018; 32:471-476. [PMID: 30535631 DOI: 10.1007/s40620-018-0551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased vascular stiffness is associated with low bone mineral density (BMD) in the general population, and both are risk factors for mortality. We wished to determine whether vascular stiffness is associated with BMD in peritoneal dialysis (PD) patients. METHODS We measured vascular stiffness by aortic pulse wave velocity (aPWV), BMD by dual electron absorptiometry (DXA) scanning, and body composition using bioimpedance. RESULTS We reviewed DXA scans in 125 PD patients, 56.8% male, mean age 64.4 ± 15.3 years, mean aPWV, 10.2 ± 2.6 m/s. We divided patients by aPWV (< 10 and > 10 m/s), and there were no statistical differences in patient demographics, body composition, PD adequacy, peritoneal and urinary calcium losses. On univariate analysis aPWV was negatively associated with total body T score (r = - 0.20, p = 0.037). On multivariable logistic regression patients with higher aPWV were prescribed fewer non-calcium containing phosphate binders, odds ratio (OR) 0.83, 95% confidence interval (CI) 0.70-0.99, p = 0.039, more had lower 25 hydroxy-vitamin D3 concentrations < 50 ng/L (OR 0.34, CI 0.12-0.93, p = 0.035, and lower femoral BMD OR 0.03 (CI 0-0.3.4), p = 0.029, but there was no association with total or lumbar spine BMD. CONCLUSION Our study reinforces the hypothesis of a link between bone disease and vascular disease in dialysis patients. As patients with higher aPWV were prescribed fewer non-calcium containing phosphate binders and fewer had higher 25 hydroxy-vitamin D3 concentrations, then this raises the possibility that differences in clinical practice and drug prescribing may help to reduce vascular stiffness, which will require testing in future trials.
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Affiliation(s)
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free hospital, University College London, Rowland Hill Street, London, NW3 2PF, UK
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Vongsanim S, Davenport A. Estimating Dietary Protein Intake in Peritoneal Dialysis Patients: The Effect of Ethnicity. Perit Dial Int 2018; 38:384-387. [PMID: 30185482 DOI: 10.3747/pdi.2017.00260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Kidney dialysis patients with sarcopenia have increased mortality. Clinical guidelines recommend peritoneal dialysis (PD) patients have a target daily protein intake to prevent sarcopenia. Protein intake is estimated from total daily urea losses in urine and peritoneal dialysate to assess the protein equivalent of nitrogen appearance rate adjusted for body weight (nPNA). Dietary habits differ among ethnic groups, so we reviewed nPNA and body composition in a multi-ethnic PD population. Body composition was measured with multifrequency bioimpedance in 598 patients (301 white, 136 black, 123 South-Asian, and 38 Asian-Pacific). South-Asians had a lower nPNA compared with white and black individuals (Randerson 0.80 ± 0.21 vs 0.88 ± 0.24 and 0.85 ± 0.24 g/kg/day, Blumenkrantz 0.97 ± 0.14 vs 1.04 ± 0.22 and 0.99 ± 0.22 g/kg/day, Bergström 0.87 ± 0.4 vs 0.95 ± 0.24 and 0.92 ± 0.24 g/kg/day all p < 0.001). South-Asians had lower weights (68.9 ± 14.9 vs 74.4 ± 16.6 and 73.5 ± 16.3 kg, p < 0.001), and although of similar body mass index (25.9 ± 4.9 vs 28.5 ± 4.9 and 26.5 ± 5.2 kg/m2), had both lower skeletal muscle and appendicular muscle mass indexed for height (9.08 ± 1.45 vs 9.89 ± 1.62 and 10.1 ± 1.85, p < 0.001; and 6.95 ± 1.39 vs 7.68 ± 1.48 and 7.67 ± 1.58 kg/m2p < 0.01). South-Asian patients had a lower calculated basal metabolic rate (BMR) (1,358 ± 218 vs 1,487 ± 257 and 1,489 ± 271 kcal/day, p < 0.001).Asian PD patients, particularly South-Asians, have lower dietary protein intakes when calculated by nPNA. However, South-Asians had lower measured muscle mass and calculated BMR. As such, dietary protein intake targets derived from studies in 1 ethnic group are not necessarily applicable for all patients, as those with less muscle mass and lower BMR may well need less daily protein intake to maintain homeostasis.
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Affiliation(s)
- Surachet Vongsanim
- Renal Division, Department of Internal Medicine, Chiang Mai University Hospital, Chiang Mai, Thailand
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
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Shendi AM, Davies N, Davenport A. Systemic Endotoxin in Peritoneal Dialysis Patients. Perit Dial Int 2018; 38:381-384. [PMID: 30185481 DOI: 10.3747/pdi.2018.00036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 - 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 - 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β-glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.
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Affiliation(s)
- Ali M Shendi
- Renal Division, Department of Internal Medicine, Zagazig University, Egypt
| | - Nathan Davies
- Institute for Liver & Digestive Health, Royal Free Hospital, UCL Medical School, London, United Kingdom
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom
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Abro A, Delicata LA, Vongsanim S, Davenport A. Differences in the prevalence of sarcopenia in peritoneal dialysis patients using hand grip strength and appendicular lean mass: depends upon guideline definitions. Eur J Clin Nutr 2018; 72:993-999. [PMID: 29921962 DOI: 10.1038/s41430-018-0238-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) patients with sarcopenia have increased risk of mortality. There is consensus that sarcopenia should combine assessments of muscle function and mass. We wished to determine the effect of using different operational definitions in PD patients. METHODS Hand grip strength (HGS) and segmental bioimpedance derived appendicular lean mass (ALM) were measured and the prevalence of sarcopenia determined using the Foundation for the National Institutes of Health Sarcopenia Project (FNIH), European Working Group on Sarcopenia Older Persons (EWGSOP), and Asian Working Group on Sarcopenia (AWGS) definitions. RESULTS We studied 155 PD patients, 95 men (61.3%), mean age 63.0 ± 14.9 years, 37.4% diabetic, treated by PD 9 (3-20) months with a HGS of 22.5 (15.5-30.2) kg, weight 73.6 ± 16.6 kg, % body fat 31.4 ± 4.2, and ALM index 7.52 ± 1.40 kg/m2. More patients were defined with muscle weakness using the EWGSOP compared to the FNIH criteria (X2 = 6.8, p = 0.009), whereas fewer patients met the EWGSOP criteria for muscle wasting compared to FNIH body mass index adjustment (X2 = 7.7, p = 0.006). However, when combining both criteria, there was no difference in the prevalence of sarcopenia between the different recommended definitions (11-15.5%). CONCLUSION We report a much lower prevalence of sarcopenia compared to studies in haemodialysis patients. Although there may be an element of patient selection bias, PD patients are not subject to changes in hydration and electrolytes with haemodialysis, which can affect HGS and muscle mass measurements. Using HGS and segmental bioimpedance we found similar prevalence of sarcopenia using EWGSOP, FNIH, AWGS definitions.
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Affiliation(s)
- Asmat Abro
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, NW3 2PF, UK
| | - Lara-Anne Delicata
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, NW3 2PF, UK
| | | | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, NW3 2PF, UK.
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Alston H, Burns A, Davenport A. Loss of appendicular muscle mass in haemodialysis patients is associated with increased self-reported depression, anxiety and lower general health scores. Nephrology (Carlton) 2018; 23:546-551. [DOI: 10.1111/nep.13075] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/18/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Helen Alston
- UCL Centre for Nephrology; Royal Free Hospital, University College London Medical School; London UK
| | - Aine Burns
- UCL Centre for Nephrology; Royal Free Hospital, University College London Medical School; London UK
| | - Andrew Davenport
- UCL Centre for Nephrology; Royal Free Hospital, University College London Medical School; London UK
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El-Kateb S, Sridharan S, Farrington K, Fan S, Davenport A. Comparison of equations of resting and total energy expenditure in peritoneal dialysis patients using body composition measurements determined by multi-frequency bioimpedance. Clin Nutr 2018; 37:646-650. [DOI: 10.1016/j.clnu.2017.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
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Son S, Park C, Han K, Seo M, So WY, An HS, Sung D. Comparison of muscle mass and its relationship to golf performance among college amateur and professional golfers. Sci Sports 2018. [DOI: 10.1016/j.scispo.2017.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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64
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Estimation of lean body mass by creatinine kinetics increases the prevalence of muscle wasting in peritoneal dialysis patients compared to bioimpedance. Eur J Clin Nutr 2018; 72:1455-1457. [DOI: 10.1038/s41430-017-0072-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/21/2017] [Accepted: 08/29/2017] [Indexed: 01/10/2023]
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Yoowannakul S, Harris LS, Davenport A. Peritoneal Protein Losses Depend on More Than Just Peritoneal Dialysis Modality and Peritoneal Membrane Transporter Status. Ther Apher Dial 2018; 22:171-177. [PMID: 29314721 DOI: 10.1111/1744-9987.12647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022]
Abstract
Peritoneal protein clearance (PPCl) depends upon vascular supply and size selective permeability. Some previous reports suggested PPCl can distinguish fast peritoneal membrane transport due to local or systemic inflammation. However, as studies have been discordant, we wished to determine factors associated with an increased PPCl. Consecutive patients starting peritoneal dialysis (PD) who were peritonitis-free were studied. Data included a baseline peritoneal equilibration test (PET), measurement of dialysis adequacy, 24-h dialysate PPCl and body composition measured by multifrequency bioimpedance. 411 patients, mean age 57.2 ± 16.6 years, 60.8% male, 39.4% diabetic, 20.2% treated by continuous ambulatory peritoneal dialysis (CAPD) were studied. Mean PET 4-h Dialysate/Serum creatinine was 0.73 ± 0.13, with daily peritoneal protein loss 4.6 (3.3-6.4) g, and median PPCl 69.6 (49.1-99.6) mL/day. On multivariate analysis, PPCl was most strongly associated with CAPD (β 0.25, P < 0.001), extracellular water (ECW)/total body water (TBW) ratio (β 0.21, P < 0.001), skeletal muscle mass index (β 0.21, P < 0.001), log N-terminal brain natriuretic peptide (NT-proBNP) (β 0.17, P = 0.001), faster PET transport (β 0.15, P = 0.005), and normalized nitrogen appearance rate (β 0.13, P = 0.008). In addition to the longer dwell times of CAPD, greater peritoneal creatinine clearance and faster PET transporter status, we observed an association between increased PPCl and ECW expansion, increased NT-proBNP, estimated dietary protein intake and muscle mass, suggesting a link to sodium intake and sodium balance, increasing both ECW and conduit artery hydrostatic pressure resulting in greater vascular protein permeability. This latter association may explain reports linking PPCl to patient mortality.
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Affiliation(s)
- Suree Yoowannakul
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Lauren S Harris
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London, London, UK
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The prevalence of muscle wasting (sarcopenia) in peritoneal dialysis patients varies with ethnicity due to differences in muscle mass measured by bioimpedance. Eur J Clin Nutr 2017; 72:381-387. [PMID: 29158495 DOI: 10.1038/s41430-017-0033-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/15/2017] [Accepted: 10/04/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Sarcopenia is associated with increased mortality. European and North American recommended screening for low muscle mass uses gender specific cut points, with no adjustment for ethnicity. We wished to determine whether the prevalence of sarcopenia was altered by ethnicity in peritoneal dialysis (PD) patients. SUBJECTS/METHODS We measured appendicular lean mass indexed to height (ALMI) in PD patients by segmental bioimpedance and determined sarcopenia using different cut off points for reduced muscle mass. RESULTS We measured ALMI in 434 PD patients, 55.1% males, mean age 55.3 ± 16.2 years, 32.3% diabetic, 54.1% white, 23.7% Asian, 19.1% black. ALMI was lower in Asian women, compared to white and black women (6.4 ± 1.1 vs. 6.6 ± 1.0 and 6.9 ± 1.4 kg/m2), and lower in Asian men (7.5 ± 1.3 vs. 8.5 ± 1.2 and 8.7 ± 1.3 kg/m2), p < 0.001. Depending on the ALM/ALMI cut point; the prevalence of sarcopenia was greater in Asian patients (25.6-41.2% using North American or European cut points) compared to white (12.3-18.7%) and black patients (3.8-15.7%), p < 0.001, but <11% when using Asian-specific cut points. The prevalence of sarcopenia obesity (BMI ≥ 30 kg/m2) was <3%, for all groups. There was no association with duration of PD, dialysis prescription, residual renal function or small solute clearances. CONCLUSIONS There is no universally agreed consensus definition for loss of muscle mass (sarcopenia) and current European and North American recommended cut points for screening are adjusted only for gender. As body composition differs also with age and ethnicity, then ideally cut points should be based on age, gender and ethnicity normative values.
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Popovic V, Zerahn B, Heaf JG. Comparison of Dual Energy X-ray Absorptiometry and Bioimpedance in Assessing Body Composition and Nutrition in Peritoneal Dialysis Patients. J Ren Nutr 2017; 27:355-363. [DOI: 10.1053/j.jrn.2017.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/27/2017] [Accepted: 03/22/2017] [Indexed: 11/11/2022] Open
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Cupisti A, D'Alessandro C, Finato V, Del Corso C, Catania B, Caselli GM, Egidi MF. Assessment of physical activity, capacity and nutritional status in elderly peritoneal dialysis patients. BMC Nephrol 2017; 18:180. [PMID: 28558794 PMCID: PMC5450102 DOI: 10.1186/s12882-017-0593-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background This study aimed to evaluate the prevalence of sedentarism, and to assess physical capacity and nutritional status in a cohort of older patients on peritoneal dialysis (PD), with respect to age-matched non-dialysis CKD population, using highly accessible, simple methods, namely the Rapid Assessment of Physical activity (RAPA) test and the 30″ Sit-to-stand (STS) test. Methods This cross-sectional multicenter study included 151 renal patients older than 60 years; 71 pts. (44 m, age 72 ± 7 yrs) were on PD and 80 pts. (63 m, age 74 ± 7 yrs) were affected by 3–4 stage CKD. Results The prevalence of sedentary/underactive patients was double of that of the active patients as assessed by RAPA test, both in the PD (65.3%) and in the CKD (67.5%) cohort. The 30"STS test showed a reduced physical performance in both groups: 84.5% of PD patients and 87.5% of CKD patients did not reach the expected number of stands by age and gender. A malnutrition-inflammation score (MIS) ≥ 6 occurred in 37 % of PD patients and in 2.5 % of CKD patients. In PD patients, an independent significant association was observed between 30”STS test and MIS (beta -0.510, p = 0.013), as well as between RAPA and MIS (beta -0.544, p = 003) and phase angle (beta -0.506, p = 0.028). Conclusions A high prevalence of low- performance capacity and sedentarism has been detected among elderly patients on PD or with CKD stage 3–4. Apart from age, a condition of malnutrition-inflammation was the major determinant of poor physical activity and capacity in PD patients. Better body composition seems to be positively associated with physical activity in PD and with physical capacity in CKD patients. Routine clinical management should include a close evaluation of nutritional status and evaluation of physical activity and capacity which can be easily assessed by RAPA and 30″STS tests.
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Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy.
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
| | - Viviana Finato
- Nephrology and Dialysis Unit, S. Miniato Hospital, S. Miniato, Italy
| | | | - Battista Catania
- Nephrology and Dialysis Unit, Pontedera Hospital, Pontedera, Italy
| | - Gian Marco Caselli
- Nephrology and Dialysis Unit, S. Giovanni di Dio Hospital, Florence, Italy
| | - Maria Francesca Egidi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126, Pisa, Italy
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Sarangi SC, Tripathi M, Kakkar AK, Gupta YK. Comparison of body composition in persons with epilepsy on conventional & new antiepileptic drugs. Indian J Med Res 2017; 143:323-30. [PMID: 27241646 PMCID: PMC4892079 DOI: 10.4103/0971-5916.182623] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND & OBJECTIVES Certain antiepileptic drugs (AEDs) such as valproic acid (VPA) are known to affect body weight, and lipid profile. However, evidences regarding effects of AEDs on the body composition are deficient. This cross-sectional study compared the body composition and lipid profile among patients with epilepsy on newer and conventional AEDs. METHODS The patients with epilepsy (n=109) on treatment with conventional and newer AEDs (levetiracetam, lamotrigine and clobazam) for > 6 months were enrolled. Of these, 70 were on monotherapy: levetiracetam (n=12), VPA (n=16), carbamazepine (n=20) and phenytoin (n=22) and the remaining on polytherapy. Their body composition [body fat mass, lean dry mass (LDM), total body water (TBW), intracellular water (ICW), extracellular water (ECW) and basal metabolic rate (BMR) was estimated and biochemical parameters were assessed. RESULTS Levetiracetam group had no significant difference with VPA, carbamazepine, phenytoin and control groups, except low LDM (17.8±2.4) than VPA groups (20.2±2.7, p<0.05). In comparison with control, AEDs monotherapy groups had no significant difference, except higher LDM and ECW in VPA group. Among groups based on conventional and newer AEDs, there was no significant difference in body composition parameters except for higher LDM (as % of BW) in conventional AEDs only treated group than control (p<0.01). INTERPRETATION & CONCLUSIONS The alterations observed in body composition with valproic acid in contrast to other AEDs like levetiracetam, carbamazepine and phenytoin could affect treatment response in epilepsy especially in subjects with already altered body composition status like obese and thin frail patients, which needs to be established by prospective studies (CTRI/2013/05/003701).
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Affiliation(s)
- Sudhir Chandra Sarangi
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi; Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi; Department of Pharmacology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
| | - Yogendra Kumar Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
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70
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Comparison of estimates of resting energy expenditure equations in haemodialysis patients. Int J Artif Organs 2017; 40:96-101. [PMID: 28362048 DOI: 10.5301/ijao.5000575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Waste products of metabolism accumulate in patients with chronic kidney disease, and require clearance by haemodialysis (HD). We wished to determine whether there was an association between resting energy expenditure (REE) and total energy expenditure (TEE) in HD patients and body composition. SUBJECTS/METHODS We determined REE by recently validated equations (CKD equation) and compared REE with that estimated by standard equations for REE, and TEE calculated from patient reported physical activity, in HD patients with corresponding body composition measured by dual energy X-ray absorptiometry (DEXA) scanning. RESULTS We studied 107 patients, 69 male (64.5%), mean age 62.7 ± 15.1 years. The CKD equation REE was 72.5 ± 13.3 watts (W) and TEE 83.2 ± 9.7 W. There was a strong association between REE with body surface area (BSA) (r2 = 0.80), total soft lean and fat lean tissue mass (r2 = 0.69), body mass index (BMI) (r2 = 0.34), all p<0.001. REE estimated using the modified Harris Benedict, Mifflin St. Jeor, Katch McArdle, Bernstein and Robertson equations underestimated REE compared to the CKD equation. TEE was more strongly associated with BSA (r2 = 0.51), appendicular muscle mass (r2 = 0.42), than BMI (r2 = 0.15) all p<0.001.TEE was greater for those employed (104.9 ± 10.7 vs. 83.1 ± 12.3 W, p<0.001), and with no co-morbidity (88.7 ± 14.8 vs. 82.7 ± 12.3 W, p<0.05). CONCLUSIONS Standard equations underestimate REE in HD patients compared to the CKD equation. TEE was greater in those with more skeletal muscle mass, in those who were employed and in those with the least co-morbidity. More metabolically active patients may well require greater dialytic clearances.
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71
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Hung R, Wong B, Goldet G, Davenport A. Differences in Prevalence of Muscle Wasting in Patients Receiving Peritoneal Dialysis per Dual-Energy X-Ray Absorptiometry Due to Variation in Guideline Definitions of Sarcopenia. Nutr Clin Pract 2017; 32:539-544. [DOI: 10.1177/0884533617696331] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Rachel Hung
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Bethany Wong
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Gabrielle Goldet
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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Argilés JM, Betancourt A, Guàrdia-Olmos J, Peró-Cebollero M, López-Soriano FJ, Madeddu C, Serpe R, Busquets S. Validation of the CAchexia SCOre (CASCO). Staging Cancer Patients: The Use of miniCASCO as a Simplified Tool. Front Physiol 2017; 8:92. [PMID: 28261113 PMCID: PMC5313479 DOI: 10.3389/fphys.2017.00092] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 02/03/2017] [Indexed: 01/06/2023] Open
Abstract
The CAchexia SCOre (CASCO) was described as a tool for the staging of cachectic cancer patients. The aim of this study is to show the metric properties of CASCO in order to classify cachectic cancer patients into three different groups, which are associated with a numerical scoring. The final aim was to clinically validate CASCO for its use in the classification of cachectic cancer patients in clinical practice. We carried out a case -control study that enrolled prospectively 186 cancer patients and 95 age-matched controls. The score includes five components: (1) body weight loss and composition, (2) inflammation/metabolic disturbances/immunosuppression, (3) physical performance, (4) anorexia, and (5) quality of life. The present study provides clinical validation for the use of the score. In order to show the metric properties of CASCO, three different groups of cachectic cancer patients were established according to the results obtained with the statistical approach used: mild cachexia (15 ≤ × ≤ 28), moderate cachexia (29 ≤ × ≤ 46), and severe cachexia (47 ≤ × ≤ 100). In addition, a simplified version of CASCO, MiniCASCO (MCASCO), was also presented and it contributes as a valid and easy-to-use tool for cachexia staging. Significant statistically correlations were found between CASCO and other validated indexes such as Eastern Cooperative Oncology Group (ECOG) and the subjective diagnosis of cachexia by specialized oncologists. A very significant estimated correlation between CASCO and MCASCO was found that suggests that MCASCO might constitute an easy and valid tool for the staging of the cachectic cancer patients. CASCO and MCASCO provide a new tool for the quantitative staging of cachectic cancer patients with a clear advantage over previous classifications.
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Affiliation(s)
- Josep M Argilés
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of BarcelonaBarcelona, Spain; Institute of Biomedicine (IBUB)Barcelona, Spain
| | - Angelica Betancourt
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona Barcelona, Spain
| | - Joan Guàrdia-Olmos
- Advanced Statistical Data Analysis Applied to Psychology, Faculty de Psicology, University of BarcelonaBarcelona, Spain; Institute for Research on the Brain, Cognition and BehaviourBarcelona, Spain
| | - Maribel Peró-Cebollero
- Advanced Statistical Data Analysis Applied to Psychology, Faculty de Psicology, University of BarcelonaBarcelona, Spain; Institute for Research on the Brain, Cognition and BehaviourBarcelona, Spain
| | - Francisco J López-Soriano
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of BarcelonaBarcelona, Spain; Institute of Biomedicine (IBUB)Barcelona, Spain
| | - Clelia Madeddu
- Department of Medical Oncology, University of Cagliari Cagliari, Italy
| | - Roberto Serpe
- Department of Medical Oncology, University of Cagliari Cagliari, Italy
| | - Sílvia Busquets
- Cancer Research Group, Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of BarcelonaBarcelona, Spain; Institute of Biomedicine (IBUB)Barcelona, Spain
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Davenport A. Is Hemodialysis Patient Survival Dependent upon Small Solute Clearance (Kt/V)?: If So How Can Kt/V be Adjusted to Prevent Under Dialysis in Vulnerable Groups? Semin Dial 2017; 30:86-92. [PMID: 28074616 DOI: 10.1111/sdi.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small solute clearance achieved during a single hemodialysis session has been traditionally evaluated by urea clearance, normalized for total body water (Kt/Vurea) for more than 30 years. By consensus, the target sessional KtVurea for thrice weekly treatments has been increased from 0.9 to 1.2 over the years. Although this is supported by observational studies, there is a fundamental lack of prospective studies to support this threshold target. In clinical practice achieving sessional Kt/Vurea targets are most closely followed in the US. Yet there appears to be a paradox in that by following Kt/Vurea targets in the US hemodialysis patient survival is better for men and the obese, the opposite of what is seen in the general population. Delivery of a lower dose of hemodialysis to women and smaller men can be explained by underestimation of total body water. The advent of bioimpedance techniques which can measure both body water and body composition will potentially allow a rescaling and re-evaluation of the importance of small solute clearances (Kt/Vurea) in the hemodialysis patient population.
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Affiliation(s)
- Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
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74
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El-Kateb S, Sridharan S, Farrington K, Fan S, Davenport A. A single weekly Kt/Vurea target for peritoneal dialysis patients does not provide an equal dialysis dose for all. Kidney Int 2016; 90:1342-1347. [DOI: 10.1016/j.kint.2016.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/11/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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75
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Greenhall GHB, Davenport A. Screening for muscle loss in patients established on peritoneal dialysis using bioimpedance. Eur J Clin Nutr 2016; 71:70-75. [DOI: 10.1038/ejcn.2016.202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/13/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
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76
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Changes in body composition following haemodialysis as assessed by bioimpedance spectroscopy. Eur J Clin Nutr 2016; 71:169-172. [DOI: 10.1038/ejcn.2016.187] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 12/14/2022]
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77
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Panorchan K, Davenport A. Incidence and Predictors of Zinc Deficiency in Stable Peritoneal Dialysis Patients. Perit Dial Int 2016; 35:597-9. [PMID: 26450484 DOI: 10.3747/pdi.2014.00134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kwanpeemai Panorchan
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
| | - Andrew Davenport
- UCL Center for Nephrology, Royal Free Hospital, University College London Medical School, London, UK
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78
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Comparison of resting and total energy expenditure in peritoneal dialysis patients and body composition measured by dual-energy X-ray absorptiometry. Eur J Clin Nutr 2016; 70:1337-1339. [DOI: 10.1038/ejcn.2016.120] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/17/2016] [Accepted: 06/05/2016] [Indexed: 01/01/2023]
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79
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Castrale C, Azar R, Piquet MA, Lobbedez T. [The specific nutritionnal care in peritoneal dialysis]. Nephrol Ther 2016; 12:198-205. [PMID: 27320370 DOI: 10.1016/j.nephro.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/10/2023]
Abstract
Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients.
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Affiliation(s)
- Cindy Castrale
- Service de néphrologie-hémodialyse, hôpital privé Saint-Martin, 18, rue des Roquemonts, 14050 Caen cedex 4, France.
| | - Raymond Azar
- Service de néphrologie, dialyse, centre hospitalier de Dunkerque, 130, avenue Louis-Herbeaux, BP 6367, 59385 Dunkerque cedex 1, France
| | - Marie-Astrid Piquet
- Unité transversale de nutrition clinique et métabolique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Thierry Lobbedez
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
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Rincón Bello A, Bucalo L, Abad Estébanez S, Vega Martínez A, Barraca Núñez D, Yuste Lozano C, Pérez de José A, López-Gómez JM. Fat tissue and inflammation in patients undergoing peritoneal dialysis. Clin Kidney J 2016; 9:374-80. [PMID: 27274820 PMCID: PMC4886903 DOI: 10.1093/ckj/sfw007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/19/2016] [Indexed: 01/10/2023] Open
Abstract
Background Body weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD. Methods This was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM®). We performed linear regression for each patient, including all BCM® measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria. Results Median follow-up was 26 (range 17–27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM® analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=−0.50, P = 0.008). Conclusions Follow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile.
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Affiliation(s)
- Abraham Rincón Bello
- Department of Nephrology, Rey Juan Carlos Hospital, Móstoles, Madrid, Spain; Department of Nephrology, Gregorio Marañón Hospital, Madrid, Spain
| | - Laura Bucalo
- Department of Nephrology , Gregorio Marañón Hospital , Madrid , Spain
| | | | | | | | | | - Ana Pérez de José
- Department of Nephrology , Gregorio Marañón Hospital , Madrid , Spain
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Davenport A, Peters SA, Bots ML, Canaud B, Grooteman MP, Asci G, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ. Higher convection volume exchange with online hemodiafiltration is associated with survival advantage for dialysis patients: the effect of adjustment for body size. Kidney Int 2016; 89:193-9. [DOI: 10.1038/ki.2015.264] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/26/2015] [Accepted: 07/02/2015] [Indexed: 12/15/2022]
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82
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The importance of overhydration in determining peritoneal dialysis technique failure and patient survival in anuric patients. Int J Artif Organs 2015; 38:575-9. [PMID: 26659479 DOI: 10.5301/ijao.5000446] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE Loss of residual renal function (RRF) is associated with an increased risk for peritoneal dialysis (PD) technique failure and patient death. We wished to determine which factors were associated with PD technique failure and patient mortality once urine output had fallen to <100 mL/day. METHODS We followed 183 PD patients who lost RRF and who had measurements taken at that time of PD small solute clearances, ultrafiltration volume, PD transport status and multiple frequency bioelectrical impedance assessments (MFBIA) of extracellular water (ECW). RESULTS RESULTS 119 (65%) patients had PD technique failure or died during a median follow-up of 20.8 (10.5-36) months. This group had more men (58.8% vs. 31.9%, p = 0.011), and were older 57.9 ± 14.7 vs. 49.3 years (p = 0.002). These patients had a higher median C-reactive protein 5.5 [4.8-8.2] vs (5.0 [2-6] p = 0.013), and greater comorbidity (Davies grade 1 [0-1] vs. 0[0-1], p<0.001, and a higher ratio of ECW/TBW (0.45 ± 0.07 vs 0.42 ± 0.04, p<0.001). There were no differences in icodextrin usage, small solute clearance or ultrafiltration volumes. On multivariate Cox regression, ECW excess was significantly associated with PD technique failure and patient survival (β 1.09, p<0.001 and β1.17, p = 0.005), respectively. CONCLUSIONS Loss of urine output requires PD to provide both adequate solute clearances and volume control. We found that PD technique failure and patient death were associated with ECW excess. Prospective interventional studies are required to determine whether correction of volume status improves PD patient outcomes.
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83
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Peritoneal dialysate effluent and serum CA125 concentrations in stable peritoneal dialysis patients. J Nephrol 2015; 29:427-434. [DOI: 10.1007/s40620-015-0250-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/13/2015] [Indexed: 10/22/2022]
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84
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Novel Anthropometry-Based Calculation of the Body Heat Capacity in the Korean Population. PLoS One 2015; 10:e0141498. [PMID: 26529594 PMCID: PMC4631517 DOI: 10.1371/journal.pone.0141498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/08/2015] [Indexed: 12/30/2022] Open
Abstract
Heat capacity (HC) has an important role in the temperature regulation process, particularly in dealing with the heat load. The actual measurement of the body HC is complicated and is generally estimated by body-composition-specific data. This study compared the previously known HC estimating equations and sought how to define HC using simple anthropometric indices such as weight and body surface area (BSA) in the Korean population. Six hundred participants were randomly selected from a pool of 902 healthy volunteers aged 20 to 70 years for the training set. The remaining 302 participants were used for the test set. Body composition analysis using multi-frequency bioelectrical impedance analysis was used to access body components including body fat, water, protein, and mineral mass. Four different HCs were calculated and compared using a weight-based HC (HC_Eq1), two HCs estimated from fat and fat-free mass (HC_Eq2 and HC_Eq3), and an HC calculated from fat, protein, water, and mineral mass (HC_Eq4). HC_Eq1 generally produced a larger HC than the other HC equations and had a poorer correlation with the other HC equations. HC equations using body composition data were well-correlated to each other. If HC estimated with HC_Eq4 was regarded as a standard, interestingly, the BSA and weight independently contributed to the variation of HC. The model composed of weight, BSA, and gender was able to predict more than a 99% variation of HC_Eq4. Validation analysis on the test set showed a very high satisfactory level of the predictive model. In conclusion, our results suggest that gender, BSA, and weight are the independent factors for calculating HC. For the first time, a predictive equation based on anthropometry data was developed and this equation could be useful for estimating HC in the general Korean population without body-composition measurement.
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85
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Effects of a 6-Week Indoor Hand-Bike Exercise Program on Health and Fitness Levels in People With Spinal Cord Injury: A Randomized Controlled Trial Study. Arch Phys Med Rehabil 2015; 96:2033-40.e1. [DOI: 10.1016/j.apmr.2015.07.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/27/2015] [Accepted: 07/18/2015] [Indexed: 11/20/2022]
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Dong J, Li YJ, Xu R, Yang ZK, Zheng YD. Novel Equations for Estimating Lean Body Mass in Peritoneal Dialysis Patients. Perit Dial Int 2015; 35:743-52. [PMID: 26293839 DOI: 10.3747/pdi.2013.00246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 03/09/2014] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED ♦ OBJECTIVES To develop and validate equations for estimating lean body mass (LBM) in peritoneal dialysis (PD) patients. ♦ METHODS Two equations for estimating LBM, one based on mid-arm muscle circumference (MAMC) and hand grip strength (HGS), i.e., LBM-M-H, and the other based on HGS, i.e., LBM-H, were developed and validated with LBM obtained by dual-energy X-ray absorptiometry (DEXA). The developed equations were compared to LBM estimated from creatinine kinetics (LBM-CK) and anthropometry (LBM-A) in terms of bias, precision, and accuracy. The prognostic values of LBM estimated from the equations in all-cause mortality risk were assessed. ♦ RESULTS The developed equations incorporated gender, height, weight, and dialysis duration. Compared to LBM-DEXA, the bias of the developed equations was lower than that of LBM-CK and LBM-A. Additionally, LBM-M-H and LBM-H had better accuracy and precision. The prognostic values of LBM in all-cause mortality risk based on LBM-M-H, LBM-H, LBM-CK, and LBM-A were similar. ♦ CONCLUSIONS Lean body mass estimated by the new equations based on MAMC and HGS was correlated with LBM obtained by DEXA and may serve as practical surrogate markers of LBM in PD patients.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital Institute of Nephrology, Peking University Key Laboratory of Renal Disease, Ministry of Health of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, People's Republic of China
| | - Yan-Jun Li
- Renal Division, Department of Medicine, Peking University First Hospital Institute of Nephrology, Peking University Key Laboratory of Renal Disease, Ministry of Health of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, People's Republic of China
| | - Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital Institute of Nephrology, Peking University Key Laboratory of Renal Disease, Ministry of Health of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, People's Republic of China
| | - Zhi-Kai Yang
- Renal Division, Department of Medicine, Peking University First Hospital Institute of Nephrology, Peking University Key Laboratory of Renal Disease, Ministry of Health of China Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, People's Republic of China
| | - Ying-Dong Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
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87
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El-Katab S, Omichi Y, Srivareerat M, Davenport A. Pinch grip strength as an alternative assessment to hand grip strength for assessing muscle strength in patients with chronic kidney disease treated by haemodialysis: a prospective audit. J Hum Nutr Diet 2015; 29:48-51. [DOI: 10.1111/jhn.12331] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S. El-Katab
- UCL Centre for Nephrology; Royal Free Hospital; University College London Medical School; London UK
| | - Y. Omichi
- University College London; London UK
| | | | - A. Davenport
- UCL Centre for Nephrology; Royal Free Hospital; University College London Medical School; London UK
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88
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Changes in muscle and fat mass with haemodialysis detected by multi-frequency bioelectrical impedance analysis. Eur J Clin Nutr 2015; 69:1109-12. [DOI: 10.1038/ejcn.2015.90] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/25/2015] [Accepted: 04/14/2015] [Indexed: 01/10/2023]
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89
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Aguiar PV, Santos O, Teixeira L, Silva F, Azevedo P, Vidinha J, Ferrer F, Carvalho MJ, Cabrita A, Rodrigues A. Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis. Nefrologia 2015; 35:189-96. [DOI: 10.1016/j.nefro.2015.05.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 12/03/2014] [Indexed: 11/15/2022] Open
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Nongnuch A, Assanatham M, Panorchan K, Davenport A. Strategies for preserving residual renal function in peritoneal dialysis patients. Clin Kidney J 2015; 8:202-11. [PMID: 25815178 PMCID: PMC4370298 DOI: 10.1093/ckj/sfu140] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022] Open
Abstract
Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis patients are at risk of sudden intravascular volume shifts associated with dialysis treatments. On the other hand, peritoneal dialysis patients are exposed to a variety of hypertonic dialysates and episodes of peritonitis. Whereas blood pressure control, using an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), and low-protein diets along with keto acid supplementation have been shown to reduce the rate of progression in patients with earlier stages of CKD, the strategies to preserve residual renal function (RRF) in dialysis patients are not well established. For peritoneal dialysis patients, there are additional technical factors that might aggravate the rate of loss of residual renal function including peritoneal dialysis prescriptions and modality, bio-incompatible dialysis fluid and over ultrafiltration of fluid causing dehydration. In this review, we aim to evaluate the evidence of interventions and treatments, which may sustain residual renal function in peritoneal dialysis patients.
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Affiliation(s)
- Arkom Nongnuch
- Renal Unit, Department of Medicine, Faculty of Medicine , Ramathibodi Hospital , Mahidol University , Bangkok , Thailand ; UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK
| | - Montira Assanatham
- Renal Unit, Department of Medicine, Faculty of Medicine , Ramathibodi Hospital , Mahidol University , Bangkok , Thailand
| | - Kwanpeemai Panorchan
- UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK ; Bumrungrad International Hospital , Bangkok , Thailand
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital , University College London Medical School , London , UK
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91
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Cloetens L, Johansson-Persson A, Helgegren H, Landin-Olsson M, Uusitupa M, Åkesson B, Önning G. Assessment of body composition in subjects with metabolic syndrome comparing single-frequency bioelectrical impedance analysis and bioelectrical spectroscopy. Metab Syndr Relat Disord 2014; 13:91-8. [PMID: 25545543 DOI: 10.1089/met.2014.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the agreement between body composition measurements made with two methods-single-frequency bioelectrical impedance analysis (SF-BIA) and bioelectrical impedance spectroscopy (BIS). METHODS The body composition measurements using SF-BIA and BIS were performed seven times during 6 months on 41 patients (13 men and 28 women) with metabolic syndrome who were taking part in a dietary intervention study. RESULTS The mean [standard deviation (SD)] fat mass (FM) and median [interquartile range (IQR)] FM% measured with SF-BIA were 32.7 (6.7) kg and 36.3 (30.3-39.3)%, respectively, compared with 38.2 (8.7) kg and 40.9 (35.5-45.6)%, respectively, using BIS. The median (IQR) fat-free mass (FFM) was 60.0 (53.3-73.5) kg according to SF-BIA and 55.4 (48.8-66.5) kg according to BIS. These results obtained with the two methods were significantly different (P<0.001). Still highly significant correlations were found between the results obtained with SF-BIA and BIS for FM and FFM (all r≥0.89, P<0.001). Using Bland-Altman analysis, the bias was found to be -5.4 (4.1) kg for FM, -5.5 (3.7)% for FM%, and 5.4 (4.1) kg for FFM. Rather wide limits of agreement were found for FM, FM%, and FFM. CONCLUSION Body composition data obtained using SF-BIA and BIS in subjects with metabolic syndrome were highly correlated but not interchangeable. FM was systematically lower when using SF-BIA than when using BIS.
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Affiliation(s)
- Lieselotte Cloetens
- 1 Biomedical Nutrition, Department of Pure and Applied Biochemistry, Centre for Applied Life Sciences, Lund University , Lund, Sweden
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92
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Davenport A. Will incremental hemodialysis preserve residual function and improve patient survival? Semin Dial 2014; 28:16-9. [PMID: 25385441 PMCID: PMC4320773 DOI: 10.1111/sdi.12320] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The progressive loss of residual renal function in peritoneal dialysis patients is associated with increased mortality. It has been suggested that incremental dialysis may help preserve residual renal function and improve patient survival. Residual renal function depends upon both patient related and dialysis associated factors. Maintaining patients in an over-hydrated state may be associated with better preservation of residual renal function but any benefit comes with a significant risk of cardiovascular consequences. Notably, it is only observational studies that have reported an association between dialysis patient survival and residual renal function; causality has not been established for dialysis patient survival. The tenuous connections between residual renal function and outcomes and between incremental hemodialysis and residual renal function should temper our enthusiasm for interventions in this area.
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Affiliation(s)
- Andrew Davenport
- University College London Center for Nephrology, Royal Free Hospital, University College London Medical School, London, United Kingdom
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93
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Agarwal B, Davenport A. Difficulties in diagnosing acute kidney injury post liver transplantation using serum creatinine based diagnostic criteria. World J Hepatol 2014; 6:696-703. [PMID: 25349641 PMCID: PMC4209415 DOI: 10.4254/wjh.v6.i10.696] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 06/16/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Renal function in patients with advanced cirrhosis is an important prognostic factor for survival both prior to and following liver transplantation. The importance of renal function is reflected by the introduction of the model for end stage liver disease (MELD) score, which includes serum creatinine. The MELD score has been shown to predict the short term risk of death for transplant wait listed patients and is currently used by many countries to allocate liver transplants on the basis of severity of underlying illness. Changes in serum creatinine are also used to stage acute kidney injury. However prior to liver transplantation the serum creatinine typically over estimates underlying renal function, particularly when a colorimetric Jaffe based assay is used, and paradoxically then under estimates renal function post liver transplantation, particularly when immunophyllins are started early as part of transplant immunosuppression. As acute kidney injury is defined by changes in serum creatinine, this potentially leads to over estimation of the incidence and severity of acute kidney injury in the immediate post-operative period.
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94
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Nongnuch A, Panorchan K, Davenport A. Predialysis NTproBNP predicts magnitude of extracellular volume overload in haemodialysis patients. Am J Nephrol 2014; 40:251-7. [PMID: 25322897 DOI: 10.1159/000368376] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 09/07/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Increased natriuretic peptides are associated with increased cardiovascular and all-cause mortality for haemodialysis (HD) patients. However, debate continues whether these biomarkers are increased by extracellular water (ECW) excess and can be used to aid clinical assessment of volume status and help determine target weight. METHODS We measured N terminal probrain natriuretic peptide (NT-proBNP) predialysis in 375 stable haemodialysis outpatients with corresponding pre and postdialysis multifrequency bioelectrical impedance assessments (MFBIA) of (ECW)/total body water (TBW). RESULTS Median age 64 (51-75), 63.9% male, 42.9% diabetic, 43.2% Caucasoid, 14.4% with a history of myocardial infarction, 8.4% coronary artery bypass surgery, dialysis vintage 28.2 (12.3-55.5) months. Median predialysis NT-proBNP 283 (123-989) pmol/l, and predialysis ECW/TBW ratio 0.397 ± 0.029. On multivariate analysis, predialysis log NT-proBNP was associated with predialysis systolic blood pressure (β 0.007, p = 0.000), weight (β -0.008, p = 0.001), valvular heart disease (β 0.342, p = 0.015, ECW/TBW (β 1.3, p = 0.019) and log CRP (β 0.145, p = 0.037). Dividing patients into NTproBNP quartiles, %ECW/TBW and relative ECW overhydration were significantly greater for the highest quartile vs. lowest (40.5 ± 4.1 vs. 39.0 ± 1.1, and 1.51 ± 1.24 vs. 0.61 ± 0.69 l, respectively, p < 0.001). CONCLUSION In this study, predialysis NTproBNP values were associated with direct assessments of the extracellular volume excess measured by MFBIA and systolic arterial blood pressure. This suggests that predialysis NTproBNP values can potentially be used to aid clinical assessment of volume status in dialysis patients to determine target weight.
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Affiliation(s)
- Arkom Nongnuch
- Renal Unit, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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95
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Davies SJ, Davenport A. The role of bioimpedance and biomarkers in helping to aid clinical decision-making of volume assessments in dialysis patients. Kidney Int 2014; 86:489-96. [DOI: 10.1038/ki.2014.207] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 03/21/2014] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
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96
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Davenport A. Effect of intra-abdominal dialysate on bioimpedance-derived fluid volume status and body composition measurements in peritoneal dialysis patients. Perit Dial Int 2014; 33:578-9. [PMID: 24133085 DOI: 10.3747/pdi.2012.00069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrew Davenport
- UCL Centre for Nephrology Royal Free Hospital University College London Medical School London, UK
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97
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Does increased glucose exposure lead to increased body fat and reduced lean body mass in anuric peritoneal dialysis patients? Eur J Clin Nutr 2014; 68:1253-4. [DOI: 10.1038/ejcn.2014.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/08/2022]
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A six-week motor-driven functional electronic stimulation rowing program improves muscle strength and body composition in people with spinal cord injury: a pilot study. Spinal Cord 2014; 52:621-4. [DOI: 10.1038/sc.2014.76] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 04/03/2014] [Accepted: 04/22/2014] [Indexed: 11/08/2022]
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Alves FD, Souza GC, Biolo A, Clausell N. Comparison of two bioelectrical impedance devices and dual-energy X-ray absorptiometry to evaluate body composition in heart failure. J Hum Nutr Diet 2014; 27:632-8. [DOI: 10.1111/jhn.12218] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- F. D. Alves
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
| | - G. C. Souza
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - A. Biolo
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
| | - N. Clausell
- Post-Graduate Program in Cardiovascular Sciences; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Internal Medicine; Faculty of Medicine; Federal University of Rio Grande do Sul; Porto, Alegre Brazil
- Department of Cardiology; Hospital de Clínicas de Porto Alegre; Porto Alegre Brazil
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Kaido T, Uemoto S. Direct segmental multi-frequency bioelectrical impedance analysis is useful to evaluate sarcopenia. Am J Transplant 2013; 13:2506-7. [PMID: 23915004 DOI: 10.1111/ajt.12373] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 01/25/2023]
Affiliation(s)
- T Kaido
- Division of Hepato-Biliary-Pancreatic and Transplant Surgery, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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