101
|
Survival in patients on hemodialysis: Effect of gender according to body mass index and creatinine. PLoS One 2018; 13:e0196550. [PMID: 29768438 PMCID: PMC5955527 DOI: 10.1371/journal.pone.0196550] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 04/16/2018] [Indexed: 11/19/2022] Open
Abstract
Background The association of a higher body mass index (BMI) with better survival is a well-known “obesity paradox” in patients on hemodialysis (HD). However, men and women have different body compositions, which could impact the effect of BMI on mortality. We investigated the effect of gender on the obesity-mortality relationship in Korean patients on HD. Methods This study included 2,833 maintenance patients on HD from a multicenter prospective cohort study in Korea (NCT00931970). The relationship between categorized BMI and gender-specific mortality was evaluated by an adjusted Cox proportional hazard model with restricted cubic spline analyses and the Competing risk analysis. We also investigated the effect of changes in BMI over 12 months and serum creatinine level on survival in male and female patients on HD. Results The mean BMI was 22.6 ± 3.3 kg/m2 and the mean follow up duration was 24.2 ± 3.4 months. The patients with the highest quintile of BMI (≥25.1 kg/m2) showed lower mortality (subdistributional hazard ratio [SHR] = 0.63, 95% confidence interval [CI] = 0.43–0.93, P = 0.019) compared with those with the reference BMI quintile. When analyzed by gender, male patients with a BMI over 25.1 kg/m2 had lower mortality risk (HR = 0.43, 95% CI = 0.25–0.75, P = 0.003); however, no significant difference was found in female patients. Increased BMI after 12 months and high serum creatinine were associated with better survival only in male patients on HD. Conclusions BMI could be used as a risk factor for mortality in male patients on HD. However, the mortality of female patients on HD was not related with baseline and follow-up BMI. This suggests that BMI is a good surrogate marker of lean body composition, especially in male patients on HD.
Collapse
|
102
|
Tian X, Chen Y, Yang ZK, Qu Z, Dong J. Novel Equations for Estimating Lean Body Mass in Patients With Chronic Kidney Disease. J Ren Nutr 2018; 28:156-164. [DOI: 10.1053/j.jrn.2017.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 01/01/2023] Open
|
103
|
Zhou DC, Yang XH, Zhan XL, Gu YH, Guo LL, Jin HM. Association of lean body mass with nutritional parameters and mortality in hemodialysis patients: A long-term follow-up clinical study. Int J Artif Organs 2018; 41:297-305. [PMID: 29562797 DOI: 10.1177/0391398818762355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: This study aimed to evaluate the correlation between lean body mass (LBM) and nutritional status in hemodialysis (HD) patients to better predict their long-term prognosis. Methods: Anthropometric body measurements and biochemical parameters were recorded from 222 patients on maintenance hemodialysis (MHD) at the Shanghai Pudong Hospital Hemodialysis Center. LBM was calculated using the serum creatinine index (LBM-SCR), mid-arm muscle circumference (LBM-MAMC), and dominant-arm hand-grip strength (LBM-HGS). Patient mortality and hospitalization were observed after 24 months. Results: LBMs measured from LBM-SCR and LBM-MAMC were associated with sex, body mass index (BMI), serum albumin, and serum creatinine (SCR) ( p < 0.05). Through three methods of LBM evaluation, low LBM was shown to be associated with a higher mortality in patients undergoing HD ( p < 0.05). In addition, the rate of hospitalization among these patients was significantly increased ( p < 0.05). Performing multivariate regression analysis using mortality and hospitalization as the dependent variable, we found LBM-SCR and LBM-HGS are strongly associated with hospitalization and mortality in HD patients, indicating LBM is an important factor in prediction of outcomes in those patients. Conclusion: LBM is associated with nutritional parameters in HD patients, and LBM-SCR, HGS, and MAMC are simple approaches for accurately predicting the patient’s risk of hospitalization and/or death.
Collapse
Affiliation(s)
- Dong Chi Zhou
- 1 Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiu Hong Yang
- 1 Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Xiao Li Zhan
- 1 Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Yan Hong Gu
- 1 Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| | - Li Li Guo
- 2 Hemodialysis Center, Bao Shan Branch of No. 1 People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Min Jin
- 1 Division of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China
| |
Collapse
|
104
|
Giglio J, Kamimura MA, Souza NC, Bichels AV, Cordeiro AC, Pinho N, Avesani CM. Muscle mass assessment by computed tomography in chronic kidney disease patients: agreement with surrogate methods. Eur J Clin Nutr 2018; 73:46-53. [PMID: 29559719 DOI: 10.1038/s41430-018-0130-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/18/2017] [Accepted: 02/10/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Patients with chronic kidney disease (CKD) are subjected to muscle wasting. Therefore, it is important to investigate surrogate methods that enable the assessment of muscle mass loss in the clinical setting. We aimed to analyze the agreement between computed tomography (CT) and surrogate methods for the assessment of muscle mass in non-dialysis CKD patients. SUBJECTS/METHODS Cross-sectional study including 233 non-dialysis patients on CKD stages 3 to 5 (61 ± 11 years; 64% men; glomerular filtration rate 22 (14-33) mL/min/1.73 m2). The muscle mass was evaluated by CT and bioelectrical impedance, skinfold thicknesses, midarm muscle circumference (MAMC), the predictive equations of Janssen and Baumgartner and the physical examination of muscle atrophy from the subjective global assessment. RESULTS In males, the MAMC showed the best agreement with CT as indicated by the kappa test (k = 0.57, P < 0.01), sensitivity (S = 68%), specificity (S = 89%) and accuracy (area under the curve-AUC = 0.78), followed by the Baumgartner equation (kappa = 0.46, P < 0.01; sensitivity = 60%; specificity = 87% and AUC = 0.73). In female, the Baumgartner equation showed the best agreement with CT (kappa = 0.43, P < 0.01; sensitivity = 57%; specificity = 86% and AUC = 0.71). CONCLUSIONS The MAMC and Baumgartner equation showed the best agreement with CT for the assessment of muscle mass in non-dialysis CKD patients.
Collapse
Affiliation(s)
- Juliana Giglio
- Nutrition Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Maria Ayako Kamimura
- Nutrition Graduate Program, Federal University of São Paulo, Rio de Janeiro, Brazil
| | - Nilian Carla Souza
- Nutrition Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.,National Institute of Cancer, Rio de Janeiro, Brazil
| | | | - Antonio Carlos Cordeiro
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, Rio de Janeiro, Brazil
| | - Nivaldo Pinho
- National Institute of Cancer, Rio de Janeiro, Brazil
| | - Carla Maria Avesani
- Nutrition Graduate Program in Food, Nutrition and Health, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil. .,Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| |
Collapse
|
105
|
Ziolkowski S, Long J, Baker JF, Simard JF, Chertow GM, Leonhard MB. Sarcopenia, Relative Sarcopenia and Excess Adiposity in Chronic Kidney Disease. JCSM CLINICAL REPORTS 2018. [DOI: 10.17987/jcsm-cr.v3i1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Conventional definitions of sarcopenia based on lean mass fail to capture low lean mass relative to fat mass, i.e., relative sarcopenia. Unlike percent body fat (%BF) and Quételet’s (body mass) index (BMI, kg/m2), definitions of obesity based on fat mass index (FMI, kg/m2) are not confounded by lean mass. The objective is to determine the prevalence of sarcopenia, relative sarcopenia, and obesity in CKD, and determine if CKD is associated with relative sarcopenia and obesity, independent of demographics and comorbidities. Methods: DXA-derived appendicular lean mass index (ALMI, kg/m2) and FMI were assessed in 13,980 NHANES participants. ALMI, FMI, and ALMI relative to FMI (ALMI FMI) were expressed as sex- and race/ethnicity-specific standard deviation scores compared with young adults (T-scores) and by age (Z-scores). Sarcopenia was defined as ALMI T-score < -2, relative sarcopenia as ALMI FMI T-score < -2, and low lean mass relative to fat mass for age as ALMI FMI Z-score < -1. Obesity was defined using conventional BMI and %BF cutpoints and as sex- and race/ethnicity-specific FMI cutpoints. Glomerular filtration rate (GFR) was estimated using creatinine- (eGFR Cr) and cystatin C- (eGFR Cys).Results: The prevalence of relative sarcopenia was higher than the prevalence of sarcopenia, especially in CKD stages 3b and 4 using eGFR Cr; these CKD stages were associated with the highest FMI. CKD stage was independently associated with low ALMI FMI for age using eGFR Cys. BMI underestimated and %BF overestimated the prevalence of obesity compared with FMI. CKD was not independently associated with obesity by FMI.Conclusions: In CKD, conventional definitions of sarcopenia underestimate muscle deficits and %BF overestimates the prevalence of obesity. CKD is independently associated with relative sarcopenia, but not excess adiposity.
Collapse
|
106
|
Chao YP, Lai YF, Kao TW, Peng TC, Lin YY, Shih MT, Chen WL, Wu LW. Mid-arm muscle circumference as a substantial factor against mortality among people with elevated gamma gaps. Oncotarget 2018; 9:1311-1325. [PMID: 29416697 PMCID: PMC5787441 DOI: 10.18632/oncotarget.19372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/07/2017] [Indexed: 11/25/2022] Open
Abstract
Gamma gap is the difference in total serum proteins and albumin and an elevated gamma gap is related to infections, malignancy, and rheumatic diseases. An elevated gamma gap is also associated with higher mortality due to the correlation with inflammatory status. The study aimed to utilize mid-arm muscle circumference (MAMC) to assist in predicting all-cause mortality, cancer mortality, and cardiovascular mortality in people with elevated gamma gaps. Data were obtained from the third U.S. National Health and Nutrition Examination Survey (1988–1994), which contained 14,011 adults aged 20 to 90 years during up to 14.3 years of follow-up. The Primary analysis examined MAMC in tertiles and revealed the demographic and characteristics of the study population. Receiver operating characteristic curve analysis was used and the most suitable cut-off point of gamma gap was 3.65 g/dl. The secondary analysis employed Cox proportional hazards models stratified by age, gender and body mass index to evaluate the hazard ratios for all-cause mortality, cancer mortality, and cardiovascular mortality associated with the MAMC. As the MAMC tertiles increased in group with gamma gap ≥ 3.65 g/dl, individuals with elder age (60–90 years), normal range of body mass index (19–24.9 kg/m2), and male gender tended to have lower hazard ratios for all-cause mortality, cancer mortality, and cardiovascular mortality. These substantial findings indicate that higher MAMC may be a protective factor of all cause-mortality, cancer mortality, and cardiovascular mortality among older male with normal body mass index and elevated gamma gaps.
Collapse
Affiliation(s)
- Yuan-Ping Chao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Fen Lai
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Yung Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Mu-Tsun Shih
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Urology, Department of Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| |
Collapse
|
107
|
Chao YP, Lai YF, Kao TW, Peng TC, Lin YY, Shih MT, Chen WL, Wu LW. Mid-arm muscle circumference as a surrogate in predicting insulin resistance in non-obese elderly individuals. Oncotarget 2017; 8:79775-79784. [PMID: 29108358 PMCID: PMC5668091 DOI: 10.18632/oncotarget.19340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/07/2017] [Indexed: 01/06/2023] Open
Abstract
The homeostatic model assessment of insulin resistance (HOMA-IR) was used to measure the degree of insulin resistance (IR). Previous literature revealed that mid-arm muscle circumference (MAMC) is one of the anthropometric indicators for nutritional status and the relationship between MAMC and HOMA-IR remains uncertain in the obese and non-obese elderly individuals. The present study included 5,607 participants aged between 60 to 84 years old, using data from the 1999 to 2006 National Health and Nutrition Examination Survey (NHANES). To further explore the association between HOMA-IR and MAMC in the obese and non-obese elderly population using multivariate Cox regression analyses, we divided the participants into obese (BMI ≥ 30 kg/m2) group and non-obese (19 ≤ BMI < 30 kg/m2) group in this study; each group was then divided into quartiles based on their MAMC levels. A positive association was noted between the MAMC and HOMA-IR in all of the designed models initially. After adjusting for multiple covariates, a higher level of the MAMC was significantly associated with elevated HOMA-IR (P < 0.05) in the non-obesity group, which was not the case in the obesity group. Additionally, subjects in the higher quartiles of MAMC tended to have higher HOMA-IR with a significant association (P for trend = 0.003 in model 1; P for trend < 0.001 in model 2, 3, and 4). These results demonstrated that the MAMC can be an auxiliary indicator of HOMA-IR in non-obese elderly individuals and may have substantial additional value in screening for IR if well extrapolated.
Collapse
Affiliation(s)
- Yuan-Ping Chao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Fen Lai
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Yung Lin
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Mu-Tsun Shih
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Urology, Department of Surgery, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| |
Collapse
|
108
|
Delgado C, Chertow GM, Kaysen GA, Dalrymple LS, Kornak J, Grimes B, Johansen KL. Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis. Am J Kidney Dis 2017; 70:817-825. [PMID: 28870376 DOI: 10.1053/j.ajkd.2017.06.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/27/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Understanding the extent to which visceral and subcutaneous body fat are associated with markers of nutrition and inflammation in patients on dialysis therapy could shed light on the obesity paradox and the biology of subcutaneous fat. STUDY DESIGN Cross-sectional. SETTING & PARTICIPANTS 609 adults receiving hemodialysis who participated in the ACTIVE/ADIPOSE Study. PREDICTORS Body mass index (BMI), waist circumference, and bioelectrical impedance spectroscopy-derived estimates of percent body fat. OUTCOMES C-Reactive protein (CRP), interleukin 6 (IL-6), prealbumin, albumin, leptin, and adiponectin concentrations. MEASUREMENTS We performed linear regression analyses to examine the extent to which proxies of visceral and subcutaneous fat were associated with inflammation, nutrition, and adiposity-related hormones. RESULTS BMI was directly associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.30 [95% CI, 0.22-0.38] per 10kg/m2; for ln[IL-6 in pg/mL]: 0.10 [95% CI, 0.02-0.18] per 10kg/m2), but was not associated with markers of nutrition. BMI was also inversely associated with adiponectin and directly associated with leptin. With waist circumference and percent body fat (as a proxy of visceral and subcutaneous fat, respectively) modeled together, waist circumference was associated with markers of inflammation (standardized estimate for ln[CRP in mg/L]: 0.21 [95% CI, 0.09-0.34] per 10cm; for ln[IL-6 in pg/mL]: 0.18 [95% CI, 0.07-0.29] per 10cm), whereas percent body fat was not associated with CRP (standardized estimate for ln[CRP in mg/L]: 0.03 [95% CI, -0.10 to 0.15] per 1%) and was inversely associated with IL-6 (standardized estimate for ln[IL-6 in pg/mL]: -0.15 [95% CI, -0.27 to -0.02] per 1%). In addition, waist circumference was inversely associated with prealbumin and albumin (standardized estimates of -0.12 [95% CI, -0.23 to -0.02] mg/dL per 10cm and -0.17 [95% CI, -0.28 to -0.06] g/dL per 10cm, respectively), and percent body fat was directly associated with prealbumin and albumin (0.20 [95% CI, 0.07-0.32] mg/dL and 0.15 [95% CI, 0.02-0.28] g/dL per 1%, respectively). Higher waist circumference was associated indirectly with adiponectin and directly with leptin concentrations. LIMITATIONS Although the observed associations implicate visceral fat as the cause of inflammation, it cannot be determined in this cross-sectional study. CONCLUSIONS Proxies of visceral and subcutaneous fat appear to have opposing associations with biomarkers of inflammation and nutrition. Subcutaneous fat may be an indicator of nutritional status, and visceral fat, an indicator of inflammation.
Collapse
Affiliation(s)
- Cynthia Delgado
- Division of Nephrology, University of California, San Francisco, CA; Nephrology Section, San Francisco VA Medical Center, San Francisco, CA.
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, CA; US Renal Data System Nutrition Special Studies Center, Ann Arbor, MI
| | - George A Kaysen
- US Renal Data System Nutrition Special Studies Center, Ann Arbor, MI; Department of Medicine, Division of Nephrology, University of California, Davis, CA; Department of Biochemistry and Molecular Medicine, University of California, Davis, CA
| | | | - John Kornak
- US Renal Data System Nutrition Special Studies Center, Ann Arbor, MI; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Barbara Grimes
- US Renal Data System Nutrition Special Studies Center, Ann Arbor, MI; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, CA; Nephrology Section, San Francisco VA Medical Center, San Francisco, CA; US Renal Data System Nutrition Special Studies Center, Ann Arbor, MI
| |
Collapse
|
109
|
Yanishi M, Tsukaguchi H, Kimura Y, Koito Y, Yoshida K, Seo M, Jino E, Sugi M, Kinoshita H, Matsuda T. Evaluation of physical activity in sarcopenic conditions of kidney transplantation recipients. Int Urol Nephrol 2017; 49:1779-1784. [DOI: 10.1007/s11255-017-1661-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/14/2017] [Indexed: 12/31/2022]
|
110
|
Obesidad y enfermedad renal: consecuencias ocultas de la epidemia. Nefrologia 2017; 37:360-369. [DOI: 10.1016/j.nefro.2017.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 01/05/2023] Open
|
111
|
Kovesdy CP, Furth S, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. Physiol Int 2017; 104:1-14. [PMID: 28361575 DOI: 10.1556/2060.104.2017.1.9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease (CKD). A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long-term. The incidence of obesity-related glomerulopathy has increased tenfold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle, and health policy measures that makes preventive behaviors an affordable option.
Collapse
Affiliation(s)
- C P Kovesdy
- 1 Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center , Memphis, TN, USA.,2 Nephrology Section, Memphis VA Medical Center , Memphis, TN, USA
| | - S Furth
- 3 Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA, USA
| | - C Zoccali
- 4 CNR - IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension , Reggio Calabria, Italy
| | | |
Collapse
|
112
|
Rhee CM, You AS, Nguyen DV, Brunelli SM, Budoff MJ, Streja E, Nakata T, Kovesdy CP, Brent GA, Kalantar-Zadeh K. Thyroid Status and Mortality in a Prospective Hemodialysis Cohort. J Clin Endocrinol Metab 2017; 102:1568-1577. [PMID: 28324018 PMCID: PMC5443328 DOI: 10.1210/jc.2016-3616] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/23/2017] [Indexed: 12/19/2022]
Abstract
CONTEXT AND OBJECTIVE Compared with the general population, hemodialysis patients have a substantially higher risk of hypothyroidism, as defined by an elevated serum thyrotropin (TSH) level, and cardiovascular mortality. Whereas an elevated TSH is associated with cardiovascular disease and death in the general population, associations among dialysis patients have been inconsistent. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME We examined 541 hemodialysis patients from 17 southern California dialysis centers in the prospective Hypothyroidism, Cardiovascular Health, and Survival study who underwent protocolized measurement of repeated serum TSH levels every 6 months from 2013 to 2015. Associations between TSH tertiles (<1.28, 1.28 to <2.14, and 2.14 to 86.7 mIU/L) and mortality were estimated using time-dependent Cox models with four adjustment levels. In sensitivity analyses, we excluded patients receiving thyroid hormone supplementation. RESULTS Compared with the lowest TSH tertile, the highest TSH tertile was associated with a 2.2- to 2.5-fold higher mortality risk in unadjusted, case-mix, expanded case-mix+laboratory, and expanded case-mix+laboratory+medication models [hazard ratios (95% confidence interval), 2.54 (1.32 to 4.89), 2.53 (1.30 to 4.93), 2.19 (1.11 to 4.32), and 2.28 (1.45 to 3.58), respectively]. We observed a consistent trend between higher TSH tertiles and numerically higher mortality risk across all models. Similar findings were observed in analyses excluding patients receiving thyroid hormone supplementation. CONCLUSION In time-dependent analyses, TSH levels in the high-normal to high range were independently associated with higher death risk in hemodialysis patients. Further studies are indicated to determine whether normalization of TSH levels with thyroid hormone supplementation improves survival in this population.
Collapse
Affiliation(s)
- Connie M. Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, Orange, California 92868
| | - Amy S. You
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, Orange, California 92868
| | - Danh V. Nguyen
- Division of General Internal Medicine, University of California Irvine, Orange, California 92868
| | | | - Matthew J. Budoff
- Los Angeles BioMedical Research Institute, Torrance, California 90502
| | - Elani Streja
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, Orange, California 92868
- Veterans Affairs Long Beach Healthcare System, Long Beach, California 90822
| | - Tracy Nakata
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, Orange, California 92868
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee 38163
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee 38104
| | - Gregory A. Brent
- Department of Medicine, VA Greater Los Angeles Healthcare System 90073
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
- Department of Physiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California Irvine, Orange, California 92868
- Los Angeles BioMedical Research Institute, Torrance, California 90502
- Veterans Affairs Long Beach Healthcare System, Long Beach, California 90822
| |
Collapse
|
113
|
Kovesdy CP, Furth S, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. JOURNAL OF ENDOCRINOLOGY METABOLISM AND DIABETES OF SOUTH AFRICA 2017. [DOI: 10.1080/16089677.2017.1299975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
114
|
Hossain M, Woywodt A, Augustine T, Sharma V. Obesity and listing for renal transplantation: weighing the evidence for a growing problem. Clin Kidney J 2017; 10:703-708. [PMID: 28979783 PMCID: PMC5622900 DOI: 10.1093/ckj/sfx022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/24/2017] [Indexed: 12/20/2022] Open
Abstract
A 56-year-old female patient was referred to the transplant assessment clinic in July 2016. She started haemodialysis in 2012 for renal failure due to urinary tract infections. She is doing very well on dialysis and has an excellent exercise tolerance without shortness of breath or angina. She has had no infections since starting dialysis and no other comorbidity, except well-controlled hypertension and hyperparathyroidism requiring treatment with cinacalcet. Clinical examination is essentially normal except for truncal obesity with height 167 cm and weight 121 kg, giving her a body mass index of 43.4. Can she be listed for a renal transplant? If not, which target weight should be given to the patient before she can be transplant listed? Which interventions, if any, should be recommended to achieve weight loss?
Collapse
Affiliation(s)
- Mohammed Hossain
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Alexander Woywodt
- Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| |
Collapse
|
115
|
Beddhu S, Wei G, Chen X, Boucher R, Kiani R, Raj D, Chonchol M, Greene T, Murtaugh MA. Associations of Dietary Protein and Energy Intakes With Protein-Energy Wasting Syndrome in Hemodialysis Patients. Kidney Int Rep 2017; 2:821-830. [PMID: 29270488 PMCID: PMC5733766 DOI: 10.1016/j.ekir.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/06/2017] [Accepted: 04/11/2017] [Indexed: 01/18/2023] Open
Abstract
Introduction The associations of dietary protein and/or energy intakes with protein or energy wasting in patients on maintenance hemodialysis are controversial. We examined these in the Hemodialysis (HEMO) Study. Methods In 1487 participants in the HEMO Study, baseline dietary protein intake (grams per kilogram per day) and dietary energy intake (kilocalories per kilograms per day) were related to the presence of the protein-energy wasting (PEW) syndrome at month 12 (defined as the presence of at least 1 criteria in 2 of the 3 categories of low serum chemistry, low body mass, and low muscle mass) in logistic regression models. In additional separate models, protein intake estimated from equilibrated normalized protein catabolic rate (enPCR) was also related to the PEW syndrome. Results Compared with the lowest quartile, the highest quartile of baseline dietary protein intake was paradoxically associated with increased risk of the PEW syndrome at month 12 (odds ratio [OR]: 4.11; 95% confidence interval [CI]: 2.79-6.05). This relationship was completely attenuated (OR: 1.35; 95% CI: 0.88-2.06) with adjustment for baseline body weight, which suggested mathematical coupling. Results were similar for dietary energy intake. Compared with the lowest quartile of baseline enPCR, the highest quartile was not associated with the PEW syndrome at 12 months (OR: 0.78; 95% CI: 0.54-1.12). Discussion These data do not support the use of dietary protein intake or dietary energy intake criteria in the definition of the PEW syndrome in patients on maintenance hemodialysis.
Collapse
Affiliation(s)
- Srinivasan Beddhu
- VA Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Guo Wei
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Xiaorui Chen
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Robert Boucher
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Rabia Kiani
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Dominic Raj
- Division of Renal Diseases and Hypertension, George Washington University, Washington, DC, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Denver, Colorado, USA
| | - Tom Greene
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Maureen A Murtaugh
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
116
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. ACTA ACUST UNITED AC 2017; 50:e6075. [PMID: 28423118 PMCID: PMC5441280 DOI: 10.1590/1414-431x20166075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
Obesity has become a worldwide epidemic and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for chronic kidney disease (CKD). A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day will promote education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- C P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - S L Furth
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| |
Collapse
|
117
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. Pediatr Nephrol 2017; 32:537-545. [PMID: 28188438 DOI: 10.1007/s00467-017-3595-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmine Zoccali
- CNR - IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio, Calabria, Italy
| | | |
Collapse
|
118
|
Kovesdy CP, Furth S, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. NEFROLOGÍA LATINOAMERICANA 2017. [DOI: 10.1016/j.nefrol.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
119
|
Kittiskulnam P, Chertow GM, Carrero JJ, Delgado C, Kaysen GA, Johansen KL. Sarcopenia and its individual criteria are associated, in part, with mortality among patients on hemodialysis. Kidney Int 2017; 92:238-247. [PMID: 28318630 DOI: 10.1016/j.kint.2017.01.024] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 01/28/2023]
Abstract
The relative importance of sarcopenia and its individual components as independent predictors of mortality in the dialysis population has not been determined. We estimated whole-body muscle mass using pre-dialysis bioimpedance spectroscopy measurements in 645 ACTIVE/ADIPOSE-enrolled prevalent hemodialysis patients from San Francisco and Atlanta. Low muscle mass was defined as two standard deviations below sex-specific means for young adults from NHANES and indexed to height2, body weight, body surface area, or body mass index. We evaluated the association of sarcopenia (low muscle mass) by four indexing methods, weak hand grip strength, and slow gait speed with mortality. Seventy-eight deaths were observed during a mean follow-up of 1.9 years. Sarcopenia was not significantly associated with mortality after adjusting for covariates. No muscle mass criteria were associated with death, regardless of indexing metrics. In contrast, having weak grip strength or slow walking speed was associated with mortality in the adjusted model. Only gait slowness significantly improved the predictive accuracy for death with an increase in C-statistic from 0.63 to 0.68. However, both gait slowness and hand grip weakness significantly improved the net reclassification index compared to models without performance measures (50.5% for slowness and 33.7% for weakness), whereas models with muscle size did not. Neither sarcopenia nor low muscle mass by itself was a better predictor of mortality than functional limitation alone in patients receiving hemodialysis. Thus, physical performance measures, including slow gait speed and weak hand grip strength, were associated with mortality even after adjustment for muscle size and other confounders.
Collapse
Affiliation(s)
- Piyawan Kittiskulnam
- Division of Nephrology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA; Division of Nephrology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Juan J Carrero
- Division of Renal Medicine, Centre for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia Delgado
- Division of Nephrology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | - George A Kaysen
- Division of Nephrology, Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento, California, USA
| | - Kirsten L Johansen
- Division of Nephrology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA.
| |
Collapse
|
120
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Can J Kidney Health Dis 2017; 4:2054358117698669. [PMID: 28540059 PMCID: PMC5433675 DOI: 10.1177/2054358117698669] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022] Open
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease (CKD). A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, TN, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
121
|
de Fornasari MLL, dos Santos Sens YA. Replacing Phosphorus-Containing Food Additives With Foods Without Additives Reduces Phosphatemia in End-Stage Renal Disease Patients: A Randomized Clinical Trial. J Ren Nutr 2017; 27:97-105. [DOI: 10.1053/j.jrn.2016.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022] Open
|
122
|
Kalantar-Zadeh K, Rhee CM, Chou J, Ahmadi SF, Park J, Chen JL, Amin AN. The Obesity Paradox in Kidney Disease: How to Reconcile it with Obesity Management. Kidney Int Rep 2017; 2:271-281. [PMID: 28439569 PMCID: PMC5399774 DOI: 10.1016/j.ekir.2017.01.009] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 12/29/2022] Open
Abstract
Obesity, a risk factor for de novo chronic kidney disease (CKD), confers survival advantages in advanced CKD. This so-called obesity paradox is the archetype of the reverse epidemiology of cardiovascular risks, in addition to the lipid, blood pressure, adiponectin, homocysteine, and uric acid paradoxes. These paradoxical phenomena are in sharp contradistinction to the known epidemiology of cardiovascular risks in the general population. In addition to advanced CKD, the obesity paradox has also been observed in heart failure, chronic obstructive lung disease, liver cirrhosis, and metastatic cancer, as well as in the elderly. These are populations in whom protein-energy wasting and inflammation are strong predictors of early death. Both larger muscle mass and higher body fat provide longevity in these patients, whereas thinner body habitus and weight loss are associated with higher mortality. Muscle mass appears to be superior to body fat in conferring an even greater survival. The obesity paradox may be the result of a time discrepancy between competing risk factors, i.e., overnutrition as the long-term killer versus undernutrition as the short-term killer. Hemodynamic stability of obesity, lipoprotein defense against circulating endotoxins, protective cytokine profiles, toxin sequestration of fat mass, and antioxidation of muscle may play important roles. Despite claims that obesity paradox is a statistical fallacy and a result of residual confounding, the consistency of data and other causality clues suggest a high biologic plausibility. Examining the causes and consequences of the obesity paradox may help discover important pathophysiologic mechanisms leading to improved outcomes in patients with CKD.
Collapse
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
- Program for Public Health, University of California Irvine, Irvine, California, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California, USA
- Nephrology Section, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - Jason Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
| | - S. Foad Ahmadi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, California, USA
- Program for Public Health, University of California Irvine, Irvine, California, USA
- Department of Medicine, University of California Irvine, School of Medicine, Orange, California, USA
| | - Jongha Park
- Nephrology Section, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Joline L.T. Chen
- Nephrology Section, VA Long Beach Healthcare System, Long Beach, California, USA
| | - Alpesh N. Amin
- Department of Medicine, University of California Irvine, School of Medicine, Orange, California, USA
| |
Collapse
|
123
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Am J Hypertens 2017; 30:328-336. [PMID: 28203687 DOI: 10.1093/ajh/hpw151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
- Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee
| | - Susan L. Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carmine Zoccali
- CNR–IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
124
|
Yanishi M, Kimura Y, Tsukaguchi H, Koito Y, Taniguchi H, Mishima T, Fukushima Y, Sugi M, Kinoshita H, Matsuda T. Factors Associated With the Development of Sarcopenia in Kidney Transplant Recipients. Transplant Proc 2017; 49:288-292. [DOI: 10.1016/j.transproceed.2016.12.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/02/2016] [Accepted: 12/20/2016] [Indexed: 12/16/2022]
|
125
|
|
126
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. Nephrology (Carlton) 2017; 22:191-198. [PMID: 28205349 DOI: 10.1111/nep.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carmine Zoccali
- CNR - IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
127
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. Intern Med J 2017; 47:134-143. [PMID: 28201856 DOI: 10.1111/imj.13342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/07/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carmine Zoccali
- CNR - IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
128
|
Wu LW, Lin YY, Kao TW, Lin CM, Liaw FY, Wang CC, Peng TC, Chen WL. Mid-arm muscle circumference as a significant predictor of all-cause mortality in male individuals. PLoS One 2017; 12:e0171707. [PMID: 28196081 PMCID: PMC5308605 DOI: 10.1371/journal.pone.0171707] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/23/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Emerging evidences indicate that mid-arm muscle circumference (MAMC) is one of the anthropometric indicators that reflect health and nutritional status, but its correlative effectiveness in all-cause mortality prediction of United States individuals remains uncertain. METHODS AND FINDINGS DESIGN We investigated the joint association between MAMC and all-cause mortality in the US general population. A population-based longitudinal study of 6,769 participants aged 40 to 90 years in the third National Health and Nutrition Examination Survey (NHANES III) conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. All participants were divided into two groups based on the gender: male and female group; each group was then divided into three subgroups depending on their MAMC level. The tertiles were as follows: T1 (18<27.3), T2 (27.3<29.6), T3 (29.6≤40.0) cm in the male group and T1 (15<22.3), T2 (22.3<24.6), T3 (24.6≤44.0) cm in the female group. Multivariable Cox regression analyses and Kaplan-Meier survival probabilities were utilized to jointly relate all-cause mortality risk to different MAMC level. For all-cause mortality in male participants, multivariable adjusted hazard ratios (HRs) were 0.83 (95% confidence interval (CI): 0.69-0.98; p = 0.033) for MAMC of 27.3-29.6 cm compared with 18-27.3 cm, and 0.76 (95% CI: 0.61-0.95; p = 0.018) for MAMC of 29.6-40 cm compared with 18-27.3 cm. For all-cause mortality in female participants, multivariable adjusted hazard ratios (HRs) were 0.84 (95% confidence interval (CI): 0.69-1.02; p = 0.075) for MAMC of 22.3-24.6 cm compared with 15-22.3 cm, and 0.94 (95% CI: 0.75-1.17; p = 0.583) for MAMC of 24.6-44 cm compared with 15-22.3 cm. CONCLUSION Results support a lower MAMC is associated with a higher mortality risk in male individuals.
Collapse
Affiliation(s)
- Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yuan-Yung Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Otolaryngology–Head and Neck Surgery, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tung-Wei Kao
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
| | - Chien-Ming Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Department of Pediatrics, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Fang-Yih Liaw
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chung-Ching Wang
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
| | - Tao-Chun Peng
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Liang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
| |
Collapse
|
129
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: hidden consequences of the epidemic. Nephrol Dial Transplant 2017; 32:203-210. [DOI: 10.1093/ndt/gfw442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
|
130
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Am J Nephrol 2017; 45:283-291. [PMID: 28178697 DOI: 10.1159/000458467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | |
Collapse
|
131
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Nephron Clin Pract 2017; 135:243-251. [PMID: 28171864 DOI: 10.1159/000455698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | | |
Collapse
|
132
|
Locke JE, Carr JJ, Nair S, Terry JG, Reed RD, Smith GD, Segev DL, Kumar V, Lewis CE. Abdominal lean muscle is associated with lower mortality among kidney waitlist candidates. Clin Transplant 2017; 31. [PMID: 28075034 DOI: 10.1111/ctr.12911] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2016] [Indexed: 01/12/2023]
Abstract
Morphometric assessments, such as muscle density and body fat distribution, have emerged as strong predictors of cardiovascular risk and postoperative morbidity and mortality. To date, no study has examined morphometric mortality risk prediction among kidney transplant (KT) candidates. KT candidates, waitlisted 2008-2009, were identified (n=96) and followed to the earliest of transplant, death, or administrative end of study. Morphometric measures, including abdominal adipose tissue, paraspinous and psoas muscle composition, and aortic calcification, were measured from CTs. Risk of waitlist mortality was examined using Cox proportional hazard regression. On adjusted analyses, radiologic measures remained independently and significantly associated with lower waitlist mortality; the addition of radiologic measures significantly improved model predictive ability over models containing traditional risk factors alone (net reclassification index: 0.56, 95% CI: 0.31-0.75). Higher psoas muscle attenuation (indicative of leaner muscle) was associated with decreased risk of death (aHR: 0.93, 95% CI: 0.91-0.96, P<.001), and for each unit increase in lean paraspinous volume, there was an associated 2% decreased risk for death (aHR: 0.98, 95% CI: 0.96-0.99, P=.03). Radiologic measures of lean muscle mass, such as psoas muscle attenuation and paraspinous lean volume, may improve waitlist mortality risk prediction and candidate selection.
Collapse
Affiliation(s)
- Jayme E Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Jeffrey Carr
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Sangeeta Nair
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA
| | - James G Terry
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Rhiannon D Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grant D Smith
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
133
|
Kovesdy CP, Furth S, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. Nephrol Ther 2017; 13:131-137. [PMID: 28159482 DOI: 10.1016/j.nephro.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 10/05/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Csaba P Kovesdy
- Division of nephrology, Department of medicine, University of Tennessee Health science center, Memphis, TN, United States; Nephrology section, Memphis VA Medical center, Memphis, TN, United States
| | - Susan Furth
- Department of pediatrics, Perelman school of medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carmine Zoccali
- CNR-IFC Clinical epidemiology and pathophysiology of renal diseases and hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
134
|
Obesity and kidney disease: hidden consequences of the epidemic. Future Sci OA 2017; 3:FSO159. [PMID: 28883987 PMCID: PMC5583661 DOI: 10.4155/fsoa-2016-0081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023] Open
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for chronic kidney disease. A high BMI is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased tenfold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
|
135
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. KIDNEY DISEASES 2017; 3:33-41. [PMID: 28785562 DOI: 10.1159/000452965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
136
|
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for chronic kidney disease (CKD). A high body mass index is one of the strongest risk factors for new-onset CKD. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing CKD in the long term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyles and health policy measures that make preventive behaviors an affordable option.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
137
|
Wang J, Streja E, Soohoo M, Chen JLT, Rhee CM, Kim T, Molnar MZ, Kovesdy CP, Mehrotra R, Kalantar-Zadeh K. Concurrence of Serum Creatinine and Albumin With Lower Risk for Death in Twice-Weekly Hemodialysis Patients. J Ren Nutr 2017; 27:26-36. [PMID: 27528412 PMCID: PMC5326741 DOI: 10.1053/j.jrn.2016.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Markers of better nutritional status including both higher levels of serum albumin (as a measure of visceral proteins) and creatinine (as a measure of the muscle mass) are associated with lower mortality in conventional (thrice weekly) hemodialysis patients. However, data for these associations in twice-weekly hemodialysis patients, in whom less frequent hemodialysis may confound nutritional predictors, are lacking. DESIGN AND SUBJECTS We identified 1,113 twice-weekly and matched 4,448 thrice-weekly hemodialysis patients from a large national dialysis cohort of incident hemodialysis patients over 5 years (2007-2011). Mortality risk, adjusted for potential confounders, was examined across two-by-two combinations of serum creatinine (<6 vs. ≥6 mg/dL) and albumin (<3.5 g/dL vs. ≥3.5 g/dL) for each treatment frequency yielding a total of 8 groups. RESULTS Patients were aged 70 ± 14 years and included 48% women and 55% diabetics. Using the thrice-weekly hemodialysis patients with creatinine ≥ 6 mg/dL and albumin ≥ 3.5 g/dL as reference, patients with creatinine <6 mg/dL and albumin <3.5 g/dL had a 1.8-fold higher risk of mortality (hazard ratio: 1.75, 95% confidence interval: 1.33-2.30) in twice-weekly and 2.2-fold increased risk of mortality (hazard ratio: 2.21, 95% confidence interval: 1.81-2.70) in thrice-weekly hemodialysis patients, respectively in fully adjusted models adjusted for demographics, comorbidities, and markers of malnutrition and inflammation. A test for interaction showed that there was no significant difference in albumin creatinine mortality associations between twice-weekly and thrice-weekly hemodialysis patients (P-for-interaction = .7667). CONCLUSIONS Surrogate markers of higher visceral protein and muscle mass combined may confer greatest survival in both twice-weekly and thrice-weekly hemodialysis patients.
Collapse
Affiliation(s)
- Jialin Wang
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, China
| | - Elani Streja
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Melissa Soohoo
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Joline L T Chen
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California
| | - Connie M Rhee
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Taehee Kim
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Department of Medicine, Inje University, Busan, South Korea
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Rajnish Mehrotra
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California.
| |
Collapse
|
138
|
Kovesdy CP, Furth S, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. Indian J Nephrol 2017; 27:85-92. [PMID: 28356657 PMCID: PMC5358165 DOI: 10.4103/ijn.ijn_61_17] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Csaba P Kovesdy
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, United States; Nephrology Section, Memphis VA Medical Center, Memphis, TN, United States
| | - Susan Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Carmine Zoccali
- CNR - IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
| | | |
Collapse
|
139
|
Vogt BP, Borges MCC, Góes CRD, Caramori JCT. Response to the letter "Handgrip strength may not accurately reflect the overall nutritional status of patients". Clin Nutr 2016; 36:317-318. [PMID: 27914714 DOI: 10.1016/j.clnu.2016.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Barbara Perez Vogt
- Department of Clinical Medicine, Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Brazil
| | | | - Cassiana Regina de Góes
- Department of Clinical Medicine, Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Brazil
| | | |
Collapse
|
140
|
Gowda C, Brown TT, Compher C, Forde KA, Kostman J, Shaw PA, Tien PC, Lo Re V. Prevalence and predictors of low muscle mass in HIV/viral hepatitis coinfection. AIDS 2016; 30:2519-2528. [PMID: 27490638 DOI: 10.1097/qad.0000000000001213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Low muscle mass is associated with reduced survival in HIV, possibly mediated by systemic inflammation. Viral hepatitis coinfection can induce additional inflammation and hepatic dysfunction that may exacerbate low muscle mass. We determined the prevalence of and risk factors for low muscle mass in HIV/viral hepatitis coinfection. DESIGN AND METHODS A cross-sectional study of participants in the Multicenter AIDS Cohort Study and Women's Interagency HIV Study with anthropometry performed after 1 January 2000. Viral hepatitis defined by positive hepatitis B virus surface antigen and/or hepatitis C virus RNA. Low muscle mass defined as less than 10th percentile of age-matched and sex-matched reference values for mid-upper arm circumference. Using multivariable logistic regression, we determined adjusted odds ratios with 95% confidence intervals (CIs) of the association of HIV/viral hepatitis coinfection with low muscle mass and factors associated with low muscle mass in coinfected persons. Analyses adjusted for age, race, BMI, alcohol use, and IDU (also, nadir CD4 cell count and HIV RNA where appropriate). RESULTS Among 3518 participants (164 HIV/viral hepatitis, 223 viral hepatitis alone, 1070 HIV alone, and 2061 uninfected), HIV/viral hepatitis-coinfected persons had a 3.50-fold (95% CI, 1.51-8.09), 1.93-fold (1.17-3.20), and 2.65-fold (1.62-4.35) higher odds of low muscle mass than viral hepatitis-monoinfected, HIV-monoinfected, and uninfected persons, respectively. Lack of HIV RNA suppression [odds ratio, 2.26 (95% CI, 1.10-4.63)] was the only factor associated with low muscle mass in coinfected persons. CONCLUSION HIV/viral hepatitis-coinfected persons have a higher likelihood of low muscle mass than those with viral hepatitis monoinfection, HIV monoinfection, or neither infection. HIV viremia is an important risk factor for low muscle mass among coinfected persons.
Collapse
|
141
|
Camilleri B, Bridson JM, Sharma A, Halawa A. From chronic kidney disease to kidney transplantation: The impact of obesity and its treatment modalities. Transplant Rev (Orlando) 2016; 30:203-11. [PMID: 27534874 DOI: 10.1016/j.trre.2016.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/25/2016] [Accepted: 07/22/2016] [Indexed: 12/19/2022]
Abstract
Obesity is associated with worse short-term outcomes after kidney transplantation but the effect on long-term outcomes is unknown. Although some studies have reported worse outcomes for obese recipients when compared to recipients with a BMI in the normal range, obese recipients who receive a transplant have better outcomes than those who remain wait-listed. Whether transplant candidates should be advised to lose weight before or after transplant has been debated and this is mainly due to the gap in the literature linking pre-transplant weight loss with better outcomes post-transplantation. The issue is further complicated by the use of BMI as a metric of body fat, the obesity paradox in dialysis patients and the different ethical viewpoints of utility versus equity. Measures used to reduce weight loss, including orlistat and bariatric surgery (in particular those with a malabsorptive component), have been associated with enteric hyperoxaluria with consequent risk of nephrolithiasis and oxalate nephropathy. In this review, we discuss the evidence regarding the use of weight loss measures in the kidney transplant candidate and recipient with a view to recommending whether weight loss should be pursued before or after kidney transplantation.
Collapse
Affiliation(s)
- Brian Camilleri
- Renal Unit, Ipswich Hospital NHS Trust, Heath Road, Ipswich, United Kingdom IP4 5PD; Faculty of Health and Life Sciences, Cedar House, Ashton Street, University of Liverpool, Liverpool, United Kingdom L69 3GB.
| | - Julie M Bridson
- Faculty of Health and Life Sciences, Cedar House, Ashton Street, University of Liverpool, Liverpool, United Kingdom L69 3GB
| | - Ajay Sharma
- Faculty of Health and Life Sciences, Cedar House, Ashton Street, University of Liverpool, Liverpool, United Kingdom L69 3GB; Link 9C, Royal Liverpool University Hospital, Liverpool, United Kingdom L7 8XP
| | - Ahmed Halawa
- Faculty of Health and Life Sciences, Cedar House, Ashton Street, University of Liverpool, Liverpool, United Kingdom L69 3GB; Northern General Hospital, Herries Road, Sheffield, United Kingdom S5 7AU
| |
Collapse
|
142
|
Carrero JJ, Johansen KL, Lindholm B, Stenvinkel P, Cuppari L, Avesani CM. Screening for muscle wasting and dysfunction in patients with chronic kidney disease. Kidney Int 2016; 90:53-66. [PMID: 27157695 DOI: 10.1016/j.kint.2016.02.025] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/12/2016] [Accepted: 02/17/2016] [Indexed: 12/15/2022]
Abstract
Skeletal muscle mass and muscle function are negatively affected by a variety of conditions inherent to chronic kidney disease (CKD) and to dialysis treatment. Skeletal muscle mass and function serve as indicators of the nutritional and clinical state of CKD patients, and low values or derangements over time are strong predictors of poor patient outcomes. However, muscle size and function can be affected by different factors, may decline at different rates, and may have different patient implications. Therefore, operational definitions of frailty and sarcopenia have emerged to encompass these 2 dimensions of muscle health, i.e., size and functionality. The aim of this review is to appraise available methods for assessment of muscle mass and functionality, with an emphasis on their accuracy in the setting of CKD patients. We then discuss the selection of reference cutoffs for defining conditions of muscle wasting and dysfunction. Finally, we review definitions applied in studies addressing sarcopenia and frailty in CKD patients and discuss their applicability for diagnosis and monitoring.
Collapse
Affiliation(s)
- Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Kirsten L Johansen
- Division of Nephrology, University of California, San Francisco, San Francisco, California, USA
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Lilian Cuppari
- Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Carla M Avesani
- Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
143
|
Vogt BP, Borges MCC, Goés CRD, Caramori JCT. Handgrip strength is an independent predictor of all-cause mortality in maintenance dialysis patients. Clin Nutr 2016; 35:1429-1433. [PMID: 27083497 DOI: 10.1016/j.clnu.2016.03.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 02/12/2016] [Accepted: 03/24/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Muscle wasting is associated with mortality in dialysis patients. The measurement of muscle mass has some limitations, while muscle strength assessment is simple, safe and allows the recognition of patients at risk of progressing to poor outcomes related to malnutrition. The aim of this study is verify if handgrip strength (HGS) is associated with all-cause mortality in patients in maintenance haemodialysis (HD) and peritoneal dialysis (PD). METHODS This was an observational retrospective cohort study which included all patients in maintenance HD and PD from July 2012 to October 2014. Patients were followed-up until June 2015. RESULTS Two-hundred sixty five patients were enrolled (218 HD and 47 PD) and they were followed for 13.4 ± 7.9 months. During the follow-up period, 53 patients (20%) have died, 36 patients (13.6%) have undergone renal transplantation, 13 patients (4.9%) have switched off dialysis method and 5 patients (1.9%) have transferred to another facility. The cut-off of HGS able to predict mortality was 22.5 kg for men and 7 kg for women. Using this cut-off to fit the Kaplan-Meier survival curve, the association of HGS with all-cause mortality for both genders was confirmed. Finally, in the multivariate analysis adjusted for demographic, clinical and nutritional variables, HGS remained significant predictor of mortality, independent of dialysis modality. CONCLUSIONS HGS cut-offs that predict mortality were 22.5 kg for men and 7 kg for women. HGS was associated with mortality independent of dialysis modality.
Collapse
Affiliation(s)
- Barbara Perez Vogt
- Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil
| | - Mariana Clementoni Costa Borges
- Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil
| | - Cassiana Regina de Goés
- Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Clinical Medicine, Botucatu, São Paulo, Brazil
| | | |
Collapse
|
144
|
Kovesdy CP, Furth SL, Zoccali C. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Blood Purif 2016; 43:346-354. [PMID: 28249281 DOI: 10.1159/000458481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease, and also for chronic kidney disease. A high body mass index is one of the strongest risk factors for new-onset chronic kidney disease. In individuals affected by obesity, a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing chronic kidney disease in the long-term. The incidence of obesity-related glomerulopathy has increased 10-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year, the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option. Video Journal Club 'Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=458481.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center Memphis, TN, USA
| | | | | | | |
Collapse
|
145
|
Kalantar-Zadeh K, Ahmadi SF. Carrying a heavier weight is healthy: Obesity-reinforced fitness hypothesis in metabolically healthy obesity. Obesity (Silver Spring) 2016; 24:281-2. [PMID: 26715395 PMCID: PMC4749917 DOI: 10.1002/oby.21399] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology & Hypertension, Harold Simons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
- Nephrology Section, VA Long Beach Healthcare System, Long Beach, California, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Seyed-Foad Ahmadi
- Division of Nephrology & Hypertension, Harold Simons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, California, USA
| |
Collapse
|
146
|
Doshi M, Streja E, Rhee CM, Park J, Ravel VA, Soohoo M, Moradi H, Lau WL, Mehrotra R, Kuttykrishnan S, Kovesdy CP, Kalantar-Zadeh K, Chen JLT. Examining the robustness of the obesity paradox in maintenance hemodialysis patients: a marginal structural model analysis. Nephrol Dial Transplant 2015; 31:1310-9. [PMID: 26590266 DOI: 10.1093/ndt/gfv379] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/08/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The inverse association between body mass index (BMI) and mortality observed in patients treated with maintenance hemodialysis (MHD), also known as the obesity paradox, may be a result of residual confounding. Marginal structural model (MSM) analysis, a technique that accounts for time-varying confounders, may be more appropriate to investigate this association. We hypothesize that after applying MSM, the inverse association between BMI and mortality in MHD patients is attenuated. METHODS We examined the associations between BMI and all-cause mortality among 123 624 adult MHD patients treated during 2001-6. We examined baseline and time-varying BMI using Cox proportional hazards models and MSM while considering baseline and time-varying covariates, including demographics, comorbidities and markers of malnutrition and inflammation. RESULTS The patients included 45% women and 32% African Americans with a mean age of 61(SD 15) years. In all models, BMI showed a linear incremental inverse association with mortality. Compared with the reference (BMI 25 to <27.5 kg/m(2)), a BMI of <18 kg/m(2) was associated with a 3.2-fold higher death risk [hazard ratio (HR) 3.17 (95% CI 3.05-3.29)], and mortality risks declined with increasing BMI with the greatest survival advantage of 31% lower risk [HR 0.69 (95% CI 0.64-0.75)] observed with a BMI of 40 to <45 kg/m(2). CONCLUSIONS The linear inverse relationship between BMI and mortality is robust across models including MSM analyses that more completely account for time-varying confounders and biases.
Collapse
Affiliation(s)
- Megha Doshi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Jongha Park
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Division of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Vanessa A Ravel
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Hamid Moradi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA
| | - Wei Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA
| | - Rajnish Mehrotra
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Sooraj Kuttykrishnan
- Harborview Medical Center and Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Joline L T Chen
- Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, School of Medicine, Orange, CA, USA Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, CA, USA
| |
Collapse
|
147
|
Stenvinkel P, Gillespie IA, Tunks J, Addison J, Kronenberg F, Drueke TB, Marcelli D, Schernthaner G, Eckardt KU, Floege J, Froissart M, Anker SD. Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients. J Am Soc Nephrol 2015; 27:1479-86. [PMID: 26567245 DOI: 10.1681/asn.2015030252] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/09/2015] [Indexed: 11/03/2022] Open
Abstract
High body mass index (BMI) is paradoxically associated with better outcome in hemodialysis (HD) patients. Persistent inflammation commonly features in clinical conditions where the obesity paradox is described. We examined the relationship between BMI and mortality in HD patients, accounting for inflammation, in a historic cohort study of 5904 incident HD patients enrolled in 2007-2009 (312 facilities; 15 European countries) with ≥3 months of follow-up. Patients were classified by presence (n=3231) or absence (n=2673) of inflammation (C-reactive protein ≥10 mg/l and/or albumin ≤35 g/l). Patients were divided into quintiles by BMI (Q1-Q5: <21.5, 21.5-24.0, >24.0-26.4, >26.4-29.8, and >29.8 kg/m(2), respectively). Noninflamed patients in BMI Q5 formed the reference group. During a median follow-up period of 36.7 months, 1929 deaths occurred (822 cardiovascular), with 655 patients censored for renal transplantation and 1183 for loss to follow-up. Greater mortality was observed in inflamed patients (P<0.001). In fully adjusted time-dependent analyses, the all-cause mortality risk in noninflamed patients was higher only in the lowest BMI quintile (hazard ratio [HR, 1.80; 95% confidence interval [95% CI], 1.26 to 2.56). No protective effect was associated with higher BMI quintiles in noninflamed patients. Conversely, higher BMI associated with lower all-cause mortality risk in inflamed patients (HR [95% CI] for Q1: 5.63 [4.25 to 7.46]; Q2: 3.88 [2.91 to 5.17]; Q3: 2.89 [2.16 to 3.89]; Q4: 2.14 [1.59 to 2.90]; and Q5: 1.77 [1.30 to 2.40]). Thus, whereas a protective effect of high BMI was observed in inflamed patients, this effect was mitigated in noninflamed patients.
Collapse
Affiliation(s)
- Peter Stenvinkel
- Department of Renal Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden;
| | - Iain A Gillespie
- Center for Observational Research, Amgen Ltd., Uxbridge, United Kingdom
| | - Jamie Tunks
- Global Biostatistical Science, Amgen Ltd., Cambridge, United Kingdom
| | - Janet Addison
- Center for Observational Research, Amgen Ltd., Uxbridge, United Kingdom
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tilman B Drueke
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Hôpital Paul Brousse and Université Paris-Sud, Villejuif, France
| | - Daniele Marcelli
- Europe, Middle East, Africa and Latin America Medical Board, Fresenius Medical Care, Bad Homburg, Germany
| | | | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Germany
| | - Jürgen Floege
- Department of Nephrology, RWTH University of Aachen, Aachen, Germany
| | - Marc Froissart
- International Development Nephrology, Amgen Europe GmbH, Zug, Switzerland; and
| | - Stefan D Anker
- Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
| | | |
Collapse
|
148
|
Rymarz A, Bartoszewicz Z, Szamotulska K, Niemczyk S. The Associations Between Body Cell Mass and Nutritional and Inflammatory Markers in Patients With Chronic Kidney Disease and in Subjects Without Kidney Disease. J Ren Nutr 2015; 26:87-92. [PMID: 26559600 DOI: 10.1053/j.jrn.2015.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/20/2015] [Accepted: 09/28/2015] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Body cell mass (BCM), a component of lean tissue mass (LTM), is a metabolically active part of the body. Lean tissue loss is one of the diagnostic criteria of protein energy wasting. In patients with chronic kidney disease (CKD), a decrease of lean tissue, including BCM, may be replaced by an increase of extracellular water. Bioimpedance spectroscopy (BIS) enables the assessment of the amount of BCM, LTM, and fluid overload. The aim of our study was to assess the relationship between BCM measured by BIS and anthropometric measurements, biochemical markers of nutrition and also inflammatory markers. METHODS Forty-eight patients treated with hemodialysis (HD; 32 males and 16 females) with a mean age 59.8 ± 15.5 (HD group), 61 patients with CKD Stage 4 to 5 (35 males and 26 females) with a mean age of 60.1 ± 17.7 (predialysis group) and 33 individuals with normal renal function (18 males and 15 women) with a mean age 58.7 ± 17.0 (control group) were included. Body mass index, handgrip strength (HGS), body composition measured by BIS, and biochemical analyses were performed on all of them. RESULTS Positive correlations were observed between BCM and LTM, HGS, serum creatinine and insulin-like growth factor 1 concentrations in all groups. Serum prealbumin concentration correlated positively with BCM only in the predialysis group (r = 0.406; P = .001). The amount of lymphocytes also correlated passively with BCM in predialysis group (r = 0.314; P = .024). Negative correlations were noted between BCM and fat mass in all groups and between BCM and interleukin 6 concentrations only in the HD group. In this study, BCM neither correlated with body mass index and serum albumin nor with C-reactive protein. CONCLUSIONS BCM is strongly associated with biochemical determinants of muscle mass (serum creatinine, insulin-like growth factor 1) and muscle function (HGS) in patients treated with HD, with CKD Stage 4 to 5 and in individuals without kidney disease. Its significance requires further investigation.
Collapse
Affiliation(s)
- Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland.
| | - Zbigniew Bartoszewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
| | | | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, Warsaw, Poland
| |
Collapse
|
149
|
Wang J, Streja E, Rhee CM, Soohoo M, Feng M, Brunelli SM, Kovesdy CP, Gillen D, Kalantar-Zadeh K, Chen JLT. Lean Body Mass and Survival in Hemodialysis Patients and the Roles of Race and Ethnicity. J Ren Nutr 2015; 26:26-37. [PMID: 26482246 DOI: 10.1053/j.jrn.2015.07.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/16/2015] [Accepted: 07/21/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lean body mass (LBM) represents the "fat-free" muscle mass in hemodialysis (HD) patients and is an important nutritional measure. Previous studies have found that both higher LBM and body mass index (BMI) were related to greater survival in HD patients. Additional studies have shown differences in survival across racial-ethnic groups of HD patients. However, the association of LBM and mortality across racial-ethnic subgroups has not been examined. OBJECTIVE We hypothesize that racial differences in LBM affect the mortality in HD patients. SETTING AND SUBJECTS Chronic HD patients from a large dialysis organization in the United States. PREDICTORS Estimated LBM (eLBM), self-identified racial subgroups. MAIN OUTCOME MEASURE 5-year survival. STUDY DESIGN We examined the association between baseline eLBM and survival using Cox proportional hazard models adjusted for demographics, comorbidities, and laboratory measures. Associations were examined across subgroups of race-ethnicity (non-Hispanic white, African American, and Hispanic) and BMI. RESULTS The final cohort included 117,683 HD patients, who were 62 ± 15 (mean ± standard deviation) years old, 43% women and 59% with diabetes mellitus. Higher eLBM was linearly associated with lower mortality. Compared with the reference group (48.4-<50.5 kg), patients with the lowest eLBM (<41.3 kg) had a 1.4-fold higher risk of mortality (hazard ratio: 1.37; 95% confidence interval: 1.30-1.44) in the fully adjusted model. A similar linear association was seen among patients with BMI < 35 kg/m(2) and in non-Hispanic whites and African American subgroups. However, higher eLBM was not associated with improved survival in Hispanic patients or patients with BMI ≥ 35 kg/m(2). LIMITATION Potential residual confounding. CONCLUSIONS Higher eLBM is associated with a lower mortality risk in HD patients, especially among non-Hispanic white and African American groups. Hispanic patients do not demonstrate a similar inverse relationship. The association between LBM and mortality among different racial groups of HD patients deserves additional study.
Collapse
Affiliation(s)
- Jialin Wang
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, China
| | - Elani Streja
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Connie M Rhee
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Melissa Soohoo
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California
| | - Mingliang Feng
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Division of Nephrology, Jiangmen Central Hospital, Guangdong, China
| | | | - Csaba P Kovesdy
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee; Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Daniel Gillen
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Department of Statistics, University of California Irvine, Irvine, California
| | - Kamyar Kalantar-Zadeh
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California.
| | - Joline L T Chen
- School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, California; Department of Medicine, Long Beach Veteran Affairs Health System, Long Beach, California.
| |
Collapse
|
150
|
Irisin, a novel myokine is an independent predictor for sarcopenia and carotid atherosclerosis in dialysis patients. Atherosclerosis 2015; 242:476-82. [DOI: 10.1016/j.atherosclerosis.2015.08.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 07/07/2015] [Accepted: 08/06/2015] [Indexed: 01/03/2023]
|