151
|
Silva BC, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, de Oliveira RB, Castro MC, Moysés RM, Elias RM. Hemodynamic Behavior During Hemodialysis: Effects of Dialysate Concentrations of Bicarbonate and Potassium. ACTA ACUST UNITED AC 2014; 39:490-6. [DOI: 10.1159/000368459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 11/19/2022]
|
152
|
Muscle wasting in hemodialysis patients: new therapeutic strategies for resolving an old problem. ScientificWorldJournal 2013; 2013:643954. [PMID: 24382946 PMCID: PMC3870868 DOI: 10.1155/2013/643954] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 10/28/2013] [Indexed: 01/01/2023] Open
Abstract
Muscle wasting has long been recognized as a major clinical problem in hemodialysis (HD) patients. In addition to its impact on quality of life, muscle wasting has been proven to be associated with increased mortality rates. Identification of the molecular mechanisms underlying muscle wasting in HD patients provides opportunities to resolve this clinical problem. Several signaling pathways and humeral factors have been reported to be involved in the pathogenic mechanisms of muscle wasting in HD patients, including ubiquitin-proteasome system, caspase-3, insulin/insulin-like growth factor-1 (IGF-1) signaling, endogenous glucocorticoids, metabolic acidosis, inflammation, and sex hormones. Targeting the aforementioned crucial signaling and molecules to suppress protein degradation and augment muscle strength has been extensively investigated in HD patients. In addition to exercise training, administration of megestrol acetate has been proven to be effective in improving anorexia and muscle wasting in HD patients. Correction of metabolic acidosis through sodium bicarbonate supplements can decrease muscle protein degradation and hormone therapy with nandrolone decanoate has been reported to increase muscle mass. Although thiazolidinedione has been shown to improve insulin sensitivity, its role in the treatment of muscle wasting remains unclear. This review paper focuses on the molecular pathways and potential new therapeutic approaches to muscle wasting in HD patients.
Collapse
|
153
|
Abstract
Abnormalities in bone turnover, mineralization, and volume represent one of the three components of chronic kidney disease–related mineral and bone disorder (CKD-MBD). The risk of hip fracture is considerably high, while the risk of spinal compression fracture may not be more elevated among CKD patients than in general population. The relationship between bone fracture and bone mineral density in CKD patients is more complex than in those without kidney disease. An increase in the rate of falls has been reported to be a major cause of high hip fracture risk among CKD patients; however, it certainly is not the only underlying mechanism. Abnormal parathyroid function is not likely to be a major cause of hip fracture among CKD patients. In experimental CKD animals, mechanical elasticity properties of long bones showed an inverse correlation with kidney function. The deterioration of bone elasticity showed a significant correlation with bone biochemical changes. Of note, administration of the oral absorbent AST-120 was capable of preventing both changes. These findings suggest that uremic toxins cause a deterioration of bone material properties, and changes in material properties disturb bone elasticity. This disease concept cannot be considered to be a direct consequence of CKD-MBD. We therefore would like to call it ‘uremic osteoporosis'. This entity may be a major cause of increased hip fracture risk among CKD patients.
Collapse
|
154
|
Abstract
Age-related muscle loss impacts on whole-body metabolism and leads to frailty and sarcopenia, which are risk factors for fractures and mortality. Although nutrients are integral to muscle metabolism the relationship between nutrition and muscle loss has only been extensively investigated for protein and amino acids. The objective of the present paper is to describe other aspects of nutrition and their association with skeletal muscle mass. Mechanisms for muscle loss relate to imbalance in protein turnover with a number of anabolic pathways of which the mechanistic TOR pathway and the IGF-1–Akt–FoxO pathways are the most characterised. In terms of catabolism the ubiquitin proteasome system, apoptosis, autophagy, inflammation, oxidation and insulin resistance are among the major mechanisms proposed. The limited research associating vitamin D, alcohol, dietary acid–base load, dietary fat and anti-oxidant nutrients with age-related muscle loss is described. Vitamin D may be protective for muscle loss; a more alkalinogenic diet and diets higher in the anti-oxidant nutrients vitamin C and vitamin E may also prevent muscle loss. Although present recommendations for prevention of sarcopenia focus on protein, and to some extent on vitamin D, other aspects of the diet including fruits and vegetables should be considered. Clearly, more research into other aspects of nutrition and their role in prevention of muscle loss is required.
Collapse
|
155
|
Mak RH, Cheung WW. MicroRNAs: a new therapeutic frontier for muscle wasting in chronic kidney disease. Kidney Int 2013; 82:373-4. [PMID: 22846810 DOI: 10.1038/ki.2012.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multiple microRNAs (miRs) are implicated in muscle cell differentiation and muscle mass regulation. Pharmacological agents targeting miR-486 and other miRs, involved in muscle mass regulation, could potentially be developed into therapeutic agents for muscle wasting. Muscle wasting is prevalent among patients with chronic kidney disease (CKD). Xu et al. showed that miR-486 mimetic ameliorated muscle wasting in mice with CKD. miR mimetics may represent a new therapeutic frontier for muscle wasting in CKD.
Collapse
|
156
|
Kuczmarski JM, Martens CR, Lennon-Edwards SL, Edwards DG. Cardiac function and tolerance to ischemia-reperfusion injury in chronic kidney disease. Nephrol Dial Transplant 2013; 29:1514-24. [PMID: 24151020 DOI: 10.1093/ndt/gft336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiac dysfunction is an independent risk factor of ischemic heart disease and mortality in chronic kidney disease (CKD) patients, yet the relationship between impaired cardiac function and tolerance to ischemia-reperfusion (IR) injury in experimental CKD remains unclear. METHODS Cardiac function was assessed in 5/6 ablation-infarction (AI) and sham male Sprague-Dawley rats at 20 weeks of age, 8 weeks post-surgery using an isolated working heart system. This included measures taken during manipulation of preload and afterload to produce left ventricular (LV) function curves as well as during reperfusion following a 15-min ischemic bout. In addition, LV tissue was used for biochemical tissue analysis. RESULTS Cardiac function was impaired in AI animals during preload and afterload manipulations. Cardiac functional impairments persisted post-ischemia in the AI animals, and 36% of AI animals did not recover sufficiently to achieve aortic overflow following ischemia (versus 0% of sham animals). However, for those animals able to withstand the ischemic perturbation, no difference was observed in percent recovery of post-ischemic cardiac function between groups. Urinary NOx (nitrite + nitrate) excretion was lower in AI animals and accompanied by reduced LV endothelial nitric oxide synthase and NOx. LV antioxidants superoxide dismutase-1 and -2 were reduced in AI animals, whereas glutathione peroxidase-1/2 as well as NADPH-oxidase-4 and H(2)O(2) were increased in these animals. CONCLUSIONS Impaired cardiac function appears to predispose AI rats to poor outcomes following short-duration ischemic insult. These findings could be, in part, mediated by increased oxidative stress via nitric oxide-dependent and -independent mechanisms.
Collapse
Affiliation(s)
- James M Kuczmarski
- Department of Kinesiology and Applied Physiology, University of Delaware, 25 N College Avenue, McDowell Hall, Newark, DE 19716, USA Department of Biological Sciences, University of Delaware, Newark, DE, USA
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, 25 N College Avenue, McDowell Hall, Newark, DE 19716, USA
| | - Shannon L Lennon-Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, 25 N College Avenue, McDowell Hall, Newark, DE 19716, USA Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, 25 N College Avenue, McDowell Hall, Newark, DE 19716, USA Department of Biological Sciences, University of Delaware, Newark, DE, USA
| |
Collapse
|
157
|
Reese PP, Cappola AR, Shults J, Townsend RR, Gadegbeku C, Anderson C, Baker JF, Carlow D, Sulik MJ, Lo JC, Go AS, Ky B, Mariani L, Feldman HI, Leonard MB. Physical performance and frailty in chronic kidney disease. Am J Nephrol 2013; 38:307-15. [PMID: 24107579 PMCID: PMC4019506 DOI: 10.1159/000355568] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 05/26/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND Poor physical performance and frailty are associated with elevated risks of death and disability. Chronic kidney disease (CKD) is also strongly associated with these outcomes. The risks of poor physical performance and frailty among CKD patients, however, are not well established. METHODS We measured the Short Physical Performance Battery (SPPB; a summary test of gait speed, chair raises and balance; range 0-12) and the five elements of frailty among 1,111 Chronic Renal Insufficiency Cohort participants. Adjusting for demographics and multiple comorbidities, we fit a linear regression model for the outcome of SPPB score and an ordinal logistic regression model for frailty status. RESULTS Median (interquartile range, IQR) age was 65 (57-71) years, median estimated glomerular filtration rate (eGFR) for non-dialysis patients was 49 (36-62) ml/min/1.73 m(2), and median SPPB score was 9 (7-10). Seven percent of participants were frail and 43% were pre-frail. Compared with the SPPB score for eGFR >60 ml/min/1.73 m(2), the SPPB was 0.51 points lower for eGFR 30-59; 0.61 points lower for eGFR 15-29, and 1.75 points lower for eGFR <15 (p < 0.01 for all comparisons). eGFR 30-59 (odds ratio, OR 1.45; p = 0.024), eGFR 15-29 (OR 2.02; p = 0.002) and eGFR <15 (OR 4.83; p < 0.001) were associated with worse frailty status compared with eGFR >60 ml/min/1.73 m(2). CONCLUSIONS CKD severity was associated with poor physical performance and frailty in a graded fashion. Future trials should determine if outcomes for CKD patients with frailty and poor physical performance are improved by targeted interventions.
Collapse
Affiliation(s)
- Peter P. Reese
- Perelman School of Medicine at the University of Pennsylvania, Renal Division, Department of Medicine, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
- University of Pennsylvania, Leonard Davis Institute of Health Economics
| | - Anne R. Cappola
- Perelman School of Medicine at the University of Pennsylvania, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Philadelphia, PA
| | - Justine Shults
- Perelman School of Medicine at the University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
- The Children's Hospital of Philadelphia
| | - Raymond R. Townsend
- Perelman School of Medicine at the University of Pennsylvania, Renal Division, Department of Medicine, Philadelphia, PA
| | - Crystal Gadegbeku
- Temple University, Renal Division, Department of Medicine, Philadelphia, PA
| | - Cheryl Anderson
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA
| | - Joshua F. Baker
- Perelman School of Medicine at the University of Pennsylvania, Rheumatology Division, Department of Medicine, Philadelphia, PA
| | | | | | - Joan C. Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, CA
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Cardiology Division, Department of Medicine, Philadelphia, PA
| | - Laura Mariani
- University of Michigan Medical School, Renal Division, Ann Arbor, MI
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - Harold I. Feldman
- Perelman School of Medicine at the University of Pennsylvania, Renal Division, Department of Medicine, Philadelphia, PA
- Perelman School of Medicine at the University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
- University of Pennsylvania, Leonard Davis Institute of Health Economics
| | - Mary B. Leonard
- Perelman School of Medicine at the University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, PA
- The Children's Hospital of Philadelphia
| | | |
Collapse
|
158
|
Myostatin/activin pathway antagonism: Molecular basis and therapeutic potential. Int J Biochem Cell Biol 2013; 45:2333-47. [DOI: 10.1016/j.biocel.2013.05.019] [Citation(s) in RCA: 198] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/17/2013] [Accepted: 05/18/2013] [Indexed: 11/21/2022]
|
159
|
Muscaritoli M, Lucia S, Molfino A, Cederholm T, Rossi Fanelli F. Muscle atrophy in aging and chronic diseases: is it sarcopenia or cachexia? Intern Emerg Med 2013; 8:553-60. [PMID: 22773188 DOI: 10.1007/s11739-012-0807-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 06/18/2012] [Indexed: 12/24/2022]
Abstract
Cachexia and sarcopenia present several analogies in both the pathogenic mechanisms and the clinical picture. The loss of muscle mass and strength is a hallmark of these two clinical conditions. Although frequently overlapping and often indistinguishable, especially in old individuals, these two conditions should be considered distinct clinical entities. A prompt and accurate patient evaluation, guiding the physician through a proper differential diagnostic procedure and providing the best therapeutic options, is recommended. Given the several commonalities between cachexia and sarcopenia, it is likely that the therapeutic approaches may prove effective in both conditions. This review focuses on the most recent available literature and aims at providing physicians with the correct tools that are available to aid in diagnosing these two different entities that often clinically overlap. Currently available or proposed therapeutic strategies for pre-cachexia, cachexia and sarcopenia are also briefly described.
Collapse
Affiliation(s)
- Maurizio Muscaritoli
- Department of Clinical Medicine, Sapienza, University of Rome, Viale dell'Università, 37, 00185, Rome, Italy,
| | | | | | | | | |
Collapse
|
160
|
Faria RDS, Fernandes N, Lovisi JCM, Reboredo MDM, Marta MSDM, Pinheiro BDV, Bastos MG. Pulmonary function and exercise tolerance are related to disease severity in pre-dialytic patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2013; 14:184. [PMID: 24007403 PMCID: PMC3847184 DOI: 10.1186/1471-2369-14-184] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/08/2013] [Indexed: 11/30/2022] Open
Abstract
Background Chronic kidney disease (CKD) involves a progressive, irreversible loss of kidney function. While early-stage CKD patients may show changes in pulmonary function and lowered exercise tolerance, the role of the estimated glomerular filtration rate (eGFR) in these patterns remains unknown. The aim of this study was to investigated pulmonary function and exercise tolerance in pre-dialytic CKD patients. Methods A cross-sectional study was carried out with 38 adult volunteers divided into a control group (CG), consisting of 9 healthy adults, and 29 pre-dialytic CKD patients in stages 3 (G3), 4 (G4), and 5 (G5). All participants underwent spirometric and manovacuometric tests, a cardiopulmonary exercise test (CPET), a 6-minute walk test (6MWT), and laboratory tests. Results The significant differences was observed in maximal exercise tolerance, measured as peak oxygen consumption percentage (VO2peak) (mL/kg/min) (CG = 28.9 ± 7.8, G3 = 23.3 ± 5.6, G4 = 21.4 ± 5.2, G5 = 20.2 ± 6.9; p = 0.03), and submaximal exercise tolerance, measured by 6MWT (m) (CG = 627.6 ± 37.8, G3 = 577.4 ± 66.1, G4 = 542.7 ± 57.3, G5 = 531.5 ± 84.2, p = 0.01). The eGFR was associated with pulmonary function-forced expiratory volume in the first second percentage (FEV1) (%) (r = 0.34, p = 0.02) and maximum inspiratory pressure (PImax) (r = 0.41, p = 0.02) - and exercise tolerance - VO2peak (mL/kg/min) (r = 0.43, p = 0.01) and 6MWT distance (m) (r = 0.55, p < 0.01). Conclusion Pre-dialytic CKD patients showed lower maximal and submaximal exercise tolerances than healthy individuals.
Collapse
Affiliation(s)
- Ruiter de Souza Faria
- Interdisciplinary Nucleus of Study, Research and Treatment in Nephrology (NIEPEN), Federal University of Juiz de Fora, José Lourenço Kelmer, 1300, São Pedro, 36036-330 Juiz de Fora, Minas Gerais, Brazil.
| | | | | | | | | | | | | |
Collapse
|
161
|
Kojo G, Yoshida T, Ohkawa S, Odamaki M, Kato A, Takita T, Maruyama Y, Kumagai H. Association of serum total testosterone concentration with skeletal muscle mass in men under hemodialysis. Int Urol Nephrol 2013; 46:985-91. [PMID: 23979817 DOI: 10.1007/s11255-013-0543-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/14/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Although skeletal muscle wasting can occur in chronic kidney diseases, its relationship with the serum testosterone concentration remains uncertain. This study investigates the relationship between serum testosterone and skeletal muscle mass in men under hemodialysis (HD). METHODS Sixty men aged between 41 and 89 years undergoing HD for 15.0 ± 8.1 years were enrolled for this study. The muscle areas of the thigh (TMA) and abdomen (AMA) were measured by computed tomography (CT), and the association between these muscle areas and serum total testosterone was examined with adjustment of age and other nutritional variables. RESULTS The mean serum total testosterone in our HD patients (6.33 ± 2.90 ng/mL) was not lower than that of the Japanese general population, but showed a positive correlation with TMA (r = 0.39, p < 0.05), AMA (r = 0.52, p < 0.001), serum creatinine (r = 0.33, p < 0.05), and the creatinine generation rate (r = 0.26, p < 0.05). Serum total testosterone was inversely correlated with age (r = -0.32, p < 0.05), CRP (r = -0.31, p < 0.05), and IL-6 (r = -0.24, p < 0.05). A multiple-regression analysis showed both serum total testosterone and age to be an independent determinant of the muscle mass in these patients. CONCLUSIONS This study identified testosterone as a determinant of muscle mass in HD men.
Collapse
Affiliation(s)
- Gloria Kojo
- Department of Clinical Nutrition, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Shizuoka, 422-8526, Japan
| | | | | | | | | | | | | | | |
Collapse
|
162
|
Ohlendieck K. Proteomic identification of biomarkers of skeletal muscle disorders. Biomark Med 2013; 7:169-86. [PMID: 23387498 DOI: 10.2217/bmm.12.96] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Disease-specific biomarkers play a central diagnostic and therapeutic role in muscle pathology. Serum levels of a variety of muscle-derived enzymes are routinely used for the detection of muscle damage in diagnostic procedures, as well as for the monitoring of physical training status in sports medicine. Over the last few years, the systematic application of mass spectrometry-based proteomics for studying skeletal muscle degeneration has greatly expanded the range of muscle biomarkers, including new fiber-associated proteins involved in muscle transformation, muscular atrophy, muscular dystrophy, motor neuron disease, inclusion body myositis, myotonia, hypoxia, diabetes, obesity and sarcopenia of old age. These mass spectrometric studies have clearly established skeletal muscle proteomics as a reliable method for the identification of novel indicators of neuromuscular diseases.
Collapse
Affiliation(s)
- Kay Ohlendieck
- Muscle Biology Laboratory, Department of Biology, National University of Ireland, Maynooth, County Kildare, Ireland.
| |
Collapse
|
163
|
Calcineurin: a poorly understood regulator of muscle mass. Int J Biochem Cell Biol 2013; 45:2173-8. [PMID: 23838168 DOI: 10.1016/j.biocel.2013.06.029] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/26/2013] [Accepted: 06/28/2013] [Indexed: 01/14/2023]
Abstract
This review will discuss the existing literature that has examined the role of calcineurin (CnA) in the regulation of skeletal muscle mass in conditions associated with hypertrophic growth or atrophy. Muscle mass is determined by the balance between protein synthesis and degradation which is controlled by a number of intracellular signaling pathways, most notably the insulin/IGF/phosphatidylinositol 3-kinase (PI3K)/Akt system. Despite being activated by IGF-1 and having well-described functions in the determination of muscle fiber phenotypes, calcineurin (CnA), a Ca(2+)-activated serine/threonine phosphatase, and its downstream signaling partners have garnered little attention as a regulator of muscle mass. Compared to other signaling pathways, the relatively few studies that have examined the role of CnA in the regulation of muscle size have produced discordant results. The reasons for these differences is not obvious but may be due to the selective nature of the genetic models studied, fluctuations in the endogenous level of CnA activity in various muscles, and the variable use of CnA inhibitors to inhibit CnA signaling. Despite the inconsistent nature of the outcomes, there is sufficient direct and indirect evidence to conclude that CnA plays a role in the regulation of skeletal muscle mass. This article is part of a Directed Issue entitled: Molecular basis of muscle wasting.
Collapse
|
164
|
Welch AA, MacGregor AJ, Skinner J, Spector TD, Moayyeri A, Cassidy A. A higher alkaline dietary load is associated with greater indexes of skeletal muscle mass in women. Osteoporos Int 2013; 24:1899-908. [PMID: 23152092 DOI: 10.1007/s00198-012-2203-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/12/2012] [Indexed: 12/15/2022]
Abstract
UNLABELLED Conservation of muscle mass is important for fall and fracture prevention but further understanding of the causes of age-related muscle loss is required. This study found a more alkaline diet was positively associated with muscle mass in women suggesting a role for dietary acid-base load in muscle loss. INTRODUCTION Conservation of skeletal muscle is important for preventing falls and fractures but age-related loss of muscle mass occurs even in healthy individuals. However, the mild metabolic acidosis associated with an acidogenic dietary acid-base load could influence loss of muscle mass. METHODS We investigated the association between fat-free mass (FFM), percentage FFM (FFM%) and fat-free mass index (FFMI, weight/height²), measured using dual-energy X-ray absorptiometry in 2,689 women aged 18-79 years from the TwinsUK Study, and dietary acid-base load. Body composition was calculated according to quartile of potential renal acid load and adjusted for age, physical activity, misreporting and smoking habit (FFM, FFMI also for fat mass) and additionally with percentage protein. RESULTS Fat-free mass was positively associated with a more alkalinogenic dietary load (comparing quartile 1 vs 4: FFM 0.79 kg P < 0.001, FFM% 1.06 % <0.001, FFMI 0.24 kg/m² P = 0.002), and with the ratio of fruits and vegetables to potential acidogenic foods. CONCLUSIONS We observed a small but significant positive association between a more alkaline diet and muscle mass indexes in healthy women that was independent of age, physical activity and protein intake equating to a scale of effect between a fifth and one half of the observed relationship with 10 years of age. Although protein is important for maintenance of muscle mass, eating fruits and vegetables that supply adequate amounts of potassium and magnesium are also relevant. The results suggest a potential role for diet in the prevention of muscle loss.
Collapse
Affiliation(s)
- A A Welch
- Department of Nutrition, Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK.
| | | | | | | | | | | |
Collapse
|
165
|
John SG, Sigrist MK, Taal MW, McIntyre CW. Natural history of skeletal muscle mass changes in chronic kidney disease stage 4 and 5 patients: an observational study. PLoS One 2013; 8:e65372. [PMID: 23741490 PMCID: PMC3669290 DOI: 10.1371/journal.pone.0065372] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
Cross-sectional studies in dialysis demonstrate muscle wasting associated with loss of function, increased morbidity and mortality. The relative drivers are poorly understood. There is a paucity of data regarding interval change in muscle in pre-dialysis and dialysis-dependant patients. This study aimed to examine muscle and fat mass change and elucidate associations with muscle wasting in advanced CKD. 134 patients were studied (60 HD, 28 PD, 46 CKD 4–5) and followed up for two years. Groups were similar in age, sex and diabetes prevalence. Soft tissue cross-sectional area (CSA) was measured annually on 3 occasions by a standardised multi-slice CT thigh. Potential determinants of muscle and fat CSA were assessed. Functional ability was assessed by sit-to-stand testing. 88 patients completed follow-up (40 HD, 16 PD, 32 CKD). There was a significant difference in percentage change in muscle CSA (MCSA) over year 1, dependant on treatment modality (χ2 = 6.46; p = 0.039). Muscle loss was most pronounced in pre-dialysis patients. Muscle loss during year 1 was partially reversed in year 2 in 39%. Incident dialysis patients significantly lost MCSA during the year which they commenced dialysis, but not the subsequent year. Baseline MCSA, change in MCSA during year 1 and dialysis modality predicted year 2 change in MCSA (adjusted R2 = 0.77, p<0.001). There was no correlation between muscle or fat CSA change and any other factors. MCSA correlated with functional testing, although MCSA change correlated poorly with change in functional ability. These data demonstrate marked variability in MCSA over 2 years. Loss of MCSA in both pre-dialysis and established dialysis patients is reversible. Factors previously cross-sectionally shown to correlate with MCSA did not correlate with wasting progression. The higher rate of muscle loss in undialysed CKD patients, and its reversal after dialysis commencement, suggests that conventional indicators may not result in optimal timing of dialysis initiation.
Collapse
Affiliation(s)
- Stephen G. John
- Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Mhairi K. Sigrist
- Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Maarten W. Taal
- Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom
| | - Christopher W. McIntyre
- Department of Renal Medicine, Royal Derby Hospital, Derby, United Kingdom
- School of Graduate Entry Medicine and Health, University of Nottingham, Derby, United Kingdom
- * E-mail:
| |
Collapse
|
166
|
Wang AYM, Woo J. Early Versus Late Initiation of Dialysis and Nutrition: Does a Transition Mean a Change in Dietary Protein Intake? J Ren Nutr 2013; 23:228-32. [DOI: 10.1053/j.jrn.2013.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 01/20/2013] [Indexed: 11/11/2022] Open
|
167
|
|
168
|
|
169
|
Espe KM, Raila J, Henze A, Blouin K, Schneider A, Schmiedeke D, Krane V, Pilz S, Schweigert FJ, Hocher B, Wanner C, Drechsler C. Low plasma α-tocopherol concentrations and adverse clinical outcomes in diabetic hemodialysis patients. Clin J Am Soc Nephrol 2013; 8:452-8. [PMID: 23335039 DOI: 10.2215/cjn.04880511] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Trials with the antioxidant vitamin E have failed to show benefit in the general population. Considering the different causes of death in ESRD, this study investigated the association between plasma concentrations of α-tocopherol and specific clinical outcomes in diabetic hemodialysis patients. DESIGN, SETTINGS, PARTICIPANTS, & MEASUREMENTS In 1046 diabetic hemodialysis patients (participants of the German Diabetes and Dialysis Study), α-tocopherol was measured in plasma by reversed-phase HPLC. By Cox regression analyses, hazard ratios were determined for prespecified end points according to baseline plasma α-tocopherol levels: sudden death (n=134), myocardial infarction (n=172), stroke (n=89), combined cardiovascular events (n=398), fatal infection (n=107), and all-cause mortality (n=508). RESULTS Patients had a mean age of 66±8 years, and mean plasma α-tocopherol level was 22.8±9.6 µmol/L. Levels of α-tocopherol were highly correlated to triglycerides (r=0.63, P<0.001). Patients in the lowest α-tocopherol quartile had (in unadjusted analyses) a 79% higher risk of stroke and a 31% higher risk of all-cause mortality compared with patients in the highest quartile. The associations were attenuated after adjustment for confounders (hazard ratiostroke=1.56, 95% confidence interval=0.75-3.25; hazard ratiomortality=1.22, 95% confidence interval=0.89-1.69, respectively). There was no association between α-tocopherol and myocardial infarction, sudden death, or infectious death. CONCLUSIONS Plasma α-tocopherol concentrations were not independently associated with cardiovascular outcomes, infectious deaths, or all-cause mortality in diabetic hemodialysis patients. The lack of association can partly be explained by a confounding influence of malnutrition, which should be considered in the planning of trials to reduce cardiovascular risk in dialysis patients.
Collapse
Affiliation(s)
- Katharina M Espe
- Department of Physiology and Pathophysiology of Nutrition, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
170
|
Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol 2012; 24:337-51. [PMID: 23264684 DOI: 10.1681/asn.2012010047] [Citation(s) in RCA: 195] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Older people constitute an increasingly greater proportion of patients with advanced CKD, including those patients undergoing maintenance dialysis treatment. Frailty is a biologic syndrome of decreased reserve and resistance to stressors that results from cumulative declines across multiple physiologic systems and causes vulnerability to adverse outcomes. Frailty is common in elderly CKD patients, and it may be associated with protein-energy wasting (PEW), sarcopenia, dynapenia, and other complications of CKD. Causes of frailty with or without PEW in the elderly with CKD can be classified into three categories: causes primarily caused by aging per se, advanced CKD per se, or a combination of both conditions. Frailty and PEW in elderly CKD patients are associated with impaired physical performance, disability, poorer quality of life, and reduced survival. Prevention and treatment of these conditions in the elderly CKD patients often require a multifaceted approach. Here, we examine the causes and consequences of these conditions and examine the interplay between frailty and PEW in elderly CKD patients.
Collapse
Affiliation(s)
- Jun Chul Kim
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502, USA
| | | | | |
Collapse
|
171
|
Henze A, Espe KM, Wanner C, Krane V, Raila J, Hocher B, Schweigert FJ, Drechsler C. Transthyretin predicts cardiovascular outcome in hemodialysis patients with type 2 diabetes. Diabetes Care 2012; 35:2365-72. [PMID: 22923667 PMCID: PMC3476886 DOI: 10.2337/dc12-0455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE BMI and albumin are commonly accepted parameters to recognize wasting in dialysis patients and are powerful predictors of morbidity and mortality. However, both parameters reveal limitations and may not cover the entire range of patients with wasting. The visceral protein transthyretin (TTR) may be helpful in overcoming the diagnostic and prognostic gap. Therefore, the aim of this study was to assess the association of TTR with morbidity and mortality in hemodialysis patients. RESEARCH DESIGN AND METHODS The TTR concentration was determined in plasma samples of 1,177 hemodialysis patients with type 2 diabetes. Cox regression analyses were used to determine hazard ratios (HRs) for the risk of cardiovascular end points (CVEs) and mortality according to quartiles of TTR concentration for the total study cohort and the subgroups BMI ≥23 kg/m(2), albumin concentration ≥3.8 g/dL, and a combination of both. RESULTS A low TTR concentration was associated with an increased risk for CVE for the total study cohort (HR 1.65 [95% CI 1.27-2.14]), patients with BMI ≥23 kg/m(2) (1.70 [1.22-2.37]), albumin ≥3.8 g/dL (1.68 [1.17-2.42]), and the combination of both (1.69 [1.13-2.53]). Additionally, a low TTR concentration predicted mortality for the total study cohort (1.79 [1.43-2.24]) and patients with BMI ≥23 kg/m(2) (1.46 [1.09-1.95]). CONCLUSIONS The current study demonstrated that TTR is a useful predictor for cardiovascular outcome and mortality in diabetic hemodialysis patients. TTR was particularly useful in patients who were not identified to be at risk by BMI or albumin status.
Collapse
Affiliation(s)
- Andrea Henze
- Institute of Nutritional Science, University of Potsdam, Brandenburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
172
|
Cheung WW, Mak RH. Melanocortin antagonism ameliorates muscle wasting and inflammation in chronic kidney disease. Am J Physiol Renal Physiol 2012; 303:F1315-24. [PMID: 22914778 DOI: 10.1152/ajprenal.00341.2012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Aberrant melanocortin signaling has been implicated in the pathogenesis of wasting in chronic kidney disease (CKD). Previously, we demonstrated that agouti-related peptide (AgRP), a melenocortin-4 receptor antagonist, reduced CKD-associated cachexia in CKD mice. Our previous studies with AgRP utilized dual energy X-ray (DXA) densitometry to assess the body composition in mice (Cheung W, Kuo HJ, Markison S, Chen C, Foster AC, Marks DL, Mak RH. J Am Soc Nephrol 18: 2517-2524, 2007; Cheung W, Yu PX, Little BM, Cone RD, Marks DL, Mak RH. J Clin Invest 115: 1659-1665, 2005). DXA is unable to differentiate water content in mice, and fluid retention in CKD may lead to an overestimate of lean mass. In this study, we employed quantitative magnetic resonance technique to evaluate body composition change following central administration of AgRP in a CKD mouse model. AgRP treatment improved energy expenditure, total body mass, fat mass, and lean body mass in CKD mouse. We also investigated the effect of CKD-associated cachexia on the signaling pathways leading to wasting in skeletal muscle, as well as whether these changes can be ameliorated by central administration of AgRP. AgRP treatment caused an overall decrease in proinflammatory cytokines, which may be one important mechanism of its effects. Muscle wasting in CKD may be due to the activation of proteolytic pathways as well as inhibition of myogenesis and muscle regeneration processes. Our results suggest that these aberrant pathological pathways leading to muscle wasting in CKD mice were ameliorated by central administration of AgRP.
Collapse
Affiliation(s)
- Wai W Cheung
- Pediatric Nephrology, University of California, San Diego, California, USA
| | | |
Collapse
|
173
|
Leal VO, Lobo JC, Stockler-Pinto MB, Farage NE, Velarde GC, Fouque D, Leite M, Mafra D. Zinc-α2-glycoprotein: is there association between this new adipokine and body composition in hemodialysis patients? Ren Fail 2012; 34:1062-7. [PMID: 22906217 DOI: 10.3109/0886022x.2012.712859] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Peptides involved in the regulation of body composition are of interest in hemodialysis (HD) patients because protein wasting associated with high fat mass (FM) is present in these patients. Zinc-α2-glycoprotein (ZAG), a new adipokine, is involved in the regulation of lipid metabolism, adiposity, and energy balance. The purpose of this study was to evaluate ZAG levels and its relationship with body composition and dietary intake in HD patients. Forty-nine HD patients (28 men, 53.1 ± 12.5 years, and BMI 24.0 ± 4.3 kg/m2) were studied and compared with 20 healthy subjects (9 men, 49.5 ± 15.2 years, and BMI 25.6 ± 4.1 kg/m(2)). Plasma ZAG levels were measured using the ELISA methods and body composition was evaluated through anthropometric data. Dietary intake was assessed 3 days by 24-hour food recall. Although most of the HD patients (59.2%) were eutrophic according to BMI, 92.3% presented high percentage of body fat (BF), and 43.5%, reduced fat-free mass according to midarm muscle circumference values. ZAG levels were ∼2.5-fold higher in HD patients (135.9 ± 40.9 mg/L) compared with healthy individuals (54.6 ± 23.0 mg/L) (p < 0.0001). Circulating ZAG was not associated with dietary intake; however, this peptide was negatively correlated with %BF and, for each 1% reduction in BF, ZAG levels increased by 2.4 mg/L (p = 0.02). In summary, circulating ZAG is increased and inversely correlated with adiposity in HD patients; however, in spite of its higher plasma levels, the majority of HD patients did not show low BF.
Collapse
Affiliation(s)
- Viviane O Leal
- Programa de Pós Graduação em Ciências Médicas, Universidade Federal Fluminense, Niterói, Brasil.
| | | | | | | | | | | | | | | |
Collapse
|
174
|
Ghrelin improves body weight loss and skeletal muscle catabolism associated with angiotensin II-induced cachexia in mice. ACTA ACUST UNITED AC 2012; 178:21-8. [PMID: 22750276 DOI: 10.1016/j.regpep.2012.06.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 05/25/2012] [Accepted: 06/20/2012] [Indexed: 12/20/2022]
Abstract
Ghrelin is a gastric peptide that regulates energy homeostasis. Angiotensin II (Ang II) is known to induce body weight loss and skeletal muscle catabolism through the ubiquitin-proteasome pathway. In this study, we investigated the effects of ghrelin on body weight and muscle catabolism in mice treated with Ang II. The continuous subcutaneous administration of Ang II to mice for 6 days resulted in cardiac hypertrophy and significant decreases in body weight gain, food intake, food efficiency, lean mass, and fat mass. In the gastrocnemius muscles of Ang II-treated mice, the levels of insulin-like growth factor 1 (IGF-1) were decreased, and the levels of mRNA expression of catabolic factors were increased. Although the repeated subcutaneous injections of ghrelin (1.0mg/kg, twice daily for 5 days) did not affect cardiac hypertrophy, they resulted in significant body weight gains and improved food efficiencies and tended to increase both lean and fat mass in Ang II-treated mice. Ghrelin also ameliorated the decreased IGF-1 levels and the increased mRNA expression levels of catabolic factors in the skeletal muscle. IGF-1 mRNA levels in the skeletal muscle significantly decreased 24h after Ang II infusion, and this was reversed by two subcutaneous injections of ghrelin. In C2C12-derived myocytes, the dexamethasone-induced mRNA expression of atrogin-1 was decreased by IGF-1 but not by ghrelin. In conclusion, we demonstrated that ghrelin improved body weight loss and skeletal muscle catabolism in mice treated with Ang II, possibly through the early restoration of IGF-1 mRNA in the skeletal muscle and the amelioration of nutritional status.
Collapse
|
175
|
Slee AD. Exploring metabolic dysfunction in chronic kidney disease. Nutr Metab (Lond) 2012; 9:36. [PMID: 22537670 PMCID: PMC3407016 DOI: 10.1186/1743-7075-9-36] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 04/26/2012] [Indexed: 02/07/2023] Open
Abstract
Impaired kidney function and chronic kidney disease (CKD) leading to kidney failure and end-stage renal disease (ESRD) is a serious medical condition associated with increased morbidity, mortality, and in particular cardiovascular disease (CVD) risk. CKD is associated with multiple physiological and metabolic disturbances, including hypertension, dyslipidemia and the anorexia-cachexia syndrome which are linked to poor outcomes. Specific hormonal, inflammatory, and nutritional-metabolic factors may play key roles in CKD development and pathogenesis. These include raised proinflammatory cytokines, such as interleukin-1 and −6, tumor necrosis factor, altered hepatic acute phase proteins, including reduced albumin, increased C-reactive protein, and perturbations in normal anabolic hormone responses with reduced growth hormone-insulin-like growth factor-1 axis activity. Others include hyperactivation of the renin-angiotensin aldosterone system (RAAS), with angiotensin II and aldosterone implicated in hypertension and the promotion of insulin resistance, and subsequent pharmacological blockade shown to improve blood pressure, metabolic control and offer reno-protective effects. Abnormal adipocytokine levels including leptin and adiponectin may further promote the insulin resistant, and proinflammatory state in CKD. Ghrelin may be also implicated and controversial studies suggest activities may be reduced in human CKD, and may provide a rationale for administration of acyl-ghrelin. Poor vitamin D status has also been associated with patient outcome and CVD risk and may indicate a role for supplementation. Glucocorticoid activities traditionally known for their involvement in the pathogenesis of a number of disease states are increased and may be implicated in CKD-associated hypertension, insulin resistance, diabetes risk and cachexia, both directly and indirectly through effects on other systems including activation of the mineralcorticoid receptor. Insight into the multiple factors altered in CKD may provide useful information on disease pathogenesis, clinical assessment and treatment rationale such as potential pharmacological, nutritional and exercise therapies.
Collapse
Affiliation(s)
- Adrian D Slee
- School of Life Sciences, Brayford Pool Campus, University of Lincoln, Lincoln, UK.
| |
Collapse
|
176
|
Sarcopenia: a major challenge in elderly patients with end-stage renal disease. J Aging Res 2012; 2012:754739. [PMID: 22536505 PMCID: PMC3321443 DOI: 10.1155/2012/754739] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/22/2011] [Accepted: 12/30/2011] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia is a condition of multifaceted etiology arising in many elderly people. In patients with chronic kidney, the loss of muscle mass is much more intensive and the first signs of sarcopenia are observed in younger patients than it is expected. It is associated with the whole-body protein-energy deficiency called protein-energy wasting (PEW). It seems to be one of the major factors limiting patient's autonomy as well as decreasing the quality of life. If it cannot be treated with the simple methods requiring some knowledge and devotion, we will fail to save patients who die due to cardiovascular disease and infection, despite proper conduction of renal replacement therapy. Many factors influencing the risk of sarcopenia development have been evaluated in number of studies. Many studies also were conducted to assess the efficacy of different therapeutic strategies (diet, physical activity, hormones). Nevertheless, there is still no consensus on treatment the patients with PEW. Therefore, in the paper we present the reasons and pathophysiology of sarcopenia as an important element of protein energy wasting (PEW) in elderly patients suffering from chronic kidney disease. We also analyze possible options for treatment according to up-to-date knowledge.
Collapse
|
177
|
Orellana RA, Suryawan A, Wilson FA, Gazzaneo MC, Fiorotto ML, Nguyen HV, Davis TA. Development aggravates the severity of skeletal muscle catabolism induced by endotoxemia in neonatal pigs. Am J Physiol Regul Integr Comp Physiol 2012; 302:R682-90. [PMID: 22277935 DOI: 10.1152/ajpregu.00259.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accretion rates of muscle protein are elevated in normal neonates, but this anabolic drive decreases with maturation. As this change occurs, it is not known whether development also influences muscle protein catabolism induced by sepsis. We hypothesize that protein degradation in skeletal muscle induced by endotoxemia becomes more severe as the neonate develops. Fasted 7- and 26-day-old pigs were infused for 8 h with LPS (0 and 10 μg·kg(-1)·h(-1)), while plasma amino acids (AA), 3-methylhistidine (3-MH), and α-actin concentrations and muscle protein degradation signal activation were determined (n = 5-7/group/age). Plasma full-length α-actin was greater in 7- than 26-day-old pigs, suggesting a higher baseline protein turnover in neonatal pigs. LPS increased plasma total AA, 3-MH, and full-length and cleaved α-actin in 26- than in 7-day-old pigs. In muscle of both age groups, LPS increased AMPK and NF-κB phosphorylation, the abundances of activated caspase 3 and E-3 ligases MuRF1 and atrogin1, as well as the abundance of cleaved α-actin, suggesting activation of muscle proteolysis by endotoxin in muscle. LPS decreased Forkhead box 01 (Fox01) and Fox04 phosphorylation and increased procaspase 3 abundance in muscle of 26-day-old pigs despite the lack of effect of LPS on PKB phosphorylation. The results suggest that skeletal muscle in healthy neonatal pigs maintains high baseline degradation signal activation that cannot be enhanced by endotoxin, but as maturation advances, the effect of LPS on muscle protein catabolism manifests its severity.
Collapse
Affiliation(s)
- Renán A Orellana
- USDA/ARS Children's Nutrition Research Center, 1100 Bates St., Rm. 9070, Houston, TX 77030, USA.
| | | | | | | | | | | | | |
Collapse
|
178
|
Chauveau P, Lasseur C, Aparicio M. [Is there a place for the physical activity in the prevention of the fractures of chronic kidney disease patients?]. Nephrol Ther 2011; 8:216-9. [PMID: 22177601 DOI: 10.1016/j.nephro.2011.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 10/20/2011] [Accepted: 10/24/2011] [Indexed: 11/18/2022]
Abstract
The risk of non-traumatic fractures is greatly increased in kidney disease patients and well demonstrated in dialysis patients. If osteoporosis plays a major role in the general population, in chronic kidney disease renal osteodystrophy is associated with neurological and muscular disorders, which probably worsen the risk. The decrease in physical activity is a factor contributing to the loss of bone mass and the initiation of a rehabilitation program improves the prognosis. Despite the association between chronic renal disease and sedentary lifestyle, the relationship between physical inactivity and bones in dialysis patients and the effect of increased activity programs, are not well documented in the literature.
Collapse
|
179
|
Rule AD, Bailey KR, Turner ST. What Is the Goal With Endogenous Filtration Markers—Estimation of GFR or Prediction of Kidney Outcomes? Am J Kidney Dis 2011; 58:865-7. [DOI: 10.1053/j.ajkd.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/11/2022]
|
180
|
Tabony AM, Yoshida T, Galvez S, Higashi Y, Sukhanov S, Chandrasekar B, Mitch WE, Delafontaine P. Angiotensin II upregulates protein phosphatase 2Cα and inhibits AMP-activated protein kinase signaling and energy balance leading to skeletal muscle wasting. Hypertension 2011; 58:643-9. [PMID: 21844485 DOI: 10.1161/hypertensionaha.111.174839] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Congestive heart failure and chronic kidney disease are characterized by chronically elevated angiotensin II (Ang II) and muscle wasting. Ang II causes skeletal muscle wasting by reducing appetite and by enhancing catabolism. The serine/threonine kinase AMP-activated protein kinase (AMPK) functions mainly as a sensor of cellular energy status. It is energy sparing and favors ATP generation. We hypothesized that Ang II induces muscle wasting in part by inhibiting AMPK signaling and altering cellular energy balance. Our results show that Ang II infusion in mice reduced gastrocnemius muscle weight by 26% and depleted ATP by 74%. In addition, Ang II upregulated protein phosphatase 2Cα by 2.6-fold and reduced AMPK phosphorylation and signaling in muscle. Importantly, the pharmacological AMPK activator 5-aminoimidazole-4-carboxamide ribonucleoside restored AMPK activity to levels of pair-fed controls and reversed Ang II-mediated ATP depletion and muscle wasting. Moreover, 5-aminoimidazole-4-carboxamide ribonucleoside activated Akt and inhibited Ang II-induced increases in E3 ubiquitin ligase expression. These novel results demonstrate critical roles for energy depletion and AMPK inhibition in Ang II-induced skeletal muscle wasting and suggest a therapeutic potential for AMPK activators in diseases characterized by muscle wasting.
Collapse
Affiliation(s)
- A Michael Tabony
- Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | | | | |
Collapse
|
181
|
|
182
|
Martín-del-Campo F, Batis-Ruvalcaba C, González-Espinoza L, Rojas-Campos E, Angel JR, Ruiz N, González J, Pazarín L, Cueto-Manzano AM. Dietary micronutrient intake in peritoneal dialysis patients: relationship with nutrition and inflammation status. Perit Dial Int 2011; 32:183-91. [PMID: 21804135 DOI: 10.3747/pdi.2010.00245] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare dietary intake of micronutrients by peritoneal dialysis (PD) patients according to their nutrition and inflammatory statuses. DESIGN This cross-sectional study evaluated 73 patients using subjective global assessment, 24-hour dietary recall, and markers of inflammation [C-reactive protein (CRP), tumor necrosis factor α, and interleukin 6]. RESULTS Half the patients had an inadequate micronutrient intake. Compared with dietary reference intakes, malnourished patients had lower intakes of iron (11 mg) and of vitamins C (45 mg) and B6 (0.8 mg). Malnourished and well-nourished patients both had lower intakes of sodium (366 mg, 524 mg respectively), potassium (1555 mg, 1963 mg), zinc (5 mg, 7 mg), calcium (645 mg, 710 mg), magnesium (161 mg, 172 mg), niacin (8 mg, 9 mg), folic acid (0.14 mg, 0.19 mg), and vitamin A (365 μg, 404 μg). Markers of inflammation were higher in malnourished than in well-nourished subjects. Compared with patients in lower quartiles, patients in the highest CRP quartile had lower intakes (p < 0.05) of sodium (241 mg vs 404 mg), calcium (453 mg vs 702 mg), vitamin B2 (0.88 mg vs 1.20 mg), and particularly vitamin A (207 μg vs 522 μg). CONCLUSIONS Among PD patients, half had inadequate dietary intakes of iron, zinc, calcium and vitamins A, B6, C, niacin, and folic acid. Lower micronutrient intakes were associated with malnutrition and inflammation. Patients with inflammation had lower intakes of sodium, calcium, and vitamins A and B2. Micronutrient intake must be investigated in various populations so as to tailor adequate supplementation.
Collapse
|
183
|
Abstract
Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease (CVD) and mortality. The increase in CKD in recent decades has paralleled increases in obesity, diabetes, and the metabolic syndrome. Physical inactivity is a modifiable risk factor that may affect the development and course of CKD. It is well established that exercise training improves a number of metabolic factors, including blood pressure and insulin resistance, which would be expected to preserve renal function as well as lower CVD risk. Epidemiological studies have suggested that partaking in vigorous physical activity may protect against kidney disease. However, to date few studies have rigorously measured physical activity levels. Instead, investigators have relied on subjective measures of physical activity and patient recall. This is particularly problematic when attempting to capture low- and very-low-intensity physical activity and in quantifying sedentary behavior. Improvements in vascular endothelial function, insulin sensitivity, adipocytokine profiles, and oxidative stress likely mediate the benefits of physical activity on the kidney. While formal exercise recommendations have been published for diabetes and hypertension, guidelines regarding the optimal type, frequency, intensity and duration of physical activity for preventing CKD have yet to be formalized.
Collapse
|
184
|
Scialla JJ, Appel LJ, Astor BC, Miller ER, Beddhu S, Woodward M, Parekh RS, Anderson CAM. Estimated net endogenous acid production and serum bicarbonate in African Americans with chronic kidney disease. Clin J Am Soc Nephrol 2011; 6:1526-32. [PMID: 21700817 PMCID: PMC3552445 DOI: 10.2215/cjn.00150111] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/23/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Metabolic acidosis may contribute to morbidity and disease progression in patients with chronic kidney disease (CKD). The ratio of dietary protein, the major source of nonvolatile acid, to dietary potassium, which is naturally bound to alkali precursors, can be used to estimate net endogenous acid production (NEAP). We tested the association between estimated NEAP and serum bicarbonate in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS NEAP was estimated among 462 African American adults with hypertensive CKD using published equations: NEAP (mEq/d) = -10.2 + 54.5 (protein [g/d]/potassium [mEq/d]). Dietary protein and potassium intake were estimated from 24-hour urinary excretion of urea nitrogen and potassium, respectively. All of the eligible measurements during follow-up were modeled using generalized linear regression clustered by participant and adjusted for demographics, 24-hour urinary sodium, kidney function, and selected medications. RESULTS Higher NEAP was associated with lower serum bicarbonate in a graded fashion (P trend < 0.001). Serum bicarbonate was 1.27 mEq/L lower among those in the highest compared with the lowest quartile of NEAP (P < 0.001). There was a greater difference in serum bicarbonate between the highest and lowest quartiles of NEAP among patients with stage 4/5 CKD (-2.43 mEq/L, P < 0.001) compared with those with stage 2/3 disease (-0.77 mEq/L, P = 0.01; P-interaction = 0.02). CONCLUSIONS Reducing NEAP, through reduction of dietary protein and increased intake of fruits and vegetables, may prevent metabolic acidosis in patients with CKD.
Collapse
Affiliation(s)
- Julia J Scialla
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
| | | | | | | | | | | | | | | |
Collapse
|
185
|
Adetokunbo OA, Ibraheem AO, Temitayo IO. The effect of prolonged oral exposure of cockerels to disinfectant (Iodosteryl(®)) on induction of oxidative stress and liver damage. ACTA ACUST UNITED AC 2011; 64:883-7. [PMID: 21514805 DOI: 10.1016/j.etp.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 02/28/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
This study was designed to investigate the effect of prolonged oral exposure of cockerels to disinfectant (Iodosteryl(®)) present in drinking water and its ability to induce liver damage and oxidative stress. Thirty-two healthy birds were used for this study. They were grouped into four groups of eight per group. Group I received 10 ml/kg body weight of physiological saline. Groups II, III and IV received 1 part per million, 2 part per million and 4 part per million of Iodosteryl(®) in their drinking water for six weeks. The results revealed significant (P<0.05) increase in alanine aminotransferase, aspartate aminotransferase and alkaline phosphatase activities in a dose-dependent manner in birds administered with Iodosteryl(®) when compared with control. Significant (P<0.05) increase in sodium and potassium ions was obtained from birds that received Iodosteryl(®) (4 part per million) compared with control. Also, there was significant (P<0.05) increase in total cholesterol, triglycerides, high density lipoprotein and low density lipoprotein levels in all treatment groups (1, 2 and 4 part per million) compared with control. Serum blood urea nitrogen levels increased significantly (P<0.05) in a dose-dependent manner. Biologic markers of oxidative stress (malondialdehyde and hydrogen peroxide generation) increased significantly with concomitant significant (P<0.05) decrease in serum glutathione level in a dose-dependent manner when compared with control. Histological sections revealed hepatic congestion, vacuolation and fibrosis at varying concentration of Iodosteryl(®). Overall, Iodosteryl(®) induced hepatic damage, increased oxidative stress and decreased antioxidant defense system; hence exposure of both animals and humans to prolonged iodine disinfectant is potentially harmful.
Collapse
Affiliation(s)
- Oyagbemi Ademola Adetokunbo
- Department of Veterinary Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria.
| | | | | |
Collapse
|
186
|
Kaysen GA, Larive B, Painter P, Craig A, Lindsay RM, Rocco MV, Daugirdas JT, Schulman G, Chertow GM. Baseline physical performance, health, and functioning of participants in the Frequent Hemodialysis Network (FHN) trial. Am J Kidney Dis 2011; 57:101-12. [PMID: 21184919 DOI: 10.1053/j.ajkd.2010.08.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 08/16/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Self-reported physical health and functioning and direct measures of physical performance are decreased in hemodialysis patients and are associated with mortality and hospitalization. STUDY DESIGN We determined baseline cross-sectional associations of physical performance, health, and functioning with demographics, clinical characteristics, nutritional indexes, laboratory benchmarks, and measures of body composition in participants in the Frequent Hemodialysis Network (FHN) trial. SETTING & PARTICIPANTS 375 persons enrolled in the FHN with data for physical performance, health, and functioning. PREDICTORS Explanatory variables were categorized into fixed factors of age, race, comorbid conditions (diabetes mellitus, heart failure, and peripheral arterial disease) and potentially modifiable factors of dialysis dose, phosphorus level, hemoglobin level, equilibrated normalized protein catabolic rate (enPCR), body composition, body mass index, phase angle, and ratio of intracellular water volume to body weight (calculated from bioelectrical impedance). OUTCOMES Scores on tests of physical performance, health, and functioning. MEASUREMENTS Physical performance measured using the Short Physical Performance Battery, self-reported physical health and functioning using the 36-Item Short Form Health Survey (SF-36). Body composition (body mass index and bioimpedance analysis) and laboratory data were obtained from affiliated dialysis providers. RESULTS Relative to population norms, scores for all 3 physicality metrics were low. Poorer scores on all 3 metrics were associated with diabetes mellitus and peripheral arterial disease. Poorer scores on the SF-36 Physical Functioning subscale and Short Physical Performance Battery also were associated with age, lower ratio of intracellular water volume to body weight, and lower enPCR. Black race was associated with poorer scores on the Short Physical Performance Battery. LIMITATIONS This was a cross-sectional study of individuals agreeing to participate in the FHN study and may not be generalizable to the general dialysis population. CONCLUSIONS Hemodialysis patients show markedly impaired physical performance, health, and functioning relative to population norms. Although some factors associated with these impairments are not modifiable, others may change with improvement in nutritional status or body composition.
Collapse
Affiliation(s)
- George A Kaysen
- University of California Davis School of Medicine, Davis, 95616, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
187
|
Verzola D, Procopio V, Sofia A, Villaggio B, Tarroni A, Bonanni A, Mannucci I, De Cian F, Gianetta E, Saffioti S, Garibotto G. Apoptosis and myostatin mRNA are upregulated in the skeletal muscle of patients with chronic kidney disease. Kidney Int 2011; 79:773-82. [PMID: 21228768 DOI: 10.1038/ki.2010.494] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Apoptosis and myostatin are major mediators of muscle atrophy and might therefore be involved in the wasting of uremia. To examine whether they are expressed in the skeletal muscle of patients with chronic kidney disease (CKD), we measured muscle apoptosis and myostatin mRNA and their related intracellular signal pathways in rectus abdominis biopsies obtained from 22 consecutive patients with stage 5 CKD scheduled for peritoneal dialysis. Apoptotic loss of myonuclei, determined by anti-single-stranded DNA antibody and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assays, was significantly increased three to fivefold, respectively. Additionally, myostatin and interleukin (IL)-6 gene expressions were significantly upregulated, whereas insulin-like growth factor-I mRNA was significantly lower than in controls. Phosphorylated JNK (c-Jun amino-terminal kinase) and its downstream effector, phospho-c-Jun, were significantly upregulated, whereas phospho-Akt was markedly downregulated. Multivariate analysis models showed that phospho-Akt and IL-6 contributed individually and significantly to the prediction of apoptosis and myostatin gene expression, respectively. Thus, our study found activation of multiple pathways that promote muscle atrophy in the skeletal muscle of patients with CKD. These pathways appear to be associated with different intracellular signals, and are likely differently regulated in patients with CKD.
Collapse
Affiliation(s)
- Daniela Verzola
- Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, Azienda Ospedale Università San Martino, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
188
|
|
189
|
Sassoon CS, Zhu E, Fang L, Ramar K, Jiao GY, Caiozzo VJ. Interactive effects of corticosteroid and mechanical ventilation on diaphragm muscle function. Muscle Nerve 2010; 43:103-11. [DOI: 10.1002/mus.21821] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
190
|
Glover EI, Phillips SM. Resistance exercise and appropriate nutrition to counteract muscle wasting and promote muscle hypertrophy. Curr Opin Clin Nutr Metab Care 2010; 13:630-4. [PMID: 20829685 DOI: 10.1097/mco.0b013e32833f1ae5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Loss of skeletal muscle mass is a common feature of a number of clinical scenarios including limb casting, bed rest, and various disorders such as HIV-AIDS, sepsis, cancer cachexia, heart failure, and uremia. Commonly, muscle disuse (hypodynamia) is the sole reason, or a large part, of why muscle mass is lost. The reduction in strength, or dynapenia, that accompanies these conditions is also a function of the degree of hypodynamia and is related to muscle loss. RECENT FINDINGS The major and consistent finding in a number of human-based models of muscle wasting is a decline in the synthesis of new muscle proteins both in the postabsorptive and fed states. Thus, countermeasures are best suited to those that augment muscle protein synthesis and not those that attempt to counteract proteolysis. Our main thesis is that retention of muscle mass in wasting conditions will be achieved to the greatest extent by focussing on increased muscle use with moderate-to-high resistance loads as the primary countermeasure with a secondary countermeasure being to provide adequate nutritional support. Either intervention alone will alleviate some part of hypodynamia-induced muscle mass loss and dynapenia; however, together nutrition and muscular contraction will result in greater mitigation of muscle loss. SUMMARY Advances in our understanding of hypodynamia-induced muscle loss, a condition common to almost all syndromes of muscle wasting, has led to a focus on reduced basal and feeding-induced elevations in protein synthesis. Countermeasures for wasting should focus on stimulating anabolism rather than alleviating catabolism.
Collapse
Affiliation(s)
- Elisa I Glover
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|