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Lertritdecha T, Tantiyavarong P, Chatkrailert A. Association between TMSE/MoCA and MIS/NAF in ESKD patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol 2024; 25:283. [PMID: 39215258 PMCID: PMC11363605 DOI: 10.1186/s12882-024-03729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Both cognitive impairment and malnutrition are common in hemodialysis (HD) patients and are associated with increased hospitalization rates, infection, poor clinical outcomes, and mortality. The study investigated the association between cognitive and nutrition status among end-stage kidney disease (ESKD) patients undergoing hemodialysis. METHODS In this cross-sectional study, we enrolled 115 patients with ESKD who underwent regular hemodialysis (HD). Data collection included the use of screening tools for mild cognitive impairment (MCI), specifically Thai Mental State Examination (TMSE) and Montreal Cognitive Assessment (MoCA). In addition, we collected data using nutritional screening tools including Malnutrition Inflammation Score (MIS) and Nutrition Alert Form (NAF). Our primary outcome was to demonstrate whether there was a relationship between TMSE/MoCA and MIS/NAF scores in this population. Secondary outcomes were a prevalence of MCI and malnutrition status in ESKD patients, an association between TMSE and MoCA with other surrogate nutritional markers, and factors affecting MCI in such patients. RESULTS A total of 109 patients undergoing HD completed our protocol. Their mean age was 63.42 (± 15.82) years, and 51.38% were male. Mean TMSE and MoCA were 23.98 (± 5.06) points and 18.3 (± 6.40) points, respectively. The prevalence of TMSE ≤ 23 and MoCA ≤ 24 were 39.45% and 83.49%, respectively. TMSE had a statistically significant negative correlation with MIS (R2 = 0.16, p < 0.001) and NAF. MoCA also negatively correlated with MIS and NAF. The age, total educational year, the status of whether having a caregiver, serum albumin, serum phosphorus level, handgrip strength, and lean mass tissue were correlated with TMSE. CONCLUSION Nutritional parameters, including MIS score, NAF score, serum albumin, lean tissue mass, and lean tissue index, significantly correlate with TMSE and MoCA.
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Affiliation(s)
- Taksaporn Lertritdecha
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pichaya Tantiyavarong
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Aphichat Chatkrailert
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
- 60th Anniversary HRH Maha Chakri Sirindhorn Hemodialysis Center, Thammasat University Hospital, Pathumthani, Thailand.
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Tian M, Yuan J, He P, Yu F, Long C, Zha Y. Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis. J Psychosom Res 2023; 174:111464. [PMID: 37757523 DOI: 10.1016/j.jpsychores.2023.111464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The relationship between body mass index (BMI) and cognitive impairment (CI) remains controversial, and no research has been done to explore the effect of lean-to-fat (L/F) tissue ratio on the risk of CI in patients undergoing maintenance hemodialysis (MHD) so far. This study aimed to explore the effect of L/F tissue ratio on the risk of incident CI in patients undergoing MHD. METHODS In this observational cohort study, 3356 patients were recruited and followed up for a median of 2 years. Global cognitive function was measured using Mini-Mental State Examination score. Lean tissue mass (LTM) and fat tissue mass (FTM) were analyzed using body composition monitor based on bioimpedance spectroscopy (BCM-BIS), and L/F tissue ratio was calculated by LTM divided by FTM. Hazard ratios (HRs) for incident CI were determined by Cox regression. RESULTS The median age of the cohort was 55 years, and 68.7% patients were less educated. During the follow-up period, 1249 patients (37.2%) experienced incident CI. Patients with lower L/F tissue ratios had significantly higher risks of CI (HR 1.51, 95% confidence interval 1.24-1.84; p < 0.001) than those with higher L/F tissue ratios. The association between L/F tissue ratio and incident CI persisted in all subgroups stratified by sex, age, education status, especially in older and less educated participants. Both in all our patients and subgroups, BMI and CI occurrence were not independently relevant. CONCLUSION The L/F tissue ratio rather than BMI was an independent risk factor of incident cognitive impairment in patients undergoing MHD.
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Affiliation(s)
- Maolu Tian
- School of Medicine, Guizhou University, Guiyang, China; Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Jing Yuan
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Pinghong He
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fangfang Yu
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Changzhu Long
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China.
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Asma A, Tuncer Ö. Risks of undernutrition and depression in hospitalized patients: A cross-sectional study. Medicine (Baltimore) 2023; 102:e35133. [PMID: 37682139 PMCID: PMC10489483 DOI: 10.1097/md.0000000000035133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023] Open
Abstract
Undernutrition in hospitalized patients is a significant healthcare burden worldwide. Depression is a major global health problem characterized by symptoms such as altered mood, loss of interest and pleasure, and impairment in cognitive and physical functions. Patients hospitalized for medical conditions have a higher risk of depression than the general population. The purpose of this study was to explore the relationship between undernutrition risk and depression risk in hospitalized patients. The design of this study was an observational cross-sectional analytic. A questionnaire form created by the investigator including sociodemographic data, dietary patterns, presence of chronic diseases and anthropometric measurements, Nutritional Risk Screening and Patient Health Questionnaire-2 were applied to the patients. All quantitative data were expressed as the median and interquartile range and qualitative data were expressed as numbers and percentage. Mann-Whitney U test and Kruskal-Wallis test were used to analyze nonparametric data; Chi-square and Fisher Exact test were used to analyze qualitative data. P < .05 was considered statistically significant. A total of 308 patients who met the criteria were reached. Undernutrition was detected in 28.6% of the participants, and depression was present in 37.3%. A statistically significant relationship was found between the risk of undernutrition and the risk of depression, with individuals without a risk of depression being found to have a lower risk of undernutrition. (P < .001). The risk of undernutrition was found to increase with advancing age. Moreover, individuals with higher values for arm muscle area, arm muscle circumference, mid-upper arm circumference, triceps skinfold thickness, calf circumference, and body mass index had a lower risk of undernutrition. No relationship was found between gender and the risk of depression. However, a statistically significant relationship was observed between age and the risk of depression, indicating that older patients had a higher risk of depression. In this study, a statistically significant relationship was found between the risk of undernutrition and the risk of depression in hospitalized patients. It was observed that the risk of undernutrition was lower in individuals without risk of depression.
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Affiliation(s)
- Ayça Asma
- Department of Family Medicine, The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Bozyaka, Izmir, Turkey
| | - Özge Tuncer
- Department of Family Medicine, The University of Health Sciences, Izmir Bozyaka Education and Training Hospital, Bozyaka, Izmir, Turkey
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Stephenson SS, Guligowska A, Cieślak-Skubel A, Wójcik A, Kravchenko G, Kostka T, Sołtysik BK. The Relationship between Nutritional Risk and the Most Common Chronic Diseases in Hospitalized Geriatric Population from Central Poland. Nutrients 2023; 15:nu15071612. [PMID: 37049453 PMCID: PMC10096810 DOI: 10.3390/nu15071612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
Abstract
The aim of this study was to assess the relationship between Nutrition Risk Screening 2002 (NRS-2002) and the prevalence of concomitant chronic diseases among hospitalized older adults. This study included 2122 consecutively hospitalized older participants with an average age of 82 years. The criteria to participate were the ability to communicate and give consent. In multivariate design, the prevalence of nutritional risk with at least 3 points in the NRS-2002 score was associated with the presence of stroke, atrial fibrillation, dementia and pressure ulcers. Patients with arterial hypertension, lipid disorders, osteoarthritis and urine incontinence had a significantly lower (better) NRS-2002 score. The explanation of the inverse relationship between some disorders and nutritional risk may be their occurrence in relatively earlier age and the relationship with body mass index. In conclusion, the study revealed which medical conditions coexist with the increased nutritional risk in a “real-world” hospitalized geriatric population. The hospital admission of an older subject with stroke, atrial fibrillation, dementia or pressure ulcers should primarily draw attention to the nutritional risk of the patient.
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Takahashi R, Yabe H, Hibino T, Yamaguchi T, Morishita S, Kono K, Moriyama Y, Yamada T. Influence of Malnutrition on the Improvement of Physical Function by Intradialytic Resistance Exercise in Patients Undergoing Hemodialysis. J Ren Nutr 2023; 33:346-354. [PMID: 36179956 DOI: 10.1053/j.jrn.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/20/2022] [Accepted: 09/18/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Intradialytic exercise improves physical function. However, malnutrition may be an essential factor affecting the effectiveness of exercise to improve physical function. Few studies of the relationship between malnutrition and the effectiveness of intradialytic exercise to improve physical function exist. Therefore, this study investigated malnutrition at the beginning of intradialytic exercise and how it affects the subsequent improvement in physical function. METHODS Patients who performed intradialytic exercise for 12 months were enrolled in this study. A Geriatric Nutritional Risk Index of 91.2 was defined as malnutrition. Patients were assigned to 2 groups using propensity score matching to adjust for confounding factors. Physical function outcomes were handgrip strength, isometric knee extension strength, short physical performance battery, and 10-m walking speed; these were compared at baseline, 3 months, 6 months, and 12 months. The 2 groups were further divided into another 2 groups as per whether the nutritional status had improved after 12 months; therefore, a total of 4 groups were analyzed. RESULTS After matching, the data of 154 patients in each group were analyzed. During the intragroup comparison, isometric knee extension strength, short physical performance battery, and 10-m walking speed improved significantly in both groups after intradialytic exercise was started compared with before intradialytic exercise was started. However, there was no significant improvement in handgrip strength in the malnutrition group. There were no significant differences in any of the physical function measurements or changes from the baseline values among the 4 groups divided as per subsequent recovery of the nutritional status. CONCLUSION Malnutrition may not impact the effectiveness of intradialytic exercise to improve lower-leg physical function. Its effect on the improvement of handgrip strength requires further investigation.
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Affiliation(s)
- Ren Takahashi
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan.
| | - Hiroki Yabe
- Department of Physical Therapy, School of Rehabilitation Sciences, Seirei Christopher University, Hamamatsu, Shizuka, Japan
| | - Takashi Hibino
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Tomoya Yamaguchi
- Department of Rehabilitation, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Sayumi Morishita
- Department of Rehabilitation, Kaikoukai Josai Hospital, Nagoya, Aichi, Japan
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare School of Health Science at Narita, Narita, Chiba, Japan
| | - Yoshifumi Moriyama
- Department of Wellness Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Yamada
- Dialysis division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
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Rotondi S, Tartaglione L, Pasquali M, Ceravolo MJ, Mitterhofer AP, Noce A, Tavilla M, Lai S, Tinti F, Muci ML, Farcomeni A, Mazzaferro S. Association between Cognitive Impairment and Malnutrition in Hemodialysis Patients: Two Sides of the Same Coin. Nutrients 2023; 15:nu15040813. [PMID: 36839171 PMCID: PMC9964006 DOI: 10.3390/nu15040813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Cognitive impairment and malnutrition are prevalent in patients on hemodialysis (HD), and they negatively affect the outcomes of HD patients. Evidence suggests that cognitive impairment and malnutrition may be associated, but clinical studies to assess this association in HD patients are lacking. The aim of this study was to evaluate the association between cognitive impairment evaluated by the Montreal Cognitive Assessment (MoCA) score and nutritional status evaluated by the malnutrition inflammation score (MIS) in HD patients. We enrolled 84 HD patients (44 males and 40 females; age: 75.8 years (63.5-82.7); HD vintage: 46.0 months (22.1-66.9)). The MISs identified 34 patients (40%) as malnourished; the MoCa scores identified 67 patients (80%) with mild cognitive impairment (MCI). Malnourished patients had a higher prevalence of MCI compared to well-nourished patients (85% vs. 70%; p = 0.014). MoCa score and MIS were negatively correlated (rho:-0.317; p < 0.01). Our data showed a high prevalence of MCI and malnutrition in HD patients. Low MoCA scores characterized patients with high MISs, and malnutrition was a risk factor for MCI. In conclusion, it is plausible that MCI and malnutrition are linked by common sociodemographic, clinical, and biochemical risk factors rather than by a pathophysiological mechanism.
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Affiliation(s)
- Silverio Rotondi
- Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, 04100 Rome, Italy
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Lida Tartaglione
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
- Nephrology Unit, Department of Internal Medicine and Medical Specialities, University Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Marzia Pasquali
- Nephrology Unit, Department of Internal Medicine and Medical Specialities, University Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Maria Josè Ceravolo
- Nephrology and Dialysis Unit, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
| | - Anna Paola Mitterhofer
- Nephrology and Dialysis Unit, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
| | - Annalisa Noce
- Nephrology and Dialysis Unit, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
- Department of Systems Medicine, University Hospital Policlinico Tor Vergata, 00133 Rome, Italy
| | - Monica Tavilla
- Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, 04100 Rome, Italy
| | - Silvia Lai
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
| | - Francesca Tinti
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
- Nephrology Unit, Department of Internal Medicine and Medical Specialities, University Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Maria Luisa Muci
- Nephrology an Dialysis Unit, Fatebenefratelli Isola Tiberina Fondazione Policlinico Universitario A. Gemelli-Isola, 00186 Rome, Italy
| | - Alessio Farcomeni
- Department of Economics & Finance, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Sandro Mazzaferro
- Nephrology and Dialysis Unit, ICOT Hospital, Polo Pontino Sapienza University of Rome, 04100 Rome, Italy
- Department of Translational and Precision Medicine, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-0649978393
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Azzeh FS, Turkistani WM, Ghaith MM, Bahubaish LA, Kensara OA, Almasmoum HA, Aldairi AF, Khan AA, Alghamdi AA, Shamlan G, Alhussain MH, Algheshairy RM, AlShahrani AM, Qutob MS, Alazzeh AY, Qutob HM. Factors associated with the prevalence of malnutrition among adult hemodialytic patients: A two-center study in the Jeddah region, Saudi Arabia. Medicine (Baltimore) 2022; 101:e30757. [PMID: 36221328 PMCID: PMC9542565 DOI: 10.1097/md.0000000000030757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Chronic kidney disease, one of the most common diseases in the world, is characterized by irreversible impairment of the kidney's metabolic, excretory, and endocrine functions. During end-stage renal disease, patients require renal replacement therapy, such as hemodialysis (HD). Protein-energy wasting is a common health problem among HD patients. This study aims to assess the nutritional status of HD patients at two HD centers in Jeddah, Saudi Arabia, and to determine its associated factors. A cross-sectional study was conducted at two different dialysis centers in Jeddah, Saudi Arabia; 211 female and male HD patients. Malnutrition was recognized using the modified-subjective global assessment (M-SGA) comprising two parts: medical history and physical examination. Sociodemographic and health status for all patients were also determined. Patients were classified based on their M-SGA score into two groups: normal and malnourished. Overall, 54.5% of the participants showed malnutrition. Unemployment, low muscle strength and mass, high level of medication use, and high dialysis vintage were positively (P < .05) associated with malnutrition. In conclusion, the M-SGA score indicates a high prevalence of malnutrition among HD patients. These results show the importance of regular assessment and follow-ups for HD patients ensuring better health and nutritional status.
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Affiliation(s)
- Firas S. Azzeh
- Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- *Correspondence: Firas Azzeh, Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 24231, Saudi Arabia (e-mail: )
| | - Waad M. Turkistani
- Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Clinical Nutrition Department, Diaverum A.B. Prince Abdulmajeed Dialysis Center, Jeddah, Saudi Arabia
| | - Mazen M. Ghaith
- Laboratory Medicine Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Lujain A. Bahubaish
- Clinical Nutrition Department, Diaverum A.B. North Jeddah, Jeddah, Saudi Arabia
| | - Osama A. Kensara
- Clinical Nutrition Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
- Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | - Hussain A. Almasmoum
- Laboratory Medicine Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah F. Aldairi
- Laboratory Medicine Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Anmar A. Khan
- Laboratory Medicine Department, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ahmad A. Alghamdi
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Ghalia Shamlan
- Department of Food Science and Nutrition, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Maha H. Alhussain
- Department of Food Science and Nutrition, College of Food and Agriculture Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Reham M. Algheshairy
- Department of Food Science and Human Nutrition, College of Agriculture and Veterinary Medicine, Qassim University, Saudi Arabia
| | - Abdullah M. AlShahrani
- Department of Basic Medical Sciences, College of Applied Medical Sciences, Khamis Mushayt, King Khalid University, Abha, Saudi Arabia
| | - Maysoun S. Qutob
- Clinical Nutrition and Dietetics Department, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Awfa Y. Alazzeh
- Department of Clinical Nutrition, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia
| | - Haitham M.H. Qutob
- Faculty of Applied Medical Sciences, Department of Medical Laboratory Technology - Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
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Muscle strength performed better than muscle mass in identifying cognitive impairment risk in maintenance hemodialysis patients. Eat Weight Disord 2022; 27:2533-2540. [PMID: 35389149 DOI: 10.1007/s40519-022-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The association between muscle mass and cognitive impairment (CI) is conflicting. We aimed to evaluate and compare the associations of muscle strength, muscle mass and CI risk in maintenance hemodialysis (MHD) patients. METHODS We conducted a multicenter, cross-sectional study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. Muscle strength was assessed by hand grip strength (HGS), muscle mass was assessed by lean tissue mass (LTM). Education status was divided into two groups: lower education status (senior middle school and below) and higher education status (high school and above). Multivariable logistic regression models and subgroup analyses were performed. Receiver-operating characteristic (ROC) analyses were conducted to compare their predictive power in discriminating CI. RESULTS 2827 adult MHD patients were included in our final analysis. Patients in the lowest quartile of HGS was 2.82-fold as likely to have CI as compared to those in the highest quartile, while participants in the lowest quartile of LTM group were 1.52-fold as likely to have CI, when compared with the highest quartile group of LTM after adjusting for age, gender and education level. The association persisted in all subgroups except for women and well-educated participants. There was a significant interaction between HGS and education status on CI and age played an interactive role in the association between LTM and incident CI (P for interaction < 0.05). The AUC value of the HGS was significantly higher than that of LTM (0.69 VS 0.63, P < 0.001). CONCLUSIONS Muscle strength performed better than muscle mass in identifying individuals at high risk of CI, particularly in male and less educated Chinese MHD patients. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Chen G, Zhang H, Du X, Yin L, Zhang H, Zhou Q. Comparison of the prevalence and associated factors of cognitive frailty between elderly and middle-young patients receiving maintenance hemodialysis. Int Urol Nephrol 2022; 54:2703-2711. [PMID: 35366144 PMCID: PMC9463251 DOI: 10.1007/s11255-022-03188-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 03/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed at comparing the prevalence of cognitive frailty and explore the differences in the influencing factors between elderly and middle-young patients receiving maintenance hemodialysis (MHD). METHODS In this cross-sectional study, the frailty phenotype, mini-mental state examination, and clinical dementia rating were used to assess the current status of cognitive frailty in 852 patients receiving MHD from four hospitals in Lianyungang City and Xuzhou City, Jiangsu Province, China; the influencing factors were then analyzed for statistical significance. RESULTS Of the total 852 patients receiving MHD, 340 were classified into an elderly group (≥ 60 years) and 512 into a middle-young group (< 60 years). The prevalence of cognitive frailty was 35.9% and 8.8%, respectively. The results of multivariate logistic regression analysis showed that the independent factors of cognitive frailty were age (P < 0.001), education level (P = 0.010), nutritional status (P = 0.001), serum albumin level (P = 0.010), calf circumference (P = 0.024), and social support level (P < 0.001) in the elderly group and comorbidity status (P = 0.037), education level (P < 0.001), nutritional status (P = 0.008), serum creatinine level (P = 0.001), waist circumference (P < 0.001), and depression (P = 0.006) in the middle-young group. CONCLUSION The prevalence of cognitive frailty was significantly higher in the elderly group than in the middle-young group, and the influencing factors differed between the two populations.
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Affiliation(s)
- Guanjie Chen
- The Affiliated Lianyungang Hospital of Xuzhou Medical University, No 6, Zhenhua East Rd, Haizhou district, Lianyungang, 222061, Jiangsu, China
| | - Hailin Zhang
- The Affiliated Lianyungang Hospital of Xuzhou Medical University, No 6, Zhenhua East Rd, Haizhou district, Lianyungang, 222061, Jiangsu, China.
| | - Xiaoju Du
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Lixia Yin
- Department of Hemopurification Center, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Huipin Zhang
- The Affiliated Lianyungang Hospital of Xuzhou Medical University, No 6, Zhenhua East Rd, Haizhou district, Lianyungang, 222061, Jiangsu, China
| | - Qifan Zhou
- Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, China
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10
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Li C, Chen L, He L, Zhang Y, Chen H, Liu Y, Tang S, Zheng H. Study on the relationship between sarcopenia and its components and anorexia in elderly maintenance haemodialysis patients. Nurs Open 2021; 9:1096-1104. [PMID: 34907670 PMCID: PMC8859065 DOI: 10.1002/nop2.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/20/2021] [Accepted: 11/16/2021] [Indexed: 02/05/2023] Open
Abstract
AIM This study aimed to investigate the current situation of sarcopenia and anorexia of elderly maintenance haemodialysis patients and analyse the influencing factors. DESIGN A cross-sectional design was used in this study. METHODS One hundred and twelve elderly patients on MHD in 3 haemodialysis centres in Sichuan, China, were selected. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia (AWGS). Anorexia was assessed with the Functional Assessment of Anorexia Cachexia Therapy/Anorexia Cachexia Subscale (FAACT/ACS). The relationship between sarcopenia and anorexia was analysed by logistic regression. RESULTS The prevalences of sarcopenia and severe sarcopenia in elderly MHD patients were 52.7% and 39.3%, respectively, and the prevalence of anorexia was 25.9%. Severe sarcopenia was independently associated with anorexia, and weekly exercise frequency was independently associated with anorexia. The low SMI value and slow gait speed were strongly associated with anorexia. This study complied with the STROBE checklist.
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Affiliation(s)
- Chao Li
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Li He
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yingjun Zhang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Hui Chen
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuan Liu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Sikai Tang
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Haotian Zheng
- Hemodialysis center, Department of Nephrology and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,West China School of Nursing, Sichuan University, Chengdu, China
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11
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Torreggiani M, Fois A, Njandjo L, Longhitano E, Chatrenet A, Esposito C, Fessi H, Piccoli GB. Toward an individualized determination of dialysis adequacy: a narrative review with special emphasis on incremental hemodialysis. Expert Rev Mol Diagn 2021; 21:1119-1137. [PMID: 34595991 DOI: 10.1080/14737159.2021.1987216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The search for the 'perfect' renal replacement therapy has been paralleled by the search for the perfect biomarkers for assessing dialysis adequacy. Three main families of markers have been assessed: small molecules (prototype: urea); middle molecules (prototype β2-microglobulin); comprehensive and nutritional markers (prototype of the simplified assessment, albumin levels; composite indexes as malnutrition-inflammation score). After an era of standardization of dialysis treatment, personalized dialysis schedules are increasingly proposed, challenging the dogma of thrice-weekly hemodialysis. AREAS COVERED In this review, we describe the advantages and limitations of the approaches mentioned above, focusing on the open questions regarding personalized schedules and incremental hemodialysis. EXPERT OPINION In the era of personalized dialysis, the assessment of dialysis adequacy should be likewise personalized, due to the limits of 'one size fits all' approaches. We have tried to summarize some of the relevant issues regarding the determination of dialysis adequacy, attempting to adapt them to an elderly, highly comorbidity population, which would probably benefit from tailor-made dialysis prescriptions. While no single biomarker allows precisely tailoring the dialysis dose, we suggest using a combination of clinical and biological markers to prescribe dialysis according to comorbidity, life expectancy, residual kidney function, and small and medium-size molecule depuration.
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Affiliation(s)
| | - Antioco Fois
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Linda Njandjo
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France
| | - Elisa Longhitano
- Department of Clinical and Experimental Medicine, Unit of Nephrology and Dialysis, A.o.u. "G. Martino," University of Messina, Messina, Italy
| | - Antoine Chatrenet
- Nèphrologie et Dialyse, Centre Hospitalier Le Mans, Le Mans, France.,Laboratory "Movement, Interactions, Performance" (EA 4334), Le Mans University, Le Mans, France
| | - Ciro Esposito
- Nephrology and Dialysis, ICS Maugeri S.p.A. Sb, Pavia, Italy.,Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Hafedh Fessi
- Department of Nephrology, Hospital Tenon, Paris, France
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12
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Estimates of malnutrition associated with chronic kidney disease patients globally and its contrast with India: An evidence based systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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13
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Badrasawi M, Zidan S, Sharif I, Qaisiyha J, Ewaida S, Jaradat T, Samamra Y. Prevalence and correlates of malnutrition among hemodialysis patients at hebron governmental hospital, Palestine: cross-sectional study. BMC Nephrol 2021; 22:214. [PMID: 34098899 PMCID: PMC8182913 DOI: 10.1186/s12882-021-02413-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/12/2021] [Indexed: 12/04/2022] Open
Abstract
Background Malnutrition is a usually observed condition among patients on hemodialysis and is considered one of sturdiest indicators of mortality and morbidity. Objectives The current study was performed to assess the prevalence of malnutrition, to verify whether functional status is associated with malnutrition, and to explore the probable factors related to malnutrition among a sample of hemodialysis patients at Hebron Governmental Hospital in West Bank, Palestine. Methods A cross-sectional study was conducted on hemodialysis patients in Hebron Governmental Hospital at Hebron city/Palestine. An interview-based questionnaire was used to obtain information related to socio-demographics, dialysis, medical history, lifestyle, anthropometric measurements, dietary data, and functional status. Renal inpatient screening tool (renal iNUT) was also utilized to screen hemodialysis patients for malnutrition. Furthermore, biochemical tests were obtained during the study period from medical files of the studied patients. Results A total of 153 patients, having a mean age of 50.1 ± 16.6 years, were involved in the final analysis. The results indicated that the prevalence of high risk of malnutrition (45.4 %). Moreover, high risk of malnutrition was significantly associated with occupation, and walking. It was further found that patients with high risk of malnutrition are more likely to had osteoporosis, unable to ambulate, didn’t feel that the amount of food they eat is enough. Our findings also figured out that some complications during hemodialysis session (e.g., headache, nausea, hypotension) and some hemodialysis side effects (e.g., itching, access site complication) were significantly correlated to malnutrition. Conclusions A high prevalence of malnutrition was revealed among hemodialysis using renal iNUT screening tool. Improving nutritional assessment methods for patients on hemodialysis is highly needed. Findings reveals that risk of malnutrition is associated with multiple factors such as osteoporosis, occupation, walking, ability to ambulate, certain complication during hemodialysis session, and some hemodialysis side effects. Further studies are highly recommended.
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Affiliation(s)
- Manal Badrasawi
- Department of Nutrition and Food technology, Faculty of Agriculture and Veterinary medicine, An-Najah National University, Nablus, West Bank, Palestine.
| | - Souzan Zidan
- Department of Nutrition and Food technology, Faculty of Agriculture, Hebron university, Hebron, West Bank, Palestine
| | - Israa Sharif
- Healthy and Therapeutic Nutrition Department, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Juliana Qaisiyha
- Healthy and Therapeutic Nutrition Department, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Sanabel Ewaida
- Healthy and Therapeutic Nutrition Department, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Tala Jaradat
- Healthy and Therapeutic Nutrition Department, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
| | - Yasmeen Samamra
- Healthy and Therapeutic Nutrition Department, Faculty of Medicine and Health Sciences, Palestine Polytechnic University, Hebron, Palestine
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14
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Nutritional status and anxiety-depression relationship in hemodialysis patients. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.802547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Delgado-Domínguez CJ, Sanz-Gómez S, López-Herradón A, Díaz Espejo B, Lamas González O, de los Santos Roig M, Berdud Godoy I, Rincón Bello A, Ramos Sánchez R. Influence of Depression and Anxiety on Hemodialysis Patients: The Value of Multidisciplinary Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3544. [PMID: 33805492 PMCID: PMC8036719 DOI: 10.3390/ijerph18073544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022]
Abstract
Affective disorders promote poorer outcomes in hemodialysis patients. According to the presence or not of depression/anxiety in these patients, aims were to analyze differences in sociodemographic, clinical and/or psychological factors and to identify predictors. One hundred eighty-six hemodialysis patients were classified based on their depression/anxiety status. Basal characteristics showed differences between groups where mainly male sex (Depression: OR 0.2; Anxiety: OR 0.3) albumin (Depression: OR 0.1; Anxiety: OR 0.2) and calcium levels (Depression: OR 0.5; Anxiety: OR 0.4), impaired quality of life (Depression: OR 1.4; Anxiety: OR 1.2) and psychological inflexibility (Depression: OR 1.3; Anxiety: OR 1.2) were associated (all p < 0.01) to these mental conditions. Multivariate models showed that worse quality of life (OR 1.3; p < 0.001) predicted depression while marital status (with a partner; OR 0.3; p = 0.025) and albumin levels (OR 0.1; p = 0.027) were protective factors. Depression represented a risk factor for anxiety (OR 1.2; p = 0.001), although calcium levels (OR 0.5; p = 0.039) would protect this state. Interestingly, psychological inflexibility predicted both disorders (Depression: OR 1.2, p < 0.001 and Anxiety: OR 1.1; p = 0.002). Results highlight the relevance of well-trained multidisciplinary hemodialysis units to control the influence of these factors on the presence of depression/anxiety, and thus, their impact on the patients' outcomes.
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Affiliation(s)
- Carlos J. Delgado-Domínguez
- Centro de Hemodiálisis San Rafael, Fresenius Medical Care Services Andalucía (FMCSA), Calle Julio Arteche, 1, 14005 Córdoba, Spain; (B.D.E.); (I.B.G.)
| | - Sergio Sanz-Gómez
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Sevilla, Avenida Sánchez Pizjuán, s/n, 41009 Sevilla, Spain;
| | - Ana López-Herradón
- Departamento Médico, Fresenius Medical Care España, Ronda de Poniente, 8, 28760 Madrid, Spain; (A.L.-H.); (O.L.G.); (A.R.B.); (R.R.S.)
| | - Beatriz Díaz Espejo
- Centro de Hemodiálisis San Rafael, Fresenius Medical Care Services Andalucía (FMCSA), Calle Julio Arteche, 1, 14005 Córdoba, Spain; (B.D.E.); (I.B.G.)
| | - Olaya Lamas González
- Departamento Médico, Fresenius Medical Care España, Ronda de Poniente, 8, 28760 Madrid, Spain; (A.L.-H.); (O.L.G.); (A.R.B.); (R.R.S.)
| | - Macarena de los Santos Roig
- Departamento de Metodología de las Ciencias del Comportamiento, Facultad de Psicología, Campus de Cartuja, s/n, Universidad de Granada, 18011 Granada, Spain;
| | - Isabel Berdud Godoy
- Centro de Hemodiálisis San Rafael, Fresenius Medical Care Services Andalucía (FMCSA), Calle Julio Arteche, 1, 14005 Córdoba, Spain; (B.D.E.); (I.B.G.)
| | - Abraham Rincón Bello
- Departamento Médico, Fresenius Medical Care España, Ronda de Poniente, 8, 28760 Madrid, Spain; (A.L.-H.); (O.L.G.); (A.R.B.); (R.R.S.)
| | - Rosa Ramos Sánchez
- Departamento Médico, Fresenius Medical Care España, Ronda de Poniente, 8, 28760 Madrid, Spain; (A.L.-H.); (O.L.G.); (A.R.B.); (R.R.S.)
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16
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Xi F, Tan S, Gao T, Ding W, Sun J, Wei C, Li W, Yu W. Low skeletal muscle mass predicts poor clinical outcomes in patients with abdominal trauma. Nutrition 2021; 89:111229. [PMID: 33887547 DOI: 10.1016/j.nut.2021.111229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/25/2021] [Accepted: 03/01/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate whether low skeletal muscle mass is associated with clinical outcomes in patients with abdominal trauma. METHODS Patients presenting to our institution with abdominal trauma from January 2010 to April 2020 were retrospectively included. Low skeletal muscle mass was defined, using computed tomography, as skeletal muscle index (SMI) at the third lumbar vertebra below the lowest sex-specific quartile within 1 wk of admission. Clinical outcomes such as complications, hospital stay, and hospital cost were recorded, and univariate and multivariate analyses were performed. RESULTS Among 684 patients, 451 were eligible. Of these, 112 (24.8%) were classified as having low skeletal muscle mass, based on SMI diagnostic cutoff values (42.08 cm2/m2 for men and 37.35 cm2/m2 for women). Low skeletal muscle mass was significantly associated with longer hospital length of stay, longer intensive care length of stay, higher cost, higher frequency of mechanical ventilation, longer duration of vasopressor use, and higher incidence of massive transfusion and overall complications (P < 0.05). Subgroup analysis showed that pneumonia, acute gastrointestinal dysfunction, cholecystitis, digestive tract fistula, gastric fistula, and intestinal fistula were significantly associated with low skeletal muscle mass (P < 0.05). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for overall complications (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.33-4.49; P = 0.004), hospital length of stay (OR, 3.49; 95% CI, 1.96-6.20; P < 0.001), and hospital cost (OR, 2.67; 95% CI, 1.48-4.80; P = 0.001). CONCLUSIONS Low skeletal muscle mass could be an independent predictor of poor clinical outcomes in patients with abdominal trauma.
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Affiliation(s)
- Fengchan Xi
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China; Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Shanjun Tan
- Department of General Surgery/Shanghai Clinical Nutrition Research Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Gao
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiwei Ding
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Jianfeng Sun
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Caiyun Wei
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Weiqin Li
- Research Institute of General Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China
| | - Wenkui Yu
- Department of Intensive Care Unit, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
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17
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Comparison of Nutrition Risk Screening 2002 and Subjective Global Assessment Form as Short Nutrition Assessment Tools in Older Hospitalized Adults. Nutrients 2021; 13:nu13010225. [PMID: 33466724 PMCID: PMC7828813 DOI: 10.3390/nu13010225] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to compare two widely recommended short nutrition assessment tools—Nutrition Risk Screening 2002 (NRS-2002) and Subjective Global Assessment Form (SGA)—with other Comprehensive Geriatric Assessment (CGA) measurements. The study included 622 consecutively hospitalized older subjects, aged 81.7 ± 7.8 years. The criteria to participate were the ability to communicate and given consent. Both NRS-2002 and SGA were inversely related to anthropometric measurements, functional assessment tests, Mini-Mental State Examination (MMSE) and positively associated with the Vulnerable Elders Survey-13 (VES-13) score. Results of SGA and NRS-2002 were not related to sex and 15-item Geriatric Depression Scale (GDS) score. Comparison of well-nourished subjects and patients with suggested problems with nutrition according to NRS-2002 (0–2 vs. 3–7) and SGA (A vs. B + C) gave comparable results. Both nutritional scales at given cut-off points similarly discriminated anthropometric data and other CGA tools in the populations of well-nourished vs. malnourished hospitalized older subjects. In conclusion, we can recommend using both NRS-2002 and SGA to detect malnutrition or risk of malnutrition in a routine clinical practice of the geriatric department ward.
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18
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Shehab-Eldin W, Shaaban MA, Atia MAS, Zewain SK. The association between thyroid function and nutritional status in patients with end-stage renal disease on hemodialysis. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1863040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Walid Shehab-Eldin
- Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shib?n Al Kawm, Egypt
| | - Mohamed Ahmed Shaaban
- Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shib?n Al Kawm, Egypt
| | | | - Shimaa Kamal Zewain
- Department of Internal Medicine, Faculty of Medicine, Menoufia University, Shib?n Al Kawm, Egypt
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19
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Influence of unstable psychological condition on the quality of life of hemodialysis patients. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Hemodialysis patients tend to be in “unstable psychological conditions” because of complications and physical activity restriction. This study aimed to investigate unusual psychological factors and their influence on the quality of life (QOL) of hemodialysis patients.
Methods
This study targeted 55 patients who had experienced > 1 year of stable maintenance outpatient hemodialysis. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate unusual psychological conditions. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to evaluate QOL. Participants were grouped into “unstable psychological conditions” if HADS indicated that “depression is suspected” or “suspected depression, anxiety stated” (“Anxiety/Depression group”); this group was then compared to the “Stable group”.
Results
A total of 18 participants (32.7%) were included in the “Anxiety/Depression group”, and all QOL scores in this group were lower than those in the “Stable group”. In particular, a significantly low value was shown in the respective criteria such as “effects of kidney disease,” “social support,” and “general health perceptions”.
Conclusions
A possibility was suggested that the major causes were the restrictions of social activity by hospital visits and treatment and unique psychological conditions.
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20
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Sahathevan S, Khor BH, Ng HM, Abdul Gafor AH, Mat Daud ZA, Mafra D, Karupaiah T. Understanding Development of Malnutrition in Hemodialysis Patients: A Narrative Review. Nutrients 2020; 12:E3147. [PMID: 33076282 PMCID: PMC7602515 DOI: 10.3390/nu12103147] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
Hemodialysis (HD) majorly represents the global treatment option for patients with chronic kidney disease stage 5, and, despite advances in dialysis technology, these patients face a high risk of morbidity and mortality from malnutrition. We aimed to provide a novel view that malnutrition susceptibility in the global HD community is either or both of iatrogenic and of non-iatrogenic origins. This categorization of malnutrition origin clearly describes the role of each factor in contributing to malnutrition. Low dialysis adequacy resulting in uremia and metabolic acidosis and dialysis membranes and techniques, which incur greater amino-acid losses, are identified modifiable iatrogenic factors of malnutrition. Dietary inadequacy as per suboptimal energy and protein intakes due to poor appetite status, low diet quality, high diet monotony index, and/or psychosocial and financial barriers are modifiable non-iatrogenic factors implicated in malnutrition in these patients. These factors should be included in a comprehensive nutritional assessment for malnutrition risk. Leveraging the point of origin of malnutrition in dialysis patients is crucial for healthcare practitioners to enable personalized patient care, as well as determine country-specific malnutrition treatment strategies.
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Affiliation(s)
- Sharmela Sahathevan
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur 50300, Malaysia;
| | - Ban-Hock Khor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (B.-H.K.); (A.H.A.G.)
| | - Hi-Ming Ng
- School of Medicine, Faculty of Health & Medical Sciences, Taylor’s University Lakeside Campus, No 1, Jalan Taylors, Subang Jaya 47500, Malaysia;
| | - Abdul Halim Abdul Gafor
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (B.-H.K.); (A.H.A.G.)
| | - Zulfitri Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, UPM Serdang 43400, Malaysia;
| | - Denise Mafra
- Post Graduation Program in Medical Sciences and Post-Graduation Program in Cardiovascular Sciences, (UFF), Federal Fluminense University Niterói-Rio de Janeiro (RJ), Niterói-RJ 24033-900, Brazil;
| | - Tilakavati Karupaiah
- School of BioSciences, Faculty of Health & Medical Sciences, Taylor’s University Lakeside Campus, No 1, Jalan Taylors, Subang Jaya 47500, Malaysia
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21
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Zsom L, Zsom M, Abdul Salim S, Fülöp T. Subjective global assessment of nutrition, dialysis quality, and the theory of the scientific method in Nephrology practice. Artif Organs 2020; 44:1021-1030. [PMID: 33617092 DOI: 10.1111/aor.13762] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
In an era of evidence-based medicine and dialysis performance measures, there is strong motivation to find specific, objective, quantifiable, and reproducible parameters to characterize the clinical condition of chronic kidney disease patients and to present population-wide statistics that may describe quality of care in dialysis centers. Yet, in the last three decades, several studies demonstrated that while parameters including Kt/V urea, serum phosphorus, parathyroid hormone, serum cholesterol fulfill all these criteria, efforts to optimize these lab parameters failed to improve survival on dialysis. However, subjective assessments of nutrition including subjective global assessment and malnutrition-inflammation score, while not ideally suited for statistical analysis and not optimal from the point of view of scientific methodology due to their general, semi-quantifiable, subjective nature have, nevertheless, proved themselves as some of the strongest predictors of clinical outcomes in the dialysis population. Where does this paradox leave us? We propose that a deeper understanding of relevance of these variables in the dialysis population may improve appreciation of the clinical situation of individual patients and may result in a paradigm shift from dialysis adequacy to quality dialysis.
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Affiliation(s)
- Lajos Zsom
- Cegléd Dialysis Unit, Fresenius Medical Care, Cegléd, Hungary
| | - Marianna Zsom
- Department of Medicine, Szent Rókus Hospital, Baja, Hungary
| | - Sohail Abdul Salim
- Department of Medicine, Nephrology Division, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.,Department of Medicine, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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22
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Gołębiowski T, Kusztal M, Konieczny A, Letachowicz K, Gawryś A, Skolimowska B, Ostrowska B, Zmonarski S, Janczak D, Krajewska M. Disability of Dialysis Patients and the Condition of Blood Vessels. J Clin Med 2020; 9:E1806. [PMID: 32531965 PMCID: PMC7356767 DOI: 10.3390/jcm9061806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 01/31/2023] Open
Abstract
The number of elderly hemodialysis patients is constantly increasing worldwide. This population has a high burden of comorbid conditions, which impair daily activities. The aim of the study was to analyze problems of disability in hemodialysis patients in the context of cardiovascular (CV) complications and vascular condition. In this cross-sectional study, 129 patients (mean age 64.5) were enrolled. The degree of disability in Barthel index (Bi) and 10-year cardiovascular risk (QRISK®3) were assessed. A Mobil-O-Graph monitor was used for measuring hemodynamic parameters. Only 6.2% of patients were professionally active, 19% used a wheelchair for transport, and 16% used crutches. More than half (51%) were independent in everyday activities reaching 80-100 points on Bi. The rest, with Bi < 80, were considered as dependent. The most common causes of disability were CV complications. The independent group (80-100 points) was characterized by significantly lower pulse wave velocity (PWV) and lower QRISK®3 compared to dependent patients. The degree of disability negatively correlated with age, PWV, and QRISK®3. Multivariate logistic regression revealed that disability (Bi < 80) was independently associated with CV events in the past adjusted odds ratio (adj.OR) 4.83 (95% confidence interval (95% CI): 1.74-13.41) and higher PWV adj.OR 1.45 (95% CI: 1.15-1.82). Our results indicate that CV diseases are the most important cause of functional impairment.
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Affiliation(s)
- Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Andrzej Konieczny
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Ada Gawryś
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Beata Skolimowska
- Department of Occupational Therapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (B.S.); (B.O.)
| | - Bożena Ostrowska
- Department of Occupational Therapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (B.S.); (B.O.)
| | - Sławomir Zmonarski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; (M.K.); (A.K.); (K.L.); (A.G.); (S.Z.); (M.K.)
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Intradialytic Nutrition and Hemodialysis Prescriptions: A Personalized Stepwise Approach. Nutrients 2020; 12:nu12030785. [PMID: 32188148 PMCID: PMC7146606 DOI: 10.3390/nu12030785] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Dialysis and nutrition are two sides of the same coin—dialysis depurates metabolic waste that is typically produced by food intake. Hence, dietetic restrictions are commonly imposed in order to limit potassium and phosphate and avoid fluid overload. Conversely, malnutrition is a major challenge and, albeit to differing degrees, all nutritional markers are associated with survival. Dialysis-related malnutrition has a multifactorial origin related to uremic syndrome and comorbidities but also to dialysis treatment. Both an insufficient dialysis dose and excessive removal are contributing factors. It is thus not surprising that dialysis alone, without proper nutritional management, often fails to be effective in combatting malnutrition. While composite indexes can be used to identify patients with poor prognosis, none is fully satisfactory, and the definitions of malnutrition and protein energy wasting are still controversial. Furthermore, most nutritional markers and interventions were assessed in hemodialysis patients, while hemodiafiltration and peritoneal dialysis have been less extensively studied. The significant loss of albumin in these two dialysis modalities makes it extremely difficult to interpret common markers and scores. Despite these problems, hemodialysis sessions represent a valuable opportunity to monitor nutritional status and prescribe nutritional interventions, and several approaches have been tried. In this concept paper, we review the current evidence on intradialytic nutrition and propose an algorithm for adapting nutritional interventions to individual patients.
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