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Chen H, Yang C, Yan S, Liu X, Zhou L, Yuan X. Sarcopenia in cirrhosis: From pathophysiology to interventional therapy. Exp Gerontol 2024; 196:112571. [PMID: 39236869 DOI: 10.1016/j.exger.2024.112571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
Sarcopenia, characterized by the loss of skeletal muscle mass and function, is a significant complication in patients with cirrhosis. This condition not only exacerbates the overall morbidity and mortality associated with liver disease but also complicates patient management, increasing the risk of hospitalization, infections, and hepatic encephalopathy. Despite its clinical significance, sarcopenia in cirrhotic patients remains underdiagnosed and undertreated. This review aims to summarize current knowledge on the pathophysiology of sarcopenia in cirrhosis, including mechanisms such as altered metabolism, hormonal imbalances, and inflammation. Additionally, we explore diagnostic challenges and discuss emerging therapeutic strategies, including nutritional support, exercise, and pharmacological interventions. By highlighting the gaps in existing research and proposing directions for future studies, this review seeks to improve the management and outcomes of cirrhotic patients affected by sarcopenia.
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Affiliation(s)
- Huiling Chen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China; Fudan University, Shanghai, China
| | - Chenyun Yang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China
| | - Shijie Yan
- Department of General Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China
| | - Xintao Liu
- Department of General Medicine, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China; Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai, China
| | - Xinlu Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, 2800 Gongwei Road, Pudong, Shanghai 201399, China.
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Tsujimoto N, Matsuzawa R, Kakita D, Imai H, Harada M, Yoshikoshi S, Yamabe S, Osada S, Shimokado K, Matsunaga A, Tamaki A. Concomitant sarcopenia and undernutrition: Impact on clinical outcomes in patients undergoing hemodialysis. Clin Nutr ESPEN 2024; 63:651-658. [PMID: 39098604 DOI: 10.1016/j.clnesp.2024.07.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sarcopenia and undernutrition are crucial in the cycle of frailty in patients requiring hemodialysis therapy, and their deleterious clinical consequences are well documented. However, little attention has been directed towards examining their combined impact on clinical outcomes. OBJECTIVE This study aimed to elucidate the effects of concomitant sarcopenia and undernutrition on clinical outcomes in patients undergoing hemodialysis. METHODS This prospective cohort study recruited outpatients undergoing hemodialysis from four facilities. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia, 2019. Undernutrition was determined using the Geriatric Nutritional Risk Index, with a score of <92 classified as undernutrition. Patients were classified into four groups according to the presence or absence of sarcopenia and undernutrition. Cox proportional hazards analysis was used to assess the independent association between concomitant sarcopenia and undernutrition, all-cause mortality, and cardiovascular (CV) events after adjusting for baseline characteristics. RESULTS We included 450 patients in this analysis. Of the 450 patients, 69 (15.3%) had concomitant sarcopenia and undernutrition. The mean follow-up period was 1067 days, and there were 61 deaths and 60 CV events. The cumulative survival rate was significantly lower in the sarcopenia with undernutrition group (P = 0.011). The overlap of sarcopenia and undernutrition was significantly associated with a risk of mortality (hazard ratio 2.10; 95% confidence interval 1.05-4.21; P = 0.037). However, no association was observed between the co-occurrence of sarcopenia and undernutrition and the risk of CV events. CONCLUSIONS Concomitant sarcopenia and undernutrition were significantly associated with an increased mortality risk among patients undergoing hemodialysis. This finding reaffirms the importance of managing sarcopenia and undernutrition in patients undergoing hemodialysis in daily clinical practice.
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Affiliation(s)
- Naoyuki Tsujimoto
- Course of Health Science, Hyogo Medical University Graduate School of Health Science, Kobe, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan.
| | - Daisuke Kakita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Medical Science Division, Department of Medical Sciences, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
| | - Hiroto Imai
- Obara Hospital, Department of Rehabilitation, Kobe, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Shun Yoshikoshi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Sachi Yamabe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Katsushika, Japan
| | | | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
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Du J, Zhao X, Ding X, Han Q, Duan Y, Ren Q, Wang H, Song C, Wang X, Zhang D, Zhu H. The Role of the Gut Microbiota in Complications among Hemodialysis Patients. Microorganisms 2024; 12:1878. [PMID: 39338552 PMCID: PMC11434415 DOI: 10.3390/microorganisms12091878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
The composition of the gut microbiota varies among end-stage renal disease (ESRD) patients on the basis of their mode of renal replacement therapy (RRT), with notably more pronounced dysbiosis occurring in those undergoing hemodialysis (HD). Interventions such as dialysis catheters, unstable hemodynamics, strict dietary restrictions, and pharmacotherapy significantly alter the intestinal microenvironment, thus disrupting the gut microbiota composition in HD patients. The gut microbiota may influence HD-related complications, including cardiovascular disease (CVD), infections, anemia, and malnutrition, through mechanisms such as bacterial translocation, immune regulation, and the production of gut microbial metabolites, thereby affecting both the quality of life and the prognosis of patients. This review focuses on alterations in the gut microbiota and its metabolites in HD patients. Additionally, understanding the impact of the gut microbiota on the complications of HD could provide insights into the development of novel treatment strategies to prevent or alleviate complications in HD patients.
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Affiliation(s)
- Junxia Du
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Xiaolin Zhao
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Xiaonan Ding
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Qiuxia Han
- Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yingjie Duan
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Qinqin Ren
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Haoran Wang
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Chenwen Song
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Xiaochen Wang
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Dong Zhang
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
| | - Hanyu Zhu
- Department of Nephrology, First Medical Center of Chinese People's Liberation Army General Hospital, Nephrology Institute of the Chinese People's Liberation Army, National Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing 100853, China
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Heitman K, Bollenbecker S, Bradley J, Czaya B, Fajol A, Thomas SM, Li Q, Komarova S, Krick S, Rowe GC, Alexander MS, Faul C. Hyperphosphatemia Contributes to Skeletal Muscle Atrophy in Mice. Int J Mol Sci 2024; 25:9308. [PMID: 39273260 PMCID: PMC11395169 DOI: 10.3390/ijms25179308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/20/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Chronic kidney disease (CKD) is associated with various pathologic changes, including elevations in serum phosphate levels (hyperphosphatemia), vascular calcification, and skeletal muscle atrophy. Elevated phosphate can damage vascular smooth muscle cells and cause vascular calcification. Here, we determined whether high phosphate can also affect skeletal muscle cells and whether hyperphosphatemia, in the context of CKD or by itself, is associated with skeletal muscle atrophy. As models of hyperphosphatemia with CKD, we studied mice receiving an adenine-rich diet for 14 weeks and mice with deletion of Collagen 4a3 (Col4a3-/-). As models of hyperphosphatemia without CKD, we analyzed mice receiving a high-phosphate diet for three and six months as well as a genetic model for klotho deficiency (kl/kl). We found that adenine, Col4a3-/-, and kl/kl mice have reduced skeletal muscle mass and function and develop atrophy. Mice on a high-phosphate diet for six months also had lower skeletal muscle mass and function but no significant signs of atrophy, indicating less severe damage compared with the other three models. To determine the potential direct actions of phosphate on skeletal muscle, we cultured primary mouse myotubes in high phosphate concentrations, and we detected the induction of atrophy. We conclude that in experimental mouse models, hyperphosphatemia is sufficient to induce skeletal muscle atrophy and that, among various other factors, elevated phosphate levels might contribute to skeletal muscle injury in CKD.
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Affiliation(s)
- Kylie Heitman
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Seth Bollenbecker
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Jordan Bradley
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Brian Czaya
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Abul Fajol
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sarah Madison Thomas
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Qing Li
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Svetlana Komarova
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Glenn C Rowe
- Division of Cardiovascular Disease, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Matthew S Alexander
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Division of Neurology, Department of Pediatrics, Children's of Alabama, The University of Alabama at Birmingham, Birmingham, AL 35233, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Civitan International Research Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Center for Neurodegeneration and Experimental Therapeutics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Christian Faul
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Kim HJ, Seong EY, Jung HJ, Song SH. The phase angle before transplantation can predict the status of low muscle mass after kidney transplantation. Clin Exp Nephrol 2024:10.1007/s10157-024-02543-1. [PMID: 39168881 DOI: 10.1007/s10157-024-02543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND This study aimed to evaluate the association between phase angle, muscle strength, and muscle mass in patients undergoing kidney transplantation. METHODS Patients whose pre- and follow-up phase angles were measured after kidney transplantation were enrolled. Phase angle and body composition were measured using a multi-frequency bioimpedance analysis device before and at 7 and 14 days and 3, 6, and 12 months after transplantation. Muscle strength was evaluated using handgrip strength (HGS). Low HGS was defined as < 28 kg in males and < 18 kg in females. Low muscle mass was defined as an appendicular lean mass index of < 7.0 kg/m2 in males and < 5.7 kg/m2 in females. RESULTS Eighty-eight patients (mean age 52.3 ± 10.1 years) were analyzed. The mean phase angle of pre-transplantation was 5.0 ± 1.0°. Body fat percentage was significantly higher at 6 and 12 months after transplantation than pre-transplantation (P < 0.0001). Twelve months after kidney transplantation, the prevalence of low HGS decreased (pre-transplantation vs. 12 months post-transplantation: 28.4% vs. 17.0%), and the prevalence of low muscle mass (pre-transplantation vs. 12 months post-transplantation: 21.6% vs. 28.4%) increased. The pre-transplantation phase angle was significantly associated with low muscle mass at 12 months after kidney transplantation (odds ratio [OR]: 0.34; 95% confidence interval [CI]: 0.16-0.72; P = 0.005). The pre-transplantation phase angle was not significantly associated with low HGS (OR: 0.37; 95% CI 0.12-1.17; P = 0.090) 12 months after kidney transplantation. CONCLUSIONS Pre-transplantation phase angle can predict muscle mass status 12 months after kidney transplantation.
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Affiliation(s)
- Hyo Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Eun Young Seong
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
| | - Hyuk Jae Jung
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea
- Department of Surgery, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Surgery and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, South Korea.
- Department of Internal Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea.
- Organ Transplantation Center, Pusan National University Hospital, Busan, South Korea.
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Molinari P, Caldiroli L, Abinti M, Nardelli L, Armelloni S, Cesari M, Castellano G, Vettoretti S. Frailty Is Associated with Malnutrition-Inflammation Syndrome in Older CKD Patients. Nutrients 2024; 16:2626. [PMID: 39203763 PMCID: PMC11356796 DOI: 10.3390/nu16162626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/04/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
Patients affected by chronic kidney disease (CKD) are generally considered to be frailer than those with preserved renal function. We cross-sectionally evaluated the associations between frailty, malnutrition-inflammation syndrome and circulating inflammatory cytokines in 115 older individuals with advanced CKD. As for frailty definition, we adopted Fried's frailty phenotype (FP), while malnutrition-inflammation syndrome was assessed using the Malnutrition-Inflammation Score (MIS) and circulating inflammatory cytokines (IL-6; TNFα; MCP-1). A total of 48 patients were frail, and mean eGFR was comparable in both frail and non-frail patients (24 ± 10 vs. 25 ± 11 mL/min/1.73 m2; p = 0.63). Frail patients had higher MIS (6 [4-11] vs. 4 [3-5]; p < 0.0001) but cytokine concentrations were comparable in both groups. At multivariate regression, FP was independently associated with MIS, age, gender and pre-albumin but not with cytokines. However, we found some associations between inflammatory cytokines and some specific frailty criteria: weight loss and slowness were associated with MCP-1 (respectively p = 0.049 and p < 0.0001) and weakness with IL-6 (p = 0.005); in conclusion, in older patients with advanced CKD, frailty is strictly associated with malnutrition-inflammation syndrome but not with circulating inflammatory cytokines.
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Affiliation(s)
- Paolo Molinari
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
| | - Lara Caldiroli
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
| | - Matteo Abinti
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
| | - Luca Nardelli
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
| | - Silvia Armelloni
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy;
| | - Simone Vettoretti
- Unit of Nephrology, Dialysis and Kidney Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy; (P.M.); (M.A.); (L.N.); (S.A.); (G.C.); (S.V.)
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Li Y, Chen T, Zhang Z, Fan Y, Lin T, Chen J, Song T. Sarcopenic obesity is associated with adverse outcomes after kidney transplantation: a retrospective cohort study. Int Urol Nephrol 2024; 56:2565-2575. [PMID: 38431534 DOI: 10.1007/s11255-024-03982-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Sarcopenia was found to be a poor prognostic factor in kidney transplant recipients, but the role of sarcopenia obesity remains unclear. This study aimed to explore the effect of sarcopenic obesity on kidney transplantation. METHODS A retrospective analysis was performed on kidney transplant recipients between 2015 and 2019. Pretransplant CT scans were utilized to assess sarcopenia and visceral obesity. Based on the presence or absence of sarcopenia and visceral obesity, the recipients were classified into four distinct groups. RESULTS The recipients were categorized into four groups based on their characteristics: the nonsarcopenic nonobesity group (n = 493, 49.85%), the nonsarcopenic obesity group (n = 248, 25.08%), the sarcopenic nonobesity group (n = 188, 19.01%), and the sarcopenic obesity group (n = 60, 6.07%). Multivariate analysis, identified sarcopenic obesity was as an independent risk factor for mortality following kidney transplantation (adjusted hazard ratio, 5.861; 95% confidence interval [CI]: 1.627-21.108; P = 0.007). Additionally, sarcopenic obesity was associated with an increased risk of delayed graft function (adjusted odds ratio [aOR], 3.342; 95% CI 1.421-7.745; P = 0.005), perioperative incision infection (aOR, 9.654; 95% CI 1.572-60.648; P = 0.011), perioperative pulmonary infection (aOR, 2.557; 95% CI 1.208-5.215; P = 0.011), and readmission within 3 months (aOR, 2.100; 95% CI 1.051-4.017; P = 0.029). While sarcopenic obesity was found to be associated with impaired graft renal function, it did not show a significant correlation with death-censored graft survival or quality of life. CONCLUSION The presence of sarcopenic obesity prior to kidney transplantation represents an independent risk factor for mortality, and it is also linked to a range of unfavorable outcomes.
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Affiliation(s)
- Yue Li
- Department of Urology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
- Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tingyu Chen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhen Zhang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yu Fan
- Department of Urology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
- Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tao Lin
- Department of Urology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
- Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, 37# Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
- Transplant Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Romejko K, Szamotulska K, Rymarz A, Tomasz R, Niemczyk S. The association of appendicular skeletal muscle mass with anthropometric, body composition, nutritional, inflammatory, and metabolic variables in non-dialysis-dependent chronic kidney disease men. Front Med (Lausanne) 2024; 11:1380026. [PMID: 39118666 PMCID: PMC11306063 DOI: 10.3389/fmed.2024.1380026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
Background Muscle atrophy affects more than 50% of patients with chronic kidney disease (CKD) and is associated with increased morbidity and mortality. It is crucial to understand the mechanisms involved in the muscle atrophy in CKD and search for specific determinants of skeletal muscle mass loss, especially those which are available in everyday medical practice. This study aimed to evaluate the association between appendicular skeletal muscle mass (ASM) and anthropometric, body composition, nutritional, inflammatory, metabolic, and kidney function variables in non-dialysis-dependent CKD men. Methods A total of 85 men with CKD and eGFR lower than 60 mL/min/1.73 m2 were included in the cross-sectional study: 24 participants with eGFR 59-45 mL/min/1.73 m2, 32 individuals with eGFR 44-30 mL/min/1.73 m2, and 29 men with eGFR ≤29 mL/min/1.73 m2. ASM was estimated by bioimpedance spectroscopy (BIS) with the use of a Body Composition Monitor (BCM). To evaluate ASM from BCM, Lin's algorithm was used. Among anthropometric parameters, height, weight, and body mass index (BMI) were measured. Serum laboratory measurements were grouped into kidney function, nutritional, inflammatory, and metabolic parameters. Results ASM was significantly associated with anthropometric and body composition variables. According to the anthropometric parameters, ASM correlated positively with weight, height, and BMI (p < 0.001 and r = 0.913, p < 0.001 and r = 0.560, and p < 0.001 and r = 0.737, respectively). Among body composition variables, ASM correlated significantly and positively with lean tissue mass (LTM) (p < 0.001, r = 0.746), lean tissue index (LTI) (p < 0.001, r = 0.609), fat mass (p < 0.001, r = 0.489), and fat tissue index (FTI) (p < 0.001, r = 0.358). No other statistically significant correlation was found between ASM and kidney, nutritional, metabolic, and inflammatory variables. Conclusion In male patients with CKD stages G3-G5 not treated with dialysis, ASM correlates significantly and positively with anthropometric and body composition parameters such as weight, height, BMI, LTM, LTI, fat mass, and FTI. We did not observe such relationship between ASM and kidney function, nutritional, metabolic, and inflammatory variables.
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Affiliation(s)
- Katarzyna Romejko
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, Warsaw, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Warsaw, Poland
| | - Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, Warsaw, Poland
| | - Rozmyslowicz Tomasz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, Warsaw, Poland
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9
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Wang L, Zhu B, Xue C, Lin H, Zhou F, Luo Q. A Prospective Cohort Study Evaluating Impact of Sarcopenia on Hospitalization in Patients on Continuous Ambulatory Peritoneal Dialysis. Sci Rep 2024; 14:16926. [PMID: 39043705 PMCID: PMC11266515 DOI: 10.1038/s41598-024-65130-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
Data regarding the association of sarcopenia with hospitalization has led to inconclusive results in patients undergoing dialysis. The main goal of this research was to investigate the association between sarcopenia and hospitalization in Chinese individuals on continuous ambulatory peritoneal dialysis (CAPD). Eligible patients on CAPD were prospectively included, and followed up for 48 weeks in our PD center. Sarcopenia was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Participants were categorized into sarcopenia (non-severe sarcopenia + severe sarcopenia) and non-sarcopenia groups. The primary outcome was all-cause hospitalization during the 48-week follow-up period. Association of sarcopenia with all-cause hospitalization was examined by employing multivariate logistic regression models. The risk of cumulative incidence of hospitalization in the 48-week follow-up was estimated using relative risk (RR and 95% CI). The cumulative hospitalization time and frequency at the end of 48-week follow-up were described as categorical variables, and compared by χ2 test or fisher's exact test as appropriate. Subgroup and sensitivity analyses were also conducted to examine whether the potential association between sarcopenia and hospitalization was modified. A total of 220 patients on CAPD (5 of whom were lost in follow-up) were included. Prevalences of total sarcopenia and severe sarcopenia were 54.1% (119/220) and 28.2% (62/220) according to AWGS 2019, respectively. A total of 113 (51.4%) participants were hospitalized during the 48-week follow-up period, of which, the sarcopenia group was 65.5% (78/119) and the non-sarcopenia group was 34.7% (35/101), with an estimated RR of 1.90 (95%CI 1.43-2.52). The cumulative hospitalization time and frequency between sarcopenia and non-sarcopenia groups were significantly different (both P < 0.001). Participants with sarcopenia (OR = 3.21, 95%CI 1.75-5.87, P < 0.001), non-severe sarcopenia (OR = 2.84, 95%CI 1.39-5.82, P = 0.004), and severe sarcopenia (OR = 3.66, 95%CI 1.68-8.00, P = 0.001) demonstrated a significant association with all-cause hospitalization compared to individuals in non-sarcopenia group in the 48-week follow-up. Moreover, participants in subgroups (male or female; < 60 or ≥ 60 years) diagnosed with sarcopenia, as per AWGS 2019, were at considerably high risk for hospitalization compared to those with non-sarcopenia. In sensitivity analyses, excluding participants lost in the follow-up, the relationships between sarcopenia and hospitalization (sarcopenia vs. non-sarcopenia; severe sarcopenia/non-severe sarcopenia vs. non-sarcopenia) were consistent. This research involving Chinese patients on CAPD demonstrated a significant association between sarcopenia and incident hospitalization, thereby emphasizing the importance of monitoring sarcopenia health in this population.
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Affiliation(s)
- Lailiang Wang
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China
| | - Beixia Zhu
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China
| | - Congping Xue
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China
| | - Haixue Lin
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China
| | - Fangfang Zhou
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China
| | - Qun Luo
- Department of Nephrology, Ningbo NO.2 Hospital, Ningbo, Zhejiang, China.
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10
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de Resende E Silva DT, Bizuti MR, de Oliveira NR, Lima LZM, Dos Santos Arraes VG, Zietz ACG, Zin C, de Sousa Silva GV, Puhle JG, Haag FB. Physical exercise as a modulator of the purinergic system in the control of sarcopenia in individuals with chronic kidney disease on hemodialysis. Purinergic Signal 2024; 20:213-222. [PMID: 37368148 PMCID: PMC11189381 DOI: 10.1007/s11302-023-09950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
The word sarcopenia derives from the Greek terms "sarx" for meat and "penia" for loss, thus being used to define reductions in muscle mass, muscle strength, and lower physical performance that compromise, mainly, the elderly population. Its high negative impact on patients' quality of life encourages the production and publication of new studies that seek to find methods to prevent and reverse cases of loss of muscle mass and strength. Furthermore, the high prevalence of sarcopenia in patients with chronic kidney disease (CKD) is closely related to its pathophysiology, which consists of a state of increased protein catabolism and decreased muscle tissue synthesis. Also considering the inflammatory nature of CKD and sarcopenia, the purinergic system has been an important target of studies, which seek to relate it to the two previous conditions. This system achieves anti-inflammatory action by inhibiting, through adenosine, pro-inflammatory factors such as interleukin-12 (IL-12), tumor necrosis factor alpha (TNF-α), and nitric oxide (NO), as well as by releasing anti-inflammatory substances such as interleukin-10 (IL-10). Simultaneously, the purinergic system presents pro-inflammatory activity, signaled by adenosine triphosphate (ATP), which occurs through the activation of T cells and the release of pro-inflammatory factors such as those mentioned above. Therefore, the ability of this system to act on inflammatory processes can promote positive and negative changes in the clinical aspect of patients with CKD and/or sarcopenia. Furthermore, it appears that there is a correlation between the practice of repeated physical exercise with the clinical improvement and in the quality of life of these patients, presenting a decrease in the levels of C-reactive protein (CRP), NTPDase, and the pro-inflammatory cytokine IL-6, such as increases in IL-10 resulting from modulation of the purinergic system. In this way, the present article seeks to evaluate the effect of physical exercise as a modulator of the purinergic system in the control of sarcopenia in patients with CKD on hemodialysis, in order to trace a relationship that can bring benefits both for biological markers and for quality of life of these patients.
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Affiliation(s)
- Débora Tavares de Resende E Silva
- Department of Graduate Studies in Biomedical Sciences, Federal University of Fronteira Sul (UFFS), Rodovia SC 484-Km 02, Fronteira Sul, Chapecó, SC, CEP 89815-899, Brazil.
| | - Matheus Ribeiro Bizuti
- Department of Medicine, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
| | | | | | | | | | - Carolina Zin
- Department of Medicine, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
| | | | - Josiano Guilherme Puhle
- Department of Health Sciences, Western Santa Catarina University, Videira, Santa Catarina, Brazil
| | - Fabiana Brum Haag
- Nursing College, Federal University of Fronteira Sul (UFFS), Chapecó, Santa Catarina, Brazil
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11
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Kajbafvala M, ShahAli S, Ebrahimi Takamjani I, Ashnagar Z, Hosseini R, Shahabi S, Hejazi A. Effect of exercise training on functional capacity, muscle strength, exercise capacity, dialysis efficacy and quality of life in children and adolescents with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol 2024; 56:1939-1951. [PMID: 38055100 DOI: 10.1007/s11255-023-03887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/12/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE To synthesize the effect of exercise training on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and quality of life (QOL) in children and adolescents with CKD. METHODS PubMed/Medline, Scopus, PEDro, Web of Science, CINAHL, Cochrane, and Embase were searched from inception to September 30, 2023. Randomized control trials (RCTs) and clinical trials that assessed the effect of exercise training programs on functional capacity, muscle strength, exercise capacity, dialysis efficacy, and QOL in children and adolescents with CKD were included. Random effect model and meta-regression were used for the meta-analysis. RESULTS Four clinical trials and three RCTs were included. The results showed that exercise training improves strength, but meta-analysis did not show a significant effect of exercise on functional capacity (WMD: 1.02; 95% CI: - 0.14 to 2.18; p = 0.083) and QOL (WMD: 8.00; 95% CI: - 3.90 to 19.91; p = 0.187). Subgroup analysis revealed that more than 25 sessions and 45 min per session of intervention, a PEDro score of more than 5, and being younger than 12 years of age had a large effect on functional capacity and QOL results. Due to the limited number of studies that reported the effect of exercise on dialysis efficacy and exercise capacity, the findings were inconclusive. CONCLUSION Exercise training could benefit children and adolescents with CKD by increasing their strength. Longer exercise interventions may be beneficial for improving functional capacity and QOL. Future well-designed RCTs should overcome the existing limitations using adequate sample sizes and longer exercise durations.
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Affiliation(s)
- Mehrnaz Kajbafvala
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Shabnam ShahAli
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ismail Ebrahimi Takamjani
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Zinat Ashnagar
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Rozita Hosseini
- Department of Pediatric Nephrology, Ali-Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Anahita Hejazi
- Department of Physiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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12
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Al-Taie A, Arueyingho O, Khoshnaw J, Hafeez A. Clinical outcomes of multidimensional association of type 2 diabetes mellitus, COVID-19 and sarcopenia: an algorithm and scoping systematic evaluation. Arch Physiol Biochem 2024; 130:342-360. [PMID: 35704400 DOI: 10.1080/13813455.2022.2086265] [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: 03/15/2022] [Revised: 05/25/2022] [Accepted: 05/31/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The aim of this study was to provide a scoping and comprehensive review for the clinical outcomes from the cross-link of Type 2 diabetes mellitus (T2DM), COVID-19, and sarcopenia. METHODS By using PRISMA guidelines and searching through different databases that could provide findings of evidence on the association of T2DM, COVID-19, and sarcopenia. RESULTS Thirty-three studies reported a relationship between sarcopenia with T2DM, twenty-one studies reported the prognosis COVID-19 in patients with T2DM, ten studies reported the prognosis of COVID-19 in patients with sarcopenia, five studies discussed the outcomes of sarcopenia in patients with COVID-19, and one study reported sarcopenia outcomes in the presence of T2DM and COVID-19. CONCLUSION There is an obvious multidimensional relationship between T2DM, COVID-19 and sarcopenia which can cause prejudicial effects, poor prognosis, prolonged hospitalisation, lowered quality of life and a higher mortality rate during the current COVID-19 pandemic.
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Affiliation(s)
- Anmar Al-Taie
- Clinical Pharmacy Department, Faculty of Pharmacy, Istinye University, Istanbul, Turkey
| | - Oritsetimeyin Arueyingho
- EPSRC Centre for Doctoral Training in Digital Health and Care, University of Bristol, Bristol, UK
| | - Jalal Khoshnaw
- Pharmacy Department, Faculty of Pharmacy, Girne American University, Mersin, Turkey
| | - Abdul Hafeez
- Department of Pharmaceutics, Glocal School of Pharmacy, Glocal University, Saharanpur, Uttar Pradesh, India
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13
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Palakshappa JA, Batt JAE, Bodine SC, Connolly BA, Doles J, Falvey JR, Ferrante LE, Files DC, Harhay MO, Harrell K, Hippensteel JA, Iwashyna TJ, Jackson JC, Lane-Fall MB, Monje M, Moss M, Needham DM, Semler MW, Lahiri S, Larsson L, Sevin CM, Sharshar T, Singer B, Stevens T, Taylor SP, Gomez CR, Zhou G, Girard TD, Hough CL. Tackling Brain and Muscle Dysfunction in Acute Respiratory Distress Syndrome Survivors: NHLBI Workshop Report. Am J Respir Crit Care Med 2024; 209:1304-1313. [PMID: 38477657 PMCID: PMC11146564 DOI: 10.1164/rccm.202311-2130ws] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/12/2024] [Indexed: 03/14/2024] Open
Abstract
Acute respiratory distress syndrome (ARDS) is associated with long-term impairments in brain and muscle function that significantly impact the quality of life of those who survive the acute illness. The mechanisms underlying these impairments are not yet well understood, and evidence-based interventions to minimize the burden on patients remain unproved. The NHLBI of the NIH assembled a workshop in April 2023 to review the state of the science regarding ARDS-associated brain and muscle dysfunction, to identify gaps in current knowledge, and to determine priorities for future investigation. The workshop included presentations by scientific leaders across the translational science spectrum and was open to the public as well as the scientific community. This report describes the themes discussed at the workshop as well as recommendations to advance the field toward the goal of improving the health and well-being of ARDS survivors.
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Affiliation(s)
| | - Jane A. E. Batt
- University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Sue C. Bodine
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
- Oklahoma City Veterans Affairs Medical Center, Oklahoma City, Oklahoma
| | - Bronwen A. Connolly
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, Belfast, United Kingdom
| | - Jason Doles
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Jason R. Falvey
- University of Maryland School of Medicine, Baltimore, Maryland
| | | | - D. Clark Files
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Michael O. Harhay
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | - Meghan B. Lane-Fall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michelle Monje
- Howard Hughes Medical Institute, Stanford University, Stanford, California
| | - Marc Moss
- University of Colorado School of Medicine, Aurora, Colorado
| | - Dale M. Needham
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Shouri Lahiri
- Cedars Sinai Medical Center, Los Angeles, California
| | - Lars Larsson
- Center for Molecular Medicine, Karolinska Institute, Solna, Sweden
- Department of Physiology & Pharmacology, Karolinska Institute and Viron Molecular Medicine Institute, Boston, Massachusetts
| | - Carla M. Sevin
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tarek Sharshar
- Anesthesia and Intensive Care Department, GHU Paris Psychiatry and Neurosciences, Institute of Psychiatry and Neurosciences of Paris, INSERM U1266, University Paris Cité, Paris, France
| | | | | | | | - Christian R. Gomez
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Guofei Zhou
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Timothy D. Girard
- Center for Research, Investigation, and Systems Modeling of Acute Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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14
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Vandecruys M, De Smet S, De Beir J, Renier M, Leunis S, Van Criekinge H, Glorieux G, Raes J, Vanden Wyngaert K, Nagler E, Calders P, Monbaliu D, Cornelissen V, Evenepoel P, Van Craenenbroeck AH. Revitalizing the Gut Microbiome in Chronic Kidney Disease: A Comprehensive Exploration of the Therapeutic Potential of Physical Activity. Toxins (Basel) 2024; 16:242. [PMID: 38922137 PMCID: PMC11209503 DOI: 10.3390/toxins16060242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Both physical inactivity and disruptions in the gut microbiome appear to be prevalent in patients with chronic kidney disease (CKD). Engaging in physical activity could present a novel nonpharmacological strategy for enhancing the gut microbiome and mitigating the adverse effects associated with microbial dysbiosis in individuals with CKD. This narrative review explores the underlying mechanisms through which physical activity may favorably modulate microbial health, either through direct impact on the gut or through interorgan crosstalk. Also, the development of microbial dysbiosis and its interplay with physical inactivity in patients with CKD are discussed. Mechanisms and interventions through which physical activity may restore gut homeostasis in individuals with CKD are explored.
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Affiliation(s)
- Marieke Vandecruys
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (M.V.); or (P.E.)
| | - Stefan De Smet
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, 3000 Leuven, Belgium;
| | - Jasmine De Beir
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium; (J.D.B.); (P.C.)
| | - Marie Renier
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (M.R.); (V.C.)
| | - Sofie Leunis
- Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, 3000 Leuven, Belgium; (S.L.); (H.V.C.); (D.M.)
| | - Hanne Van Criekinge
- Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, 3000 Leuven, Belgium; (S.L.); (H.V.C.); (D.M.)
| | - Griet Glorieux
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (K.V.W.); (E.N.)
| | - Jeroen Raes
- Department of Microbiology and Immunology, Rega Institute for Medical Research, 3000 Leuven, Belgium;
- VIB-KU Leuven Center for Microbiology, 3000 Leuven, Belgium
| | - Karsten Vanden Wyngaert
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (K.V.W.); (E.N.)
| | - Evi Nagler
- Department of Internal Medicine and Pediatrics, Nephrology Section, Ghent University Hospital, 9000 Ghent, Belgium; (G.G.); (K.V.W.); (E.N.)
| | - Patrick Calders
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium; (J.D.B.); (P.C.)
| | - Diethard Monbaliu
- Department of Microbiology, Immunology and Transplantation, Abdominal Transplantation, KU Leuven, 3000 Leuven, Belgium; (S.L.); (H.V.C.); (D.M.)
- Transplantoux Foundation, 3000 Leuven, Belgium
| | - Véronique Cornelissen
- Group Rehabilitation for Internal Disorders, Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (M.R.); (V.C.)
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (M.V.); or (P.E.)
- Department of Nephrology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium; (M.V.); or (P.E.)
- Department of Nephrology, University Hospitals Leuven, 3000 Leuven, Belgium
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15
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Heitman K, Alexander MS, Faul C. Skeletal Muscle Injury in Chronic Kidney Disease-From Histologic Changes to Molecular Mechanisms and to Novel Therapies. Int J Mol Sci 2024; 25:5117. [PMID: 38791164 PMCID: PMC11121428 DOI: 10.3390/ijms25105117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024] Open
Abstract
Chronic kidney disease (CKD) is associated with significant reductions in lean body mass and in the mass of various tissues, including skeletal muscle, which causes fatigue and contributes to high mortality rates. In CKD, the cellular protein turnover is imbalanced, with protein degradation outweighing protein synthesis, leading to a loss of protein and cell mass, which impairs tissue function. As CKD itself, skeletal muscle wasting, or sarcopenia, can have various origins and causes, and both CKD and sarcopenia share common risk factors, such as diabetes, obesity, and age. While these pathologies together with reduced physical performance and malnutrition contribute to muscle loss, they cannot explain all features of CKD-associated sarcopenia. Metabolic acidosis, systemic inflammation, insulin resistance and the accumulation of uremic toxins have been identified as additional factors that occur in CKD and that can contribute to sarcopenia. Here, we discuss the elevation of systemic phosphate levels, also called hyperphosphatemia, and the imbalance in the endocrine regulators of phosphate metabolism as another CKD-associated pathology that can directly and indirectly harm skeletal muscle tissue. To identify causes, affected cell types, and the mechanisms of sarcopenia and thereby novel targets for therapeutic interventions, it is important to first characterize the precise pathologic changes on molecular, cellular, and histologic levels, and to do so in CKD patients as well as in animal models of CKD, which we describe here in detail. We also discuss the currently known pathomechanisms and therapeutic approaches of CKD-associated sarcopenia, as well as the effects of hyperphosphatemia and the novel drug targets it could provide to protect skeletal muscle in CKD.
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Affiliation(s)
- Kylie Heitman
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Matthew S. Alexander
- Division of Neurology, Department of Pediatrics, The University of Alabama at Birmingham and Children’s of Alabama, Birmingham, AL 35294, USA
- Center for Exercise Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Department of Genetics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Civitan International Research Center, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Center for Neurodegeneration and Experimental Therapeutics, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Christian Faul
- Division of Nephrology and Section of Mineral Metabolism, Department of Medicine, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL 35294, USA;
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16
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Yang Y, Liu L, Li Y, Tan R, Zhong X, Liu Y, Liu Y. Associations between pinch strength, cardiovascular events and all-cause mortality in patients undergoing maintenance hemodialysis. BMC Nephrol 2024; 25:150. [PMID: 38698329 PMCID: PMC11064367 DOI: 10.1186/s12882-024-03587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND AIMS Patients undergoing maintenance hemodialysis (MHD) experience increased mortality and cardiovascular disease (CVD) risks; however, the potential connection between pinch strength (PS) and the prognosis of these patients remains unknown. Consequently, this study aimed to comprehensively assess the influence of PS and handgrip strength (HGS) on both survival and cardiovascular events (CVE) in patients undergoing MHD. METHODS Data were gathered from patients undergoing MHD at the Hemodialysis Center of Guangzhou Red Cross Hospital in March 2021. We performed a retrospective follow-up spanning 24 months, with death serving as the primary endpoint for observation and CVE as the secondary endpoint. Multifactorial Cox regression analysis, Kaplan-Meier survival curves, trend tests, and restricted cubic spline were applied to explore the association. RESULTS During a 24-month follow-up, data were collected from 140 patients undergoing MHD with an average age of 66.71 ± 12.61 years. Among them, 52 (37.14%) experienced mortality, whereas 36 (40.00%) had CVE without baseline CVD. Kaplan-Meier survival curves demonstrated better survival rates and reduced CVE risk for patients in the second, third, and fourth quartiles compared with those in the first quartile for PS. Adjusted analyses in different models revealed higher PS levels were independently associated with all-cause mortality (major model, model 4, HR, 0.78; 95% CI, 0.64-0.95) but not with CVE risk (unadjusted HR, 0.90; 95% CI, 0.77-1.05). Compared with lower quartile PS levels, higher PS levels significantly reduced all-cause mortality (HR, 0.31; 95% CI, 0.10-1.02), and this trend remained consistent (P for trend = 0.021). Finally, the restricted cubic spline method using different models showed a linear relationship between PS and all-cause mortality (P > 0.05), when PS exceeded 4.99 kg, the all-cause mortality of MHD patients significantly decreased. CONCLUSIONS PS was independently associated with all-cause mortality but not with CVE in patients undergoing MHD.
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Affiliation(s)
- Yaqi Yang
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, China
| | - Lin Liu
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, China
| | - Yuzhuo Li
- Department of Nephrology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Rongshao Tan
- Department of Nephrology, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Xiaoshi Zhong
- Department of Nephrology, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Yun Liu
- Department of Nephrology, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
| | - Yan Liu
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, China.
- Department of Nephrology, Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
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17
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Higashihara T, Odawara M, Nishi H, Sugasawa T, Suzuki Y, Kametaka S, Inagi R, Nangaku M. Uremia Impedes Skeletal Myocyte Myomixer Expression and Fusogenic Activity: Implication for Uremic Sarcopenia. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:759-771. [PMID: 38637109 DOI: 10.1016/j.ajpath.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 12/10/2023] [Accepted: 01/10/2024] [Indexed: 04/20/2024]
Abstract
In patients with chronic kidney disease (CKD), skeletal muscle mass and function are known to occasionally decline. However, the muscle regeneration and differentiation process in uremia has not been extensively studied. In mice with CKD induced by adenine-containing diet, the tibialis anterior muscle injured using a barium chloride injection method recovered poorly as compared to control mice. In the cultured murine skeletal myocytes, stimulation with indoxyl sulfate (IS), a representative uremic toxin, morphologically jeopardized the differentiation, which was counteracted by L-ascorbic acid (L-AsA) treatment. Transcriptome analysis of cultured myocytes identified a set of genes whose expression was down-regulated by IS stimulation but up-regulated by L-AsA treatment. Gene silencing of myomixer, one of the genes in the set, impaired myocyte fusion during differentiation. By contrast, lentiviral overexpression of myomixer compensated for a hypomorphic phenotype caused by IS treatment. The split-luciferase technique demonstrated that IS stimulation negatively affected early myofusion activity that was rescued by L-AsA treatment. Lastly, in mice with CKD compared with control mice, myomixer expression in the muscle tissue in addition to the muscle weight after the injury was reduced, both of which were restored with L-AsA treatment. Collectively, data showed that the uremic milieu impairs the expression of myomixer and impedes the myofusion process. Considering frequent musculoskeletal injuries in uremic patients, defective myocyte fusion followed by delayed muscle damage recovery could underlie their muscle loss and weakness.
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Affiliation(s)
- Takaaki Higashihara
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Motoki Odawara
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Nishi
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
| | - Takehito Sugasawa
- Laboratory of Clinical Examination/Sports Medicine, Department of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Department of Sports Medicine Analysis, Open Facility Network Office, Research Facility Center for Science and Technology, University of Tsukuba, Ibaraki, Japan
| | - Yumika Suzuki
- Division of Biofunctional Sciences, Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Aichi, Japan
| | - Satoshi Kametaka
- Division of Biofunctional Sciences, Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Aichi, Japan
| | - Reiko Inagi
- Division of CKD Pathophysiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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He J, He Z, Wang H, Zhang C, Pei T, Yan S, Yan Y, Wang F, Chen Y, Yuan N, Wang M, Xiao W. Caffeic acid alleviates skeletal muscle atrophy in 5/6 nephrectomy rats through the TLR4/MYD88/NF-kB pathway. Biomed Pharmacother 2024; 174:116556. [PMID: 38636398 DOI: 10.1016/j.biopha.2024.116556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024] Open
Abstract
Skeletal muscle atrophy is a common complication of chronic kidney disease (CKD) that affects the quality of life and prognosis of patients. We aimed to investigate the effects and mechanisms of caffeic acid (CA), a natural phenolic compound, on skeletal muscle atrophy in CKD rats. Male Sprague-Dawley rats underwent 5/6 nephrectomy (NPM) and were treated with CA (20, 40, or 80 mg/kg/day) for 10 weeks. The body and muscle weights, renal function, hemoglobin, and albumin were measured. The histological, molecular, and biochemical changes in skeletal muscles were evaluated using hematoxylin-eosin staining, quantitative real-time PCR, malondialdehyde/catalase/superoxide dismutase/glutathione level detection, and enzyme-linked immunosorbent assay. Western blotting and network pharmacology were applied to identify the potential targets and pathways of CA, CKD, and muscle atrophy. The results showed that CA significantly improved NPM-induced muscle-catabolic effects, reduced the expression of muscle atrophy-related proteins (muscle atrophy F-box and muscle RING finger 1) and proinflammatory cytokines (interleukin [IL]-6, tumor necrosis factor-alpha, and IL-1β), and attenuated muscle oxidative stress. Network pharmacology revealed that CA modulated the response to oxidative stress and nuclear factor kappa B (NF-κB) signaling pathway and that Toll-like receptor 4 (TLR4) was a key target. In vivo experiment confirmed that CA inhibited the TLR4/myeloid differentiation primary response 88 (MYD88)/NF-kB signaling pathway, reduced muscle iron levels, and restored glutathione peroxidase 4 activity, thereby alleviating ferroptosis and inflammation in skeletal muscles. Thus, CA might be a promising therapeutic agent for preventing and treating skeletal muscle atrophy in CKD by modulating the TLR4/MYD88/NF-κB pathway and ferroptosis.
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Affiliation(s)
- Jinyue He
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhuoen He
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Hao Wang
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Chi Zhang
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Tingting Pei
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Shihua Yan
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yangtian Yan
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Fujing Wang
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuchi Chen
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Ningning Yuan
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Mingqing Wang
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Wei Xiao
- School of traditional Chinese medicine, Southern Medical University, Guangzhou, Guangdong 510515, China; Key Laboratory of Glucolipid Metabolic Disorder, Ministry of Education, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, China.
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19
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Thome T, Vugman NA, Stone LE, Wimberly K, Scali ST, Ryan TE. A tryptophan-derived uremic metabolite/Ahr/Pdk4 axis governs skeletal muscle mitochondrial energetics in chronic kidney disease. JCI Insight 2024; 9:e178372. [PMID: 38652558 PMCID: PMC11141944 DOI: 10.1172/jci.insight.178372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
Chronic kidney disease (CKD) causes accumulation of uremic metabolites that negatively affect skeletal muscle. Tryptophan-derived uremic metabolites are agonists of the aryl hydrocarbon receptor (AHR), which has been shown to be activated in CKD. This study investigated the role of the AHR in skeletal muscle pathology of CKD. Compared with controls with normal kidney function, AHR-dependent gene expression (CYP1A1 and CYP1B1) was significantly upregulated in skeletal muscle of patients with CKD, and the magnitude of AHR activation was inversely correlated with mitochondrial respiration. In mice with CKD, muscle mitochondrial oxidative phosphorylation (OXPHOS) was markedly impaired and strongly correlated with the serum level of tryptophan-derived uremic metabolites and AHR activation. Muscle-specific deletion of the AHR substantially improved mitochondrial OXPHOS in male mice with the greatest uremic toxicity (CKD + probenecid) and abolished the relationship between uremic metabolites and OXPHOS. The uremic metabolite/AHR/mitochondrial axis in skeletal muscle was verified using muscle-specific AHR knockdown in C57BL/6J mice harboring a high-affinity AHR allele, as well as ectopic viral expression of constitutively active mutant AHR in mice with normal renal function. Notably, OXPHOS changes in AHRmKO mice were present only when mitochondria were fueled by carbohydrates. Further analyses revealed that AHR activation in mice led to significantly increased pyruvate dehydrogenase kinase 4 (Pdk4) expression and phosphorylation of pyruvate dehydrogenase enzyme. These findings establish a uremic metabolite/AHR/Pdk4 axis in skeletal muscle that governs mitochondrial deficits in carbohydrate oxidation during CKD.
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Affiliation(s)
- Trace Thome
- Department of Applied Physiology and Kinesiology and
| | | | | | - Keon Wimberly
- Department of Applied Physiology and Kinesiology and
| | - Salvatore T. Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Florida, USA
- Malcom Randall VA Medical Center, Gainesville, Florida, USA
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology and
- Center for Exercise Science and
- Myology Institute, University of Florida, Gainesville, Florida, USA
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20
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Barbalho-Moulim MC, Paro FM, Pedrosa DF, Serafim LM, Kuster E, Carmo WAD, de Oliveira GP, de Lima MHBS, Pedreira AB, Duarte H, Wittmer VL. Effects of upper limbs' neuromuscular electrical stimulation (NMES) superimposed to voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise, in muscle strength, functional capacity and quality of life of adult patients with CKD: a randomized clinical trial protocol. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2079. [PMID: 38477078 DOI: 10.1002/pri.2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To investigate the effects of unilateral upper limbs' (ULM) neuromuscular electrical stimulation (NMES) superimposed on a voluntary contraction added to a protocol of intradialytic leg cycle ergometer exercise on muscle strength, functional capacity and quality of life of adult patients with chronic kidney disease (CKD). METHODS This randomized controlled clinical trial will be carried out at a Brazilian University Hospital. The patients will be evaluated and randomly allocated to an intervention group (i.e., unilateral NMES on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min) or a control group (i.e., unilateral NMES-Sham on the upper limb without hemodialysis fistula for 20 min and leg cycle ergometer for 30 min). The patients will be treated for 8 weeks, with three weekly treatment sessions totaling 24 sessions. MEASUREMENTS ULM muscle strength, functional capacity, quality of life and also the feasibility, safety and patient adherence to the exercise protocol. All physical measurements will be collected by trained researchers before treatment (week 0) and at the end of treatment (week 9), always in the second hemodialysis session of the week. It will be used in an intention-to-treat analysis. RESULTS/CONCLUSIONS The outcomes of this clinical trial protocol may help to know the possible benefits of unilateral ULM' NMES superimposed on a voluntary contraction added to a protocol of leg cycle ergometer for patients with CKD and to aid clinical decisions about future implementation or not of this technique (NMES) in intradialytic physical training programs.
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Affiliation(s)
| | - Flavia Marini Paro
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Diego França Pedrosa
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Lais Mello Serafim
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Elizângela Kuster
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Willian Assis do Carmo
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Gabriela P de Oliveira
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Maria Helena B S de Lima
- Cassiano Antônio Moraes University Hospital (HUCAM), Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Alexandre Bittencourt Pedreira
- Hemodialysis Sector-Nephrology Unit, Cassiano Antônio Moraes University Hospital (HUCAM), Brazilian Hospital Services Company (EBSERH), Vitória, Espírito Santo, Brazil
| | - Halina Duarte
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
| | - Verônica Lourenço Wittmer
- Department of Integrated Education on Health, Federal University of Espírito Santo (UFES), Vitória, Espírito Santo, Brazil
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21
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Tavares FS, de Luca Corrêa H, Wilund KR, Deus LA, de Araújo TB, Tzanno-Martins C, da Motta Vilalva Mestrinho VM, Dos Santos RL, Reis AL, Souza FH, de Sousa Ulisses LR, Cardoso HSS, Pascoal IJF, Guimarães VCC, de Oliveira Gomes L, Neves RVP, Dos Santos Rosa T. Exploring the impact of short daily haemodialysis on muscle strength and bone health in end-stage kidney disease patients. J Cachexia Sarcopenia Muscle 2024; 15:718-725. [PMID: 38272859 PMCID: PMC10995248 DOI: 10.1002/jcsm.13428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Short-daily haemodialysis (SDH) has been strongly recommended over conventional haemodialysis (CHD) for end-stage kidney disease patients, though few studies have directly compared the effects of these two haemodialysis (HD) modalities on clinical variables related to patient's health. METHODS We conducted a cross-sectional study in individuals undergoing HD, comparing epidemiological, clinical, metabolic, inflammatory, anthropometric, bone health/metabolism, and skeletal muscle function according to dialysis modality. One-hundred seventy-eight patients (20.8% females, 62 ± 2.5 years old), were analysed in this study, 86 (48%) of whom were undergoing CHD versus 92 (51%) who were undergoing SDH. RESULTS SDH patients had significantly higher serum albumin levels (3.93 vs. 3.66 g/dL, P < 0.0001) and higher Kt/v (2.6 vs. 2.38, P < 0.0001). SDH group presented a significantly lower number of erythropoietin-stimulating agents compared with CHD group (percentage: 53.3 vs. 83.7%, P < 0.0001) and had lower levels of serum phosphate (4.9 vs. 5.3 mg/dL, P = 0.004) and parathyroid hormone (PTH) (398.4 vs. 480.4 pg/mL, P < 0.001) compared with CHD patients. In terms of bone health and metabolism, SDH patients had significantly higher total BMD, femur BMD, lumbar BMD, and femoral neck BMD compared with CHD patients (all P < 0.05). SDH patients also had lower anti-osteogenic and inflammatory biomarkers, including FGF23, sclerostin, TNF, IL-18, IL-17a, and C-reactive peptide (all P < 0.05). CHD modality was demonstrated to be a risk factor for low BMD (odds ratio: 4.02; 95% CI: 1.59-10.2, P = 0.003). In terms of skeletal muscle function, SDH patients had significantly higher 6-minute walking test (444.6 vs. 424.9 m, P = 0.04) and higher fat-free mass (52.3 vs. 51.68 kg, P = 0.02) compared with CHD patients. Higher fat-free mass and handgrip strength were associated with a 34% and 23% lower risk of low BMD, respectively. SDH patients had lower levels of the uremic toxin asymmetric dimethyl-l-arginine (ADMA) (1.8 vs. 2.07 μM, P = 0.002) and fasting blood glucose (132.6 vs. 141.7 mg/dL, P < 0.02) than CHD group. SDH patients also displayed higher levels of haemoglobin when compared with CHD group (11.9 vs. 10.2 g/dL, P < 0.0001). CONCLUSIONS The present study improves our understanding of the relationship between dialysis modality and clinical variables that may influence HD patient's health. Grip strength and lean mass were positively correlated with bone mineral density in HD patients regardless of dialysis modality. SDH was associated with better bone mineral density, inflammatory profile, and skeletal muscle function when compared with CHD patients. These findings provide more evidence of the clinical benefits of SDH that should be explored in greater detail.
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Affiliation(s)
| | - Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Kenneth R Wilund
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Lysleine Alves Deus
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | | | | | | | - Rafael Lavarini Dos Santos
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | | | | | | | | | | | | | | | - Thiago Dos Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasilia, Brazil
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22
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Li Y, Chen J, Tang Y, Lin T, Song T. Effect of pretransplant sarcopenia on patient and graft outcomes in solid organ transplant recipients: A systematic review and meta-analysis. Asian J Surg 2024; 47:1723-1733. [PMID: 38169165 DOI: 10.1016/j.asjsur.2023.12.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
The relationship between sarcopenia and prognosis in solid organ transplantation recipients (SOTr) remains unverified. We aimed to quantify the prevalence of pretransplant sarcopenia and its effect on patient and graft survival in SOTr. We used PubMed, EMBASE, Cochrane Library and Web of Science to search relevant studies published in English (from inception to December 31, 2021). Prospective and retrospective cohort studies that reported the prevalence of sarcopenia before transplant or the association between sarcopenia and clinical outcomes in SOTr were included. Primary outcomes were the prevalence of sarcopenia and its impact on patient and graft survival. Secondary outcomes included perioperative complications, acute rejection, length of hospital stay, length of intensive care unit stay (ICU LOS) and early readmission. Thirty-nine studies involving 5792 patients were included. Pooled prevalence of sarcopenia amongst SOTr candidates was 40 % (95 % confidence interval [CI]: 34%-47 % and I2 = 97 %). Sarcopenia was associated with increased risk of death (hazard ratio [HR] = 1.87, 95 % CI: 1.46-2.41 and I2 = 60 %), poor graft survival (HR = 1.71, 95 % CI: 1.16-2.54 and I2 = 57 %) and increased liver graft loss (HR = 1.43, 95 % CI: 1.03-1.99 and I2 = 38 %). Patients with sarcopenia demonstrated increased incidence of perioperative complications (risk ratio [RR] = 1.34, 95 % CI: 1.17-1.53 and I2 = 40 %), long ICU LOS (mean difference = 2.31 days, 95 % CI: 0.58-4.04 and I2 = 97 %) and decreased risk of acute rejection (RR = 0.61, 95 % CI: 0.42-0.89 and I2 = 0 %). In Conclusion, sarcopenia is prevalent in SOTr candidates and associated with death and graft loss. Identifying sarcopenia before transplantation and intervening may improve long-term outcomes.
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Affiliation(s)
- Yue Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Yangming Tang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Tao Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China
| | - Turun Song
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 61004, China; Transplant Center, West China Hospital, Sichuan University, Chengdu, 61004, China.
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23
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Kennard AL, Glasgow NJ, Rainsford SE, Talaulikar GS. Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD. Kidney Int Rep 2024; 9:791-806. [PMID: 38765572 PMCID: PMC11101734 DOI: 10.1016/j.ekir.2023.12.022] [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: 09/14/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 05/22/2024] Open
Abstract
Frailty is a multidimensional clinical syndrome characterized by low physical activity, reduced strength, accumulation of multiorgan deficits, decreased physiological reserve, and vulnerability to stressors. Frailty has key social, psychological, and cognitive implications. Frailty is accelerated by uremia, leading to a high prevalence of frailty in patients with advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) as well as contributing to adverse outcomes in this patient population. Frailty assessment is not routine in patients with CKD; however, a number of validated clinical assessment tools can assist in prognostication. Frailty assessment in nephrology populations supports shared decision-making and advanced communication and should inform key medical transitions. Frailty screening and interventions in CKD or ESKD are a developing research priority with a rapidly expanding literature base.
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Affiliation(s)
- Alice L. Kennard
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Nicholas J. Glasgow
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Suzanne E. Rainsford
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Girish S. Talaulikar
- Department of Renal Medicine, Canberra Health Services, Australian Capital Territory, Australia
- Australian National University, Canberra, Australian Capital Territory, Australia
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24
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Yang C, Su G. Letter to the Editor: prevalence and associated factors of frailty in patients with chronic kidney disease: a cross-sectional analysis of PEAKING study. Int Urol Nephrol 2024; 56:1201-1202. [PMID: 37676385 DOI: 10.1007/s11255-023-03780-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Changyuan Yang
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China
| | - Guobin Su
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, 510000, China.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 11228, Stockholm, Sweden.
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25
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Wong Vega M, Starr MC, Brophy PD, Devarajan P, Soranno DE, Akcan-Arikan A, Basu R, Goldstein SL, Charlton JR, Barreto E. Advances in pediatric acute kidney injury pharmacology and nutrition: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference. Pediatr Nephrol 2024; 39:981-992. [PMID: 37878137 PMCID: PMC10817838 DOI: 10.1007/s00467-023-06178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND In the past decade, there have been substantial advances in our understanding of pediatric AKI. Despite this progress, large gaps remain in our understanding of pharmacology and nutritional therapy in pediatric AKI. METHODS During the 26th Acute Disease Quality Initiative (ADQI) Consensus Conference, a multidisciplinary group of experts reviewed the evidence and used a modified Delphi process to achieve consensus on recommendations for gaps and advances in care for pharmacologic and nutritional management of pediatric AKI. The current evidence as well as gaps and opportunities were discussed, and recommendations were summarized. RESULTS Two consensus statements were developed. (1) High-value, kidney-eliminated medications should be selected for a detailed characterization of their pharmacokinetics, pharmacodynamics, and pharmaco-"omics" in sick children across the developmental continuum. This will allow for the optimization of real-time modeling with the goal of improving patient care. Nephrotoxin stewardship will be identified as an organizational priority and supported with necessary resources and infrastructure. (2) Patient-centered outcomes (functional status, quality of life, and optimal growth and development) must drive targeted nutritional interventions to optimize short- and long-term nutrition. Measures of acute and chronic changes of anthropometrics, body composition, physical function, and metabolic control should be incorporated into nutritional assessments. CONCLUSIONS Neonates and children have unique metabolic and growth parameters compared to adult patients. Strategic investments in multidisciplinary translational research efforts are required to fill the knowledge gaps in nutritional requirements and pharmacological best practices for children with or at risk for AKI.
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Affiliation(s)
- Molly Wong Vega
- Renal and Apheresis Services, Texas Children's Hospital, Houston, TX, USA
| | - Michelle C Starr
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick D Brophy
- Department of Pediatrics, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA
| | - Prasad Devarajan
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Danielle E Soranno
- Department of Pediatrics, Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Bioengineering, Purdue University, West Lafayette, IN, USA
| | - Ayse Akcan-Arikan
- Divisions of Critical Care and Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rajit Basu
- Division of Critical Care, Department of Pediatrics, Northwestern University, Chicago, IL, USA
| | - Stuart L Goldstein
- Division of Nephrology and Hypertension, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer R Charlton
- Division of Nephrology, Department of Pediatrics, University of Virginia, Box 800386, Charlottesville, VA, 22901, USA.
| | - Erin Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, USA
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26
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Gollie JM, Ryan AS, Sen S, Patel SS, Kokkinos PF, Harris-Love MO, Scholten JD, Blackman MR. Exercise for patients with chronic kidney disease: from cells to systems to function. Am J Physiol Renal Physiol 2024; 326:F420-F437. [PMID: 38205546 PMCID: PMC11208028 DOI: 10.1152/ajprenal.00302.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Chronic kidney disease (CKD) is among the leading causes of death and disability, affecting an estimated 800 million adults globally. The underlying pathophysiology of CKD is complex creating challenges to its management. Primary risk factors for the development and progression of CKD include diabetes mellitus, hypertension, age, obesity, diet, inflammation, and physical inactivity. The high prevalence of diabetes and hypertension in patients with CKD increases the risk for secondary consequences such as cardiovascular disease and peripheral neuropathy. Moreover, the increased prevalence of obesity and chronic levels of systemic inflammation in CKD have downstream effects on critical cellular functions regulating homeostasis. The combination of these factors results in the deterioration of health and functional capacity in those living with CKD. Exercise offers protective benefits for the maintenance of health and function with age, even in the presence of CKD. Despite accumulating data supporting the implementation of exercise for the promotion of health and function in patients with CKD, a thorough description of the responses and adaptations to exercise at the cellular, system, and whole body levels is currently lacking. Therefore, the purpose of this review is to provide an up-to-date comprehensive review of the effects of exercise training on vascular endothelial progenitor cells at the cellular level; cardiovascular, musculoskeletal, and neural factors at the system level; and physical function, frailty, and fatigability at the whole body level in patients with CKD.
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Affiliation(s)
- Jared M Gollie
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, District of Columbia, United States
| | - Alice S Ryan
- Department of Medicine, University of Maryland, Baltimore, Maryland, United States
- Division of Geriatrics and Palliative Medicine, Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, United States
| | - Sabyasachi Sen
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
| | - Samir S Patel
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
| | - Peter F Kokkinos
- Division of Cardiology, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Kinesiology and Health, Rutgers University, New Brunswick, New Jersey, United States
| | - Michael O Harris-Love
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Geriatric Research Education and Clinical Center, Eastern Colorado Veterans Affairs Health Care System, Denver, Colorado, United States
| | - Joel D Scholten
- Physical Medicine and Rehabilitation Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
| | - Marc R Blackman
- Research and Development Service, Washington DC Veterans Affairs Medical Center, Washington, District of Columbia, United States
- Department of Medicine, Washington DC Veterans Affairs, Medical Center, Washington, District of Columbia, United States
- Department of Medicine, The George Washington University, Washington, District of Columbia, United States
- Department of Medicine, Georgetown University, Washington, District of Columbia, United States
- Department of Rehabilitation Medicine, Georgetown University, Washington, District of Columbia, United States
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Cha RH. Pharmacologic therapeutics in sarcopenia with chronic kidney disease. Kidney Res Clin Pract 2024; 43:143-155. [PMID: 38389147 PMCID: PMC11016676 DOI: 10.23876/j.krcp.23.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 02/24/2024] Open
Abstract
Inflammation, metabolic acidosis, renin-angiotensin system activation, insulin resistance, and impaired perfusion to skeletal muscles, among others, are possible causes of uremic sarcopenia. These conditions induce the activation of the nuclear factor-kappa B and mitogen-activated protein kinase pathways, adenosine triphosphate ubiquitin-proteasome system, and reactive oxygen species system, resulting in protein catabolism. Strategies for the prevention and treatment of sarcopenia in chronic kidney disease (CKD) are aerobic and resistance exercises along with nutritional interventions. Anabolic hormones have shown beneficial effects. Megestrol acetate increased weight, protein catabolic rate, and albumin concentration, and it increased intracellular water component and muscle mass. Vitamin D supplementation showed improvement in physical function, muscle strength, and muscle mass. Correction of metabolic acidosis showed an increase in protein intake, serum albumin levels, body weight, and mid-arm circumference. The kidney- gut-muscle axis indicates that dysbiosis and changes in gut-derived uremic toxins and short-chain fatty acids affect muscle mass, composition, strength, and functional capacity. Biotic supplements, AST-120 administration, hemodiafiltration, and preservation of residual renal function are alleged to reduce uremic toxins, including indoxyl sulfate (IS) and p-cresyl sulfate (PCS). Synbiotics reversed the microbiota change in CKD patients and decreased uremic toxins. AST-120 administration changed the overall gut microbiota composition in CKD. AST-120 prevented IS and PCS tissue accumulation, ameliorated muscle atrophy, improved exercise capacity and mitochondrial biogenesis, restored epithelial tight junction proteins, and reduced plasma endotoxin levels and markers of oxidative stress and inflammation. In a human study, the addition of AST-120 to standard treatment had modest beneficial effects on gait speed change and quality of life.
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Affiliation(s)
- Ran-hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
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28
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Frassetto LA, Masharani U. Effects of Alterations in Acid-Base Effects on Insulin Signaling. Int J Mol Sci 2024; 25:2739. [PMID: 38473990 DOI: 10.3390/ijms25052739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Insulin tightly regulates glucose levels within a narrow range through its action on muscle, adipose tissue and the liver. The activation of insulin receptors activates multiple intracellular pathways with different functions. Another tightly regulated complex system in the body is acid-base balance. Metabolic acidosis, defined as a blood pH < 7.35 and serum bicarbonate < 22 mmol/L, has clear pathophysiologic consequences including an effect on insulin action. With the ongoing intake of typical acid-producing Western diets and the age-related decline in renal function, there is an increase in acid levels within the range considered to be normal. This modest increase in acidosis is referred to as "acid stress" and it may have some pathophysiological consequences. In this article, we discuss the effects of acid stress on insulin actions in different tissues.
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Affiliation(s)
- Lynda A Frassetto
- Department of Medicine, Division of Nephrology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Umesh Masharani
- Department of Medicine, Division of Endocrinology, University of California San Francisco, San Francisco, CA 94143, USA
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29
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de Souza Francisco D, Moraes IG, Brito CP, Righetti RF, Yamaguti WP. The phase angle cut-off point capable of discriminating hemodialysis patients with reduced exercise tolerance: a cross-sectional study. BMC Sports Sci Med Rehabil 2024; 16:34. [PMID: 38308310 PMCID: PMC10835815 DOI: 10.1186/s13102-024-00825-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Phase angle (PhA) is a prognostic marker of all-cause mortality in chronic kidney disease. However, no study has investigated this marker as a predictor of exercise intolerance in hemodialysis (HD) patients. The aim of this study was to determine a cut-off point for the PhA capable of discriminating HD patients with reduced exercise tolerance. METHODS Thirty-one patients (80.6% men, median age 69 years) were included. The evaluations were performed on three different days, before the HD session. The outcomes evaluated were: biochemical markers, inflammatory and nutritional status, body composition, peripheral muscle strength and exercise tolerance. Performance ≤50% of the predicted value in the six-minute step test (6MST) was defined as reduced exercise tolerance. RESULTS Patients presented an average of 67.6 steps (50.5% of predicted) in the 6MST. Fifteen patients (48.4%) were classified with reduced exercise tolerance. The receiver operating characteristic curve indicated a cut-off point of 3.73° for the PhA (sensitivity = 87%, specificity = 81%, and area under the curve = 0.88 [95% CI: 0.76-1.00]; p < 0.001). Patients with reduced exercise tolerance had worse inflammatory and nutritional status, lower PhA and greater impairment of peripheral muscle strength. CONCLUSION The cut-off point of 3.73° for the PhA is sensitive and specific to discriminate HD patients with reduced exercise tolerance. TRIAL REGISTRATION This study was registered in the Clinical Trials database (no. NCT03779126, date of first registration 19/12/2018).
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Affiliation(s)
| | | | - Camila Porto Brito
- Hospital Sírio-Libanês, Rehabilitation Service, São Paulo, São Paulo, Brazil
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30
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Yang C, Xiao C, Zeng J, Duan R, Ling X, Qiu J, Li Q, Qin X, Zhang L, Huang J, He J, Wu Y, Liu X, Hou H, Lindholm B, Lu F, Su G. Prevalence and associated factors of frailty in patients with chronic kidney disease: a cross-sectional analysis of PEAKING study. Int Urol Nephrol 2024; 56:751-758. [PMID: 37556106 PMCID: PMC10808408 DOI: 10.1007/s11255-023-03720-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/22/2023] [Indexed: 08/10/2023]
Abstract
AIM Frailty is common and is reported to be associated with adverse outcomes in patients with chronic diseases in Western countries. However, the prevalence of frailty remains unclear in individuals with chronic kidney disease (CKD) in China. We examined the prevalence of frailty and factors associated with frailty in patients with CKD. METHODS This was a cross-sectional analysis of 177 adult patients (mean age 54 ± 15 years, 52% men) with CKD from the open cohort entitled Physical Evaluation and Adverse outcomes for patients with chronic Kidney disease IN Guangdong (PEAKING). Frailty at baseline were assessed by FRAIL scale which included five items: fatigue, resistance, ambulation, illnesses, and loss of weight. Potential risk factors of frailty including age, sex, body mass index, and daily step counts recorded by ActiGraph GT3X + accelerometer were analyzed by multivariate logistic regression analysis. RESULTS The prevalence of prefrailty and frailty was 50.0% and 11.9% in patients with stages 4-5 CKD, 29.6% and 9.3% in stage 3, and 32.1% and 0 in stages 1-2. In the multivariate logistic regression analysis, an increase of 100 steps per day (OR = 0.95, 95% CI 0.91-0.99, P = 0.01) and an increase of 5 units eGFR (OR = 0.82, 95% CI 0.68-0.99, P = 0.045) were inversely associated with being frail; higher BMI was associated with a higher likelihood of being frail (OR = 1.52, 95% CI 1.11-2.06, P = 0.008) and prefrail (OR = 1.25, 95% CI 1.10-1.42, P = 0.001). CONCLUSION Frailty and prefrailty were common in patients with advanced CKD. A lower number of steps per day, lower eGFR, and a higher BMI were associated with frailty in this population.
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Affiliation(s)
- Changyuan Yang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
| | - Cuixia Xiao
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Jiahao Zeng
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Ruolan Duan
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
| | - Xitao Ling
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
| | - Jiamei Qiu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
| | - Qin Li
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
| | - Xindong Qin
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - La Zhang
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Jiasheng Huang
- Department of Nephrology, Shenzhen Hospital, Guangzhou University of Chinese Medicine, Shenzhen City, 518000, China
| | - Jiawei He
- Department of Nephrology, Peking University First Hospital, Beijing City, 100034, China
| | - Yifan Wu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Xusheng Liu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Haijing Hou
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 11228, Stockholm, Sweden
| | - Fuhua Lu
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China.
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China.
| | - Guobin Su
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou City, 510000, China.
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, GuangzhouUniversity of Chinese Medicine, Guangzhou, 510000, China.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 11228, Stockholm, Sweden.
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Özcan B, Güner M, Ceylan S, Öztürk Y, Girgin S, Okyar Baş A, Koca M, Balcı C, Doğu BB, Cankurtaran M, Yıldırım T, Halil MG. Calf circumference predicts sarcopenia in maintenance hemodialysis. Nutr Clin Pract 2024; 39:193-201. [PMID: 37933421 DOI: 10.1002/ncp.11089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 10/07/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD. METHODS This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface. RESULTS Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m2 [18.9-24.6] vs 24.7 kg/m2 [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765). CONCLUSIONS Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.
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Affiliation(s)
- Berşan Özcan
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Güner
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serdar Ceylan
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Öztürk
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sinem Girgin
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Okyar Baş
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balcı
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Doğu
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tolga Yıldırım
- Department of Internal Medicine, Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Gülhan Halil
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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32
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de Geus M, Dam M, Visser WJ, Ipema KJR, de Mik-van Egmond AME, Tieland M, Weijs PJM, Kruizenga HM. The Impact of Combined Nutrition and Exercise Interventions in Patients with Chronic Kidney Disease. Nutrients 2024; 16:406. [PMID: 38337689 PMCID: PMC10857632 DOI: 10.3390/nu16030406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Combined nutrition and exercise interventions potentially improve protein-energy wasting/malnutrition-related outcomes in patients with chronic kidney disease (CKD). The aim was to systematically review the effect of combined interventions on nutritional status, muscle strength, physical performance and QoL. MEDLINE, Cochrane, Embase, Web of Science and Google Scholar were searched for studies up to the date of July 2023. Methodological quality was appraised with the Cochrane risk-of-bias tool. Ten randomized controlled trials (nine publications) were included (334 patients). No differences were observed in body mass index, lean body mass or leg strength. An improvement was found in the six-minute walk test (6-MWT) (n = 3, MD 27.2, 95%CI [7 to 48], p = 0.008), but not in the timed up-and-go test. No effect was found on QoL. A positive impact on 6-MWT was observed, but no improvements were detected in nutritional status, muscle strength or QoL. Concerns about reliability and generalizability arise due to limited statistical power and study heterogeneity of the studies included.
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Affiliation(s)
- Manon de Geus
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands; (W.J.V.); (A.M.E.d.M.-v.E.)
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (P.J.M.W.); (H.M.K.)
| | - Manouk Dam
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Wesley J. Visser
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands; (W.J.V.); (A.M.E.d.M.-v.E.)
| | - Karin J. R. Ipema
- Department of Dietetics, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Anneke M. E. de Mik-van Egmond
- Department of Internal Medicine, Division of Dietetics, Erasmus MC, University Medical Center, 3015 GD Rotterdam, The Netherlands; (W.J.V.); (A.M.E.d.M.-v.E.)
| | - Michael Tieland
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (P.J.M.W.); (H.M.K.)
| | - Peter J. M. Weijs
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (P.J.M.W.); (H.M.K.)
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, 1081 HZ Amsterdam, The Netherlands
| | - Hinke M. Kruizenga
- Center of Expertise Urban Vitality, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands; (M.T.); (P.J.M.W.); (H.M.K.)
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, 1081 HV Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Ageing and Vitality, 1081 HZ Amsterdam, The Netherlands
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Bi X, Liu Y, Yao L, Ling L, Lu J, Hu C, Ding W. Gut microbiota dysbiosis and protein energy wasting in patients on hemodialysis: an observational longitudinal study. Front Nutr 2024; 10:1270690. [PMID: 38268676 PMCID: PMC10806119 DOI: 10.3389/fnut.2023.1270690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/26/2023] [Indexed: 01/26/2024] Open
Abstract
Background Protein energy wasting (PEW) is common in patients on hemodialysis, and its development may involve gut microbial dysbiosis. However, the exact relationship between the composition of different flora and the development of PEW remains unclear. Methods This is an observational longitudinal study on 115 patients undergoing hemodialysis who were followed up for 1 year. All the patients were evaluated at baseline, and different microbiota compositions were determined. After a 1 year follow-up period, the correlations between clinical parameter variations and the relative abundance of different gut flora were assessed using Spearman correlation. Moreover, the associations of the abundance of different gut microbiota with decrease in lean tissue mass and the development of PEW were analyzed using ROC curve and logistical regression analyses. Results We found that the relative abundances of Actinobacteria and Bifidobacteriaceae were significantly lower in patients with PEW than in those who did not develop PEW (p < 0.05). The abundance of Actinobacteria and Bifidobacteriaceae correlated positively with variations in serum albumin levels (r = 0.213, p = 0.035 and r = 0.214, p = 0.034, respectively), lean tissue mass (r = 0.296, p = 0.007 and r = 0.238, p = 0.002, respectively), and lean tissue index (r = 0.377, p < 0.001 and r = 0.419, p < 0.001, respectively). The area under the ROC curve or AUC values of Actinobacteria and Bifidobacteriaceae for the prediction of lean tissue mass decrease ranged from 0.676 to 0.708 (p < 0.05). Thus, decrease in the abundance of Actinobacteria and Bifidobacteriaceae may be associated with decrease in lean tissue mass and the occurrence of PEW. Conclusion The present findings imply Actinobacteria and Bifidobacteriaceae may be potential markers for predicting skeletal muscle mass decrease and PEW development in patients on hemodialysis.
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Affiliation(s)
| | | | | | | | | | - Chun Hu
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wei Ding
- Division of Nephrology, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Yang Q, Zhang C, Zhang Z, Su B. Muscle ultrasound to diagnose sarcopenia in chronic kidney disease: a systematic review and bayesian bivariate meta-analysis. BMC Nephrol 2024; 25:12. [PMID: 38178026 PMCID: PMC10768384 DOI: 10.1186/s12882-023-03445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The aim of this systematic review was to assess the diagnostic test accuracy of muscle ultrasound for sarcopenia among chronic kidney disease (CKD) populations. BACKGROUND Sarcopenia has become a worldwide health issue, especially for CKD patients. Conventional techniques of muscle mass assessment often prove limited, thus prompts increasing interest in ultrasound suitability. METHODS We searched the Cochrane Library, PubMed and Embase for literature published up to June 2023. Ultrasound diagnosis of sarcopenia in CKD patients was included. Two independent investigators used the Quality Assessment Tool for Diagnosis Accuracy Studies (QUADAS-2) to assess the quality. We extracted valuable information from eligible studies. Using a Bayesian bivariate model, we pooled sensitivity and specificity values and summary receiver operating characteristic (SROC) curves. RESULTS Five articles, involving 428 participants at various stages of CKD were included. Three studies diagnosed by the cross-sectional area (CSA) of the rectus femoris, while two others by muscle thickness (MT) and shear wave elastography (SWE) from the same muscle, separately. Overall, CSA or SWE had a pooled sensitivity of 0.95 (95% CrI, 0.80, 1.00), and the specificity was 0.73 (95% CrI, 0.55, 0.88) for diagnosing sarcopenia in CKD patients. CONCLUSIONS Ultrasound measurements of CSA and SWE were more sensitive for diagnosing sarcopenia in the CKD population than in the general population. Ultrasound assessment from a single peripheral skeletal muscle site may serve as a rapid screening tool for identifying sarcopenic individuals within the CKD population, if a specific cut-off value could be determined.
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Affiliation(s)
- Qinbo Yang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chen Zhang
- West China Hospital, West China School of Medicine, Sichuan University, 610041, Chengdu, China
| | - Zhuyun Zhang
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, 610041, Chengdu, China.
- Med+ Biomaterial Institute of West China Hospital/West China School of Medicine, Sichuan University, Guoxue Alley No. 37, Chengdu, Sichuan Province, 610041, Chengdu, China.
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Mathur S, Haynes E, Allender MC, Gibbs HL. Genetic mechanisms and biological processes underlying host response to ophidiomycosis (snake fungal disease) inferred from tissue-specific transcriptome analyses. Mol Ecol 2024; 33:e17210. [PMID: 38010927 DOI: 10.1111/mec.17210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 07/28/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Emerging infectious diseases in wildlife species caused by pathogenic fungi are of growing concern, yet crucial knowledge gaps remain for diseases with potentially large impacts. For example, there is detailed knowledge about host pathology and mechanisms underlying response for chytridiomycosis in amphibians and white-nose syndrome in bats, but such information is lacking for other more recently described fungal infections. One such disease is ophidiomycosis, caused by the fungus Ophidiomyces ophidiicola, which has been identified in many species of snakes, yet the biological mechanisms and molecular changes occurring during infection are unknown. To gain this information, we performed a controlled experimental infection in captive Prairie rattlesnakes (Crotalus viridis) with O. ophidiicola at two different temperatures: 20 and 26°C. We then compared liver, kidney, and skin transcriptomes to assess tissue-specific genetic responses to O. ophidiicola infection. Given previous histopathological studies and the fact that snakes are ectotherms, we expected highest fungal activity on skin and a significant impact of temperature on host response. Although we found fungal activity to be localized on skin, most of the differential gene expression occurred in internal tissues. Infected snakes at the lower temperature had the highest host mortality whereas two-thirds of the infected snakes at the higher temperature survived. Our results suggest that ophidiomycosis is likely a systemic disease with long-term effects on host response. Our analysis also identified candidate protein coding genes that are potentially involved in host response, providing genetic tools for studies of host response to ophidiomycosis in natural populations.
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Affiliation(s)
- Samarth Mathur
- Department of Evolution, Ecology, and Organismal Biology, The Ohio State University, Columbus, Ohio, USA
- Ohio Biodiversity Conservation Partnership, The Ohio State University, Columbus, Ohio, USA
| | - Ellen Haynes
- Wildlife Epidemiology Laboratory, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Southeastern Cooperative Wildlife Disease Study, University of Georgia, Athens, Georgia, USA
| | - Matthew C Allender
- Wildlife Epidemiology Laboratory, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
- Brookfield Zoo, Chicago Zoological Society, Brookfield, Illinois, USA
| | - H Lisle Gibbs
- Department of Evolution, Ecology, and Organismal Biology, The Ohio State University, Columbus, Ohio, USA
- Ohio Biodiversity Conservation Partnership, The Ohio State University, Columbus, Ohio, USA
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Navaneethan SD, Mitch WE. Does Serum Creatinine Reflect Muscle Mass in Patients with Kidney Failure? J Am Soc Nephrol 2024; 35:1-2. [PMID: 38015564 PMCID: PMC10786607 DOI: 10.1681/asn.0000000000000270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Sankar D. Navaneethan
- Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
- Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas
- Institute of Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - William E. Mitch
- Section of Nephrology, Selzman Institute for Kidney Health, Baylor College of Medicine, Houston, Texas
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Machfer A, Tagougui S, Fekih N, Ben Haj Hassen H, Amor HIH, Bouzid MA, Chtourou H. Muscle oxygen supply impairment during maximal exercise in patients undergoing dialysis therapy. Respir Physiol Neurobiol 2024; 319:104169. [PMID: 37813323 DOI: 10.1016/j.resp.2023.104169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
This study aimed to investigate whether Chronic Kidney Disease (CKD) influences O2 supply including O2 delivery and release to the active muscles during maximal physical exercise. Twelve CKD patients undergoing dialysis therapy (HD group) and twelve healthy adults (CTR group) performed an incremental exercise test to determine maximal oxygen uptake (VO2peak). Throughout the exercise, near-infrared spectroscopy allowed the investigation of changes in oxyhemoglobin (∆O2Hb), deoxyhemoglobin (∆HHb), and total hemoglobin (∆THb) in the vastus lateralis muscle. VO2peak was significantly lower in HD group. In addition, HD patients had impaired changes in muscular oxygenation (∆HHb and ∆O2Hb) and blood volume (∆THb) during the exercise (p < 0.05). Moreover, a positive correlation was observed between VO2peak and muscle blood volume (∆THb) in both groups (p < 0.05). This study provides the first evidence that HD patients displayed lower VO2peak and blunted muscular deoxyhemoglobin increase during exercise. This result supports the hypothesis of an increase in oxygen affinity and/or mitochondrial dysfunction in this population.
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Affiliation(s)
- Amal Machfer
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Tunisia
| | - Sémah Tagougui
- Université de Lille, Université d'Artois, Université du Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport, Santé, Société (URePSSS), Lille, France; Montreal Clinical Research Institute (IRCM), Montreal, Canada
| | - Nadia Fekih
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Tunisia
| | - Hayfa Ben Haj Hassen
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Tunisia
| | | | - Mohamed Amine Bouzid
- Research Laboratory: Education, Motricité, Sport et Santé, EM2S, LR19JS01, High Institute of Sport and Physical Education, University of Sfax, Tunisia.
| | - Hamdi Chtourou
- Activité Physique, Sport et Santé, UR18JS01, Observatoire National du Sport, 1003 Tunis, Tunisia
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Qin X, Wei J, Wei J, Wei J, Chen J, Lei F, Qin Y. The association between appendicular skeletal muscle index and bone mineral density in children and adolescents with chronic kidney disease: A cross-sectional study. Medicine (Baltimore) 2023; 102:e36613. [PMID: 38115339 PMCID: PMC10727626 DOI: 10.1097/md.0000000000036613] [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: 07/11/2023] [Revised: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Chronic kidney disease (CKD), a pervasive public health concern, can lead to complications like sarcopenia and reduced bone mineral density (BMD). However, it is still unclear exactly how muscle mass correlates with BMD in youngsters and adolescents with CKD. We aimed to investigate the association between appendicular skeletal muscle index (ASMI) and BMD among children and adolescents with CKD. In our research, we utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 2011 and 2014 to investigate the association of ASMI with BMD among this population. The association linking ASMI with total BMD was examined through multivariate linear regression models. Furthermore, fitted smoothing curves were employed, as well as generalized additive models. Our analysis finally included 503 CKD participants aged between 8 and 19 years. We found a significant association linking ASMI with total BMD among children and adolescents with CKD. The connection persisted even after accounting for covariates. Upon subgroup analysis, there was a statistically significant association of ASMI with total BMD for both males and females, as well as for Mexican-American and non-Hispanic White populations. However, no significant association was observed in other Hispanic, non-Hispanic Black, or populations of other races. We discovered a positive correlation linking the ASMI and the total BMD in children and teenagers with CKD. In CKD patients, maintaining skeletal muscle mass may be crucial for managing and preventing renal osteodystrophy.
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Affiliation(s)
- Xuankai Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiahui Wei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jinshuang Wei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Junyu Wei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jie Chen
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Fengying Lei
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuanhan Qin
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Johri N, Vengat M, Kumar D, Nagar P, John D, Dutta S, Mittal P. A comprehensive review on the risks assessment and treatment options for Sarcopenia in people with diabetes. J Diabetes Metab Disord 2023; 22:995-1010. [PMID: 37975099 PMCID: PMC10638272 DOI: 10.1007/s40200-023-01262-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: 03/24/2023] [Accepted: 07/03/2023] [Indexed: 11/19/2023]
Abstract
Objectives This comprehensive review aims to examine the reciprocal interplay between Type 2 diabetes mellitus (T2DM) and sarcopenia, identify prevailing research gaps, and discuss therapeutic approaches and measures to enhance healthcare practices within hospital settings. Methods A thorough literature review was conducted to gather relevant studies and articles on the relationship between T2DM and sarcopenia. Various databases were searched, including Google Scholar, PubMed, Scopus, and Science Direct databases. The search terms included T2DM, sarcopenia, inflammation, insulin resistance, advanced glycation end products, oxidative stress, muscle dimensions, muscle strength, muscle performance, aging, nutrition, hormone levels, and physical activity. The collected articles were critically analysed to extract key findings and identify gaps in current research. Results The prevalence and incidence of metabolic and musculoskeletal disorders, notably T2DM and sarcopenia, have surged in recent years. T2DM is marked by inflammation, insulin resistance, accumulation of advanced glycation end products, and oxidative stress, while sarcopenia involves a progressive decline in skeletal muscle mass and function. The review underscores the age-related correlation between sarcopenia and adverse outcomes like fractures, falls, and mortality. Research gaps regarding optimal nutritional interventions for individuals with T2DM and sarcopenia are identified, emphasizing the necessity for further investigation in this area. Conclusions The reciprocal interplay between T2DM and sarcopenia holds significant importance. Further research is warranted to address knowledge gaps, particularly in utilizing precise measurement tools during clinical trials. Lifestyle modifications appear beneficial for individuals with T2DM and sarcopenia. Additionally, practical nutritional interventions require investigation to optimize healthcare practices in hospital settings. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01262-w.
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Affiliation(s)
- Nishant Johri
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
| | | | - Deepanshu Kumar
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
| | - Priya Nagar
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
| | - Davis John
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
| | - Shubham Dutta
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
| | - Piyush Mittal
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh India
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40
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Xu Y, Wan W, Zeng H, Xiang Z, Li M, Yao Y, Li Y, Bortolanza M, Wu J. Exosomes and their derivatives as biomarkers and therapeutic delivery agents for cardiovascular diseases: Situations and challenges. J Transl Int Med 2023; 11:341-354. [PMID: 38130647 PMCID: PMC10732499 DOI: 10.2478/jtim-2023-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Microvesicles known as exosomes have a diameter of 40 to 160 nm and are derived from small endosomal membranes. Exosomes have attracted increasing attention over the past ten years in part because they are functional vehicles that can deliver a variety of lipids, proteins, and nucleic acids to the target cells they encounter. Because of this function, exosomes may be used for the diagnosis, prognosis and treatment of many diseases. All throughout the world, cardiovascular diseases (CVDs) continue to be a significant cause of death. Because exosomes are mediators of communication between cells, which contribute to many physiological and pathological aspects, they may aid in improving CVD therapies as biomarkers for diagnosing and predicting CVDs. Many studies demonstrated that exosomes are associated with CVDs, such as coronary artery disease, heart failure, cardiomyopathy and atrial fibrillation. Exosomes participate in the progression or inhibition of these diseases mainly through the contents they deliver. However, the application of exosomes in diferent CVDs is not very mature. So further research is needed in this field.
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Affiliation(s)
- Yunyang Xu
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Weimin Wan
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Huixuan Zeng
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Ze Xiang
- Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Mo Li
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Yiwen Yao
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Yuan Li
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
| | - Mariza Bortolanza
- Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, 66424Homburg, Germany
| | - Jian Wu
- Department of Clinical Laboratory, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou215008, Jiangsu Province, China
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41
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Xuan Y, Pang S, Xie W, He R, Qin L, Yuan J. Sarcopenia predicts cardiovascular disease in chronic kidney disease at advanced stage and associated risks. Medicine (Baltimore) 2023; 102:e35976. [PMID: 37960747 PMCID: PMC10637482 DOI: 10.1097/md.0000000000035976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Chronic kidney disease (CKD) has been associated with a higher risk of cardiovascular disease (CVD), and sarcopenia is a new risk factor for CKD. However, whether sarcopenia predicts CVD in CKD remains to be determined. Sarcopenia would predict CVD in CKD at advanced stage. This analysis included 101 patients with CKD at stage 3 or over to determine the prevalence of sarcopenia and cardiovascular disease in patients with CKD at stage 3 or over in our center. The patients were further categorized into sarcopenia group (N = 19) and non-sarcopenia group (N = 82) according to the diagnostic criteria for sarcopenia. Data on demographics, laboratory tests, and measurements of extracardiac adipose tissue thickness (EAT) was collected. The prevalence of sarcopenia in patients with CKD at stage ≥ 3 was 19%. Compared with non-sarcopenia group, patients from the sarcopenia group were older (P = .005), and presented longer disease durations (P = .002). The serum level of albumin was significantly decreased, (P = .047), and high-sensitivity C-reactive protein level (CRP) was significantly increased (P = .003) in sarcopenia group. In addition, the EAT was thicker in the sarcopenia group compared with non-sarcopenia group (P = .032). Furthermore, the le-stratified atherosclerotic cardiovascular disease (ASCVD) risk scores were positively correlated with inflammation, nutrition, body mass index (BMI) and disease duration of CKD in sarcopenia group (P < .001). Patients with CKD are prone to have sacropenia, which is associated with inflammation and malnutrition. Presence of sarcopenia in CKD patients predicts the risk of ASCVD.
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Affiliation(s)
- Yingli Xuan
- Department of Nephrology, Baoshan Branch of Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China
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Vega MRW, Cerminara D, Desloovere A, Paglialonga F, Renken-Terhaerdt J, Walle JV, Shaw V, Stabouli S, Anderson CE, Haffner D, Nelms CL, Polderman N, Qizalbash L, Tuokkola J, Warady BA, Shroff R, Greenbaum LA. Nutritional management of children with acute kidney injury-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2023; 38:3559-3580. [PMID: 36939914 PMCID: PMC10514117 DOI: 10.1007/s00467-023-05884-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 03/21/2023]
Abstract
The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
| | | | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - José Renken-Terhaerdt
- Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vanessa Shaw
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University, Hippokratio Hospital, Thessaloniki, Greece
| | | | - Dieter Haffner
- Hannover Medical School, Children's Hospital, Hannover, Germany
| | | | | | | | - Jetta Tuokkola
- New Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Rukshana Shroff
- University College London Great Ormond Street Hospital Institute of Child Health, London, UK
| | - Larry A Greenbaum
- Emory University, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Zhang F, Wang H, Bai Y, Huang L, Zhang H. Handgrip strength and all-cause mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis of cohort studies. Int Urol Nephrol 2023; 55:2857-2865. [PMID: 37076597 DOI: 10.1007/s11255-023-03603-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES In observational studies, handgrip strength (HGS), a prognostic marker for healthy aging, has been associated with several chronic disease outcomes. The present systematic review and meta-analysis aimed to determine the quantitative relationship between HGS and the risk of all-cause mortality in patients with chronic kidney disease (CKD). METHODS Search PubMed, Embase, and Web of Science databases. The search was performed from inception to July 20, 2022, and the search was updated in February 2023. Cohort studies were included exploring the relationship between handgrip strength and the risk of all-cause mortality in patients with chronic kidney disease. Effect estimates and 95% confidence intervals (95% CI) were extracted from the studies to perform pooling. The quality of included studies was assessed using the Newcastle-Ottawa scale. We evaluated the overall certainty of evidence using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). RESULTS This systematic review included 28 articles. A random-effects meta-analysis that included 16,106 patients with CKD showed that participants with lower HGS had an increased mortality risk of 96.1% compared to higher HGS (HR: 1.961; 95% CI 1.591-2.415) (GRADE: very low). Moreover, this association was independent of baseline mean age and follow-up time. In 2,967 patients with CKD, a random-effects model-based meta-analysis showed that for each 1-unit increase in HGS, the risk of death in patients with CKD was reduced by 3.9% (HR: 0.961; 95% CI 0.949-0.974) (GRADE: moderate). CONCLUSIONS In patients with CKD, better HGS is associated with a lower risk of all-cause mortality. This study supports using HGS as a strong predictor of mortality in this population.
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Affiliation(s)
- Fan Zhang
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hui Wang
- Department of Anorectology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Bai
- Department of Cardiology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liuyan Huang
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huachun Zhang
- Department of Nursing, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Navab F, Rouhani MH, Moeinzadeh F, Clark CCT, Ziaei R. The effects of oral sodium bicarbonate supplementation on anthropometric measures in patients with chronic kidney disease: A systematic review and meta-analysis of randomized clinical trials. Food Sci Nutr 2023; 11:6749-6760. [PMID: 37970385 PMCID: PMC10630834 DOI: 10.1002/fsn3.3627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 11/17/2023] Open
Abstract
Metabolic acidosis (MA) may play a key role in the pathogenesis of protein-energy wasting (PEW) in patients with chronic kidney disease (CKD). To present a comprehensive synthesis of the effect of oral sodium bicarbonate (SB) supplementation on anthropometric measures in patients with CKD, a systematic review was undertaken in PubMed/MEDLINE, Web of Science, Cochrane CENTRAL, and Google Scholar, of relevant articles published prior to September 2022. The summary statistics of effect size, nonstandardized weighted mean difference (WMD), and 95% confidence interval (CI) were used to compare the effects of SB supplementation on anthropometric parameters vs. control group. To detect probable sources of heterogeneity, a series of predefined subgroup analyses were conducted. In total, 17 studies with 21 treatment arms, including 2203 participants (1149 cases, 1054 controls), met our inclusion criteria and were included in the meta-analysis. SB supplementation had no significant effect on body weight (BW), midarm muscle circumference (MAMC), or lean body mass (LBM) in patients with CKD. There was a significant increase in body mass index (BMI) (MD: 0.59 kg/m2, 95% CI: 0.25 to 0.93, p = 0.001) after SB supplementation in the overall analysis. In subgroup analysis, LBM was increased in studies that were ≥ 24-week duration (MD: 1.81 kg, 95% CI: 0.81 to 2.81) and in participants with BMI lower than 27 kg/m2 (MD: 1.81 mg/L, 95% CI: 0.81 to 2.81). SB supplementation may yield increases in BMI in predialysis CKD patients. However, our findings did not support the beneficial effects of SB supplementation on other anthropometric outcomes. There is an evident need for long-term high-quality interventions to confirm these findings.
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Affiliation(s)
- Fatemeh Navab
- Student Research Committee, Nutrition and Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Mohammad Hossein Rouhani
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Rahele Ziaei
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
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Marcotte-Chénard A, Oliveira B, Little JP, Candow DG. Sarcopenia and type 2 diabetes: Pathophysiology and potential therapeutic lifestyle interventions. Diabetes Metab Syndr 2023; 17:102835. [PMID: 37542749 DOI: 10.1016/j.dsx.2023.102835] [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: 04/09/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
AIMS Sarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity. METHODS AND RESULTS Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise. CONCLUSIONS The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D.
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Affiliation(s)
- Alexis Marcotte-Chénard
- Faculty of Physical Activity Sciences, University of Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
| | - Barbara Oliveira
- School of Health and Exercise Sciences, The University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada
| | - Jonathan P Little
- School of Health and Exercise Sciences, The University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada
| | - Darren G Candow
- Faculty of Kinesiology & Health Studies, University of Regina, Saskatchewan, S4S 0A2, Canada.
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46
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Rudenko TE, Bobkova IN, Kamyshova ES, Stavrovskaya EV. [Frailty and chronic kidney disease - the real problem of modern nephrology: A review]. TERAPEVT ARKH 2023; 95:516-520. [PMID: 38158973 DOI: 10.26442/00403660.2023.06.202270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 01/03/2024]
Abstract
The article deals with the syndrome of frailty or senile asthenia in patients with chronic kidney disease. The questions of prevalence, diagnosis, pathogenesis of this syndrome and its clinical consequences in chronic kidney disease are discussed.
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Affiliation(s)
- T E Rudenko
- Sechenov First Moscow State Medical University (Sechenov University)
| | - I N Bobkova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E S Kamyshova
- Sechenov First Moscow State Medical University (Sechenov University)
| | - E V Stavrovskaya
- Sechenov First Moscow State Medical University (Sechenov University)
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47
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Ju SH, Yi HS. Clinical features and molecular mechanism of muscle wasting in end stage renal disease. BMB Rep 2023; 56:426-438. [PMID: 37482754 PMCID: PMC10471459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
Muscle wasting in end-stage renal disease (ESRD) is an escalating issue due to the increasing global prevalence of ESRD and its significant clinical impact, including a close association with elevated mortality risk. The phenomenon of muscle wasting in ESRD, which exceeds the rate of muscle loss observed in the normal aging process, arises from multifactorial processes. This review paper aims to provide a comprehensive understanding of muscle wasting in ESRD, covering its epidemiology, underlying molecular mechanisms, and current and emerging therapeutic interventions. It delves into the assessment techniques for muscle mass and function, before exploring the intricate metabolic and molecular pathways that lead to muscle atrophy in ESRD patients. We further discuss various strategies to mitigate muscle wasting, including nutritional, pharmacological, exercise, and physical modalities intervention. This review seeks to provide a solid foundation for future research in this area, fostering a deeper understanding of muscle wasting in ESRD, and paving the way for the development of novel strategies to improve patient outcomes. [BMB Reports 2023; 56(8): 426-438].
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Affiliation(s)
- Sang Hyeon Ju
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea
| | - Hyon-Seung Yi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon 35015, Korea
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon 35015, Korea
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48
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Du W, Gao C, Wang X, Ma X, Xie J, Yu H, Yang Z, Chen Z, Chen X. Validity of the SARC-F questionnaire in assessing sarcopenia in patients with chronic kidney disease: a cross-sectional study. Front Med (Lausanne) 2023; 10:1188971. [PMID: 37534318 PMCID: PMC10391647 DOI: 10.3389/fmed.2023.1188971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Objective To examine the validity of the 5-component SARC-F questionnaire for screening sarcopenia among patients with chronic kidney disease (CKD). Methods Eligible participants were enrolled from the Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from March 2019 to November 2019. Evaluations were performed using the self-administered SARC-F questionnaire. Sarcopenia was diagnosed by grip strength, the chair stand test and appendicular skeletal muscle mass. The severity of sarcopenia was evaluated by gait speed. We calculated the sensitivity and specificity of the SARC-F to evaluate construct validity. Moreover, receiver operating characteristic (ROC) curve analysis was performed to identify the cutoff value for nondialysis-dependent (NDD) CKD patients' and maintenance hemodialysis (MHD) patients' scores. Results A total of 105 NDD-CKD patients and 125 MHD patients were included, and the prevalence of sarcopenia was 5.7 and 31.2%, respectively. Among them, there were 21 (16.8%) MHD patients with severe sarcopenia but no NDD-CKD patients with severe sarcopenia. The sensitivity and specificity of the SARC-F were 16.7 and 98.0% for NDD-CKD patients, and 48.7 and 89.5% for MHD patients, respectively. For NDD-CKD patients, the area under the receiver operating characteristic curve (AUROC) of the total SARC-F score was 0.978 (95% confidence interval (CI): 0.929-0.997, p < 0.001), and the cutoff value of 1 reached the highest Youden index of 0.950 and max ROC curve area of 0.974. For MHD patients, the AUROC of the total SARC-F score was 0.730 (95% CI: 0.644-0.806, p < 0.001), and the cutoff value of 4 reached the highest Youden index of 0.383 and max ROC curve area of 0.691. Conclusion CKD patients, especially MHD patients, were at high risk of suffering sarcopenia. The SARC-F had low-to-moderate sensitivity but high specificity for screening sarcopenia among patients with CKD. The best cutoff values of the SARC-F score were different for screening sarcopenia among NDD-CKD and MHD patients.
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Affiliation(s)
- Wen Du
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenni Gao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuejie Wang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, RuiJin Hospital LuWan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaobo Ma
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyuan Xie
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijin Yu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenhua Yang
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijin Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Nephrology, Wuxi Branch of Ruijin Hospital, Wuxi, Jiangsu Province, China
| | - Xiaonong Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Balestrieri N, Palzkill V, Pass C, Tan J, Salyers ZR, Moparthy C, Murillo A, Kim K, Thome T, Yang Q, O’Malley KA, Berceli SA, Yue F, Scali ST, Ferreira LF, Ryan TE. Activation of the Aryl Hydrocarbon Receptor in Muscle Exacerbates Ischemic Pathology in Chronic Kidney Disease. Circ Res 2023; 133:158-176. [PMID: 37325935 PMCID: PMC10330629 DOI: 10.1161/circresaha.123.322875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) accelerates the development of atherosclerosis, decreases muscle function, and increases the risk of amputation or death in patients with peripheral artery disease (PAD). However, the mechanisms underlying this pathobiology are ill-defined. Recent work has indicated that tryptophan-derived uremic solutes, which are ligands for AHR (aryl hydrocarbon receptor), are associated with limb amputation in PAD. Herein, we examined the role of AHR activation in the myopathy of PAD and CKD. METHODS AHR-related gene expression was evaluated in skeletal muscle obtained from mice and human PAD patients with and without CKD. AHRmKO (skeletal muscle-specific AHR knockout) mice with and without CKD were subjected to femoral artery ligation, and a battery of assessments were performed to evaluate vascular, muscle, and mitochondrial health. Single-nuclei RNA sequencing was performed to explore intercellular communication. Expression of the constitutively active AHR was used to isolate the role of AHR in mice without CKD. RESULTS PAD patients and mice with CKD displayed significantly higher mRNA expression of classical AHR-dependent genes (Cyp1a1, Cyp1b1, and Aldh3a1) when compared with either muscle from the PAD condition with normal renal function (P<0.05 for all 3 genes) or nonischemic controls. AHRmKO significantly improved limb perfusion recovery and arteriogenesis, preserved vasculogenic paracrine signaling from myofibers, increased muscle mass and strength, as well as enhanced mitochondrial function in an experimental model of PAD/CKD. Moreover, viral-mediated skeletal muscle-specific expression of a constitutively active AHR in mice with normal kidney function exacerbated the ischemic myopathy evidenced by smaller muscle masses, reduced contractile function, histopathology, altered vasculogenic signaling, and lower mitochondrial respiratory function. CONCLUSIONS These findings establish AHR activation in muscle as a pivotal regulator of the ischemic limb pathology in CKD. Further, the totality of the results provides support for testing of clinical interventions that diminish AHR signaling in these conditions.
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Affiliation(s)
- Nicholas Balestrieri
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Victoria Palzkill
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Caroline Pass
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Jianna Tan
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Zachary R. Salyers
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Chatick Moparthy
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Ania Murillo
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Kyoungrae Kim
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Trace Thome
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Qingping Yang
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
| | - Kerri A. O’Malley
- Department of Surgery, The University of Florida, Gainesville, FL, USA
| | - Scott A. Berceli
- Department of Surgery, The University of Florida, Gainesville, FL, USA
| | - Feng Yue
- Department of Animal Sciences, The University of Florida, Gainesville, FL, USA
- Myology Institute, The University of Florida, Gainesville, FL, USA
| | | | - Leonardo F. Ferreira
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
- Center for Exercise Science, The University of Florida, Gainesville, FL, USA
- Myology Institute, The University of Florida, Gainesville, FL, USA
| | - Terence E. Ryan
- Department of Applied Physiology and Kinesiology, The University of Florida, Gainesville, FL, USA
- Center for Exercise Science, The University of Florida, Gainesville, FL, USA
- Myology Institute, The University of Florida, Gainesville, FL, USA
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50
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Hendriks FK, Trommelen J, van der Sande FM, van Kranenburg JMX, Kuijpers JHW, Houtvast DCJ, Jetten GHJ, Goessens JPB, Meex SJR, Kooman JP, van Loon LJC. Branched-chain ketoacid co-ingestion with protein lowers amino acid oxidation during hemodialysis: A randomized controlled cross-over trial. Clin Nutr 2023; 42:1436-1444. [PMID: 37441814 DOI: 10.1016/j.clnu.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND & AIMS Hemodialysis removes amino acids from the circulation, thereby stimulating muscle proteolysis. Protein ingestion during hemodialysis can compensate for amino acid removal but may also increase uremic toxin production. Branched-chain ketoacid (BCKA) co-ingestion may provide an additional anabolic stimulus without adding to uremic toxin accumulation. In the present study we assessed the impact of BCKA co-ingestion with protein on forearm amino acid balance and amino acid oxidation during hemodialysis. METHODS Nine patients (age: 73 ± 10 y) on chronic hemodialysis participated in this crossover trial. During two 4-h hemodialysis sessions, patients ingested 18 g protein with (PRO + BCKA) or without (PRO) 9 g BCKAs in a randomized order. Test beverages were labeled with L-[ring-13C6]-phenylalanine and provided throughout the last 3 h of hemodialysis as 18 equal sips consumed with 10-min intervals. Arterial and venous plasma as well as breath samples were collected frequently throughout hemodialysis. RESULTS Arterial plasma total amino acid (TAA) concentrations during PRO and PRO + BCKA treatments were significantly lower after 1 h of hemodialysis (2.6 ± 0.3 and 2.6 ± 0.3 mmol/L, respectively) when compared to pre-hemodialysis concentrations (4.2 ± 1.0 and 4.0 ± 0.5 mmol/L, respectively; time effect: P < 0.001). Arterial plasma TAA concentrations increased throughout test beverage ingestion (time effect: P = 0.027) without differences between treatments (time∗treatment: P = 0.62). Forearm arteriovenous TAA balance during test beverage ingestion did not differ between timepoints (time effect: P = 0.31) or treatments (time∗treatment: P = 0.34). Whole-body phenylalanine oxidation was 33 ± 16% lower during PRO + BCKA when compared to PRO treatments (P < 0.001). CONCLUSIONS BCKA co-ingestion with protein during hemodialysis does not improve forearm net protein balance but lowers amino acid oxidation.
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Affiliation(s)
- Floris K Hendriks
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jorn Trommelen
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Frank M van der Sande
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Janneau M X van Kranenburg
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Jeffrey H W Kuijpers
- Department of Clinical Chemistry, Central Diagnostic Laboratory, CARIM Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Dion C J Houtvast
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Guus H J Jetten
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joy P B Goessens
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Steven J R Meex
- Department of Clinical Chemistry, Central Diagnostic Laboratory, CARIM Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Jeroen P Kooman
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
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