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Masola V, Bonomini M, Onisto M, Ferraro PM, Arduini A, Gambaro G. Biological Effects of XyloCore, a Glucose Sparing PD Solution, on Mesothelial Cells: Focus on Mesothelial-Mesenchymal Transition, Inflammation and Angiogenesis. Nutrients 2021; 13:2282. [PMID: 34209455 PMCID: PMC8308380 DOI: 10.3390/nu13072282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Glucose-based solutions remain the most used osmotic agents in peritoneal dialysis (PD), but unavoidably they contribute to the loss of peritoneal filtration capacity. Here, we evaluated at a molecular level the effects of XyloCore, a new PD solution with a low glucose content, in mesothelial and endothelial cells. Cell viability, integrity of mesothelial and endothelial cell membrane, activation of mesothelial and endothelial to mesenchymal transition programs, inflammation, and angiogenesis were evaluated by several techniques. Results showed that XyloCore preserves mesothelial and endothelial cell viability and membrane integrity. Moreover XyloCore, unlike glucose-based solutions, does not exert pro-fibrotic, -inflammatory, and -angiogenic effects. Overall, the in vitro evidence suggests that XyloCore could represent a potential biocompatible solution promising better outcomes in clinical practice.
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Affiliation(s)
- Valentina Masola
- Division of Nephrology and Dialysis, Department of Medicine, Piazzale A. Stefani 1, 37126 Verona, Italy;
- Department of Biomedical Sciences, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
| | - Mario Bonomini
- Nephrology and Dialysis Unit, Department of Medicine, G. d’Annunzio University, Chieti-Pescara, SS.Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy;
| | - Maurizio Onisto
- Department of Biomedical Sciences, University of Padova, Viale G. Colombo 3, 35121 Padova, Italy;
| | - Pietro Manuel Ferraro
- U.O.S. Terapia Conservativa della Malattia Renale Cronica, U.O.C. Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00178 Rome, Italy;
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00178 Rome, Italy
| | - Arduino Arduini
- R&D Department, Iperboreal Pharma Srl, 65122 Pescara, Italy;
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Department of Medicine, Piazzale A. Stefani 1, 37126 Verona, Italy;
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Association analysis of body composition with survival among prevalent peritoneal dialysis patients. Int Urol Nephrol 2021; 54:437-446. [PMID: 34181145 DOI: 10.1007/s11255-021-02923-6] [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: 12/28/2020] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Progressive decline in lean mass and gain of fat mass are common in patients treated with peritoneal dialysis (PD). It is unclear whether body composition or its longitudinal changes contribute to increased mortality among prevalent PD patients. METHODS This was a retrospective cohort study. Body composition was assessed using bioelectrical impedance spectroscopy (BIS). Lean and fat tissue indices were derived from lean and fat mass indexed to height-squared, respectively. The patient's baseline BIS results were used to explore its mortality risk prediction for the entire cohort. Among patients with subsequent BIS measurements, changes of lean and fat mass over time were also examined with survival outcomes. RESULTS Among all participants (n = 555, PD vintage 38 months), higher baseline lean tissue index was associated with lower mortality after adjusting for fat tissue index and confounders (HR 0.90; 95% CI 0.84-0.97, p = 0.01). However, this association was no longer significance after the final adjustment with serum albumin level (p = 0.06). A total of 136 patients had repeated BIS data. After the interval of 10.1 months during two consecutive BIS measurements, there was a strong inverse correlation between the percentage changes of lean and fat tissue indices (r = - 0.73, p < 0.001). The longitudinal changes in lean mass, either high or low categories, were not significantly associated with all-cause mortality. In contrast, patients who were classified as having low values of fat tissue index (below median) from baseline to the next BIS measurements had a lower odds of death in the univariable (HR 0.32; 95% CI 0.12-0.84, p = 0.02) but not in the adjusted models. CONCLUSION Among prevalent PD patients, higher baseline lean mass was independently associated with better survival. However, the longitudinal changes in lean mass were not significantly associated with mortality. In contrast, the maintenance of low fat status over time appeared to be associated with a lower likelihood of death among PD population.
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Kusumawardhani Y, Yetti K, Kariasa IM. Predominant Factors Affecting Sexual Dysfunction on Patients with Continuous Ambulatory Peritoneal Dialysis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Sexual dysfunction is a complication of terminal kidney failure. The problem of fulfilling sexual needs of men undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) is influenced by many factors.
AIM: This study aims to find out the most dominant factor affecting the sexual dysfunction of men who undergo CAPD.
METHODS: The design of this study was cross-sectional analysis with a sample of 70 men CAPD patients using a purposive sampling technique from February to May 2020. Data collection was carried out offline and online by filling in the questionnaire sheets for respondent characteristics, International Index of Erectile Function, and looking at laboratory result.
RESULTS: The results showed there was a correlation between age (p=0.0024), plasma urea (p=0.018), and albumin (p=0.001) with sexual dysfunction in male patients using CAPD. There was no significant correlation between length of time undergoing CAPD (p=0.678), fasting glucose (0.051), triglycerides (p=0.536), and cholesterol (p=0.183) with sexual dysfunction in male patients who undergo CAPD. The most dominant factor affecting is albumin, where patients who have albumin levels < 3.5 g/dL are at risk of experiencing sexual dysfunction 9.3 times greater than patients with albumin levels 3.5-5 g/dL after being controlled by age variables.
CONCLUSION: The recommendation of this study is protein intake of 1.2-1.5 g/kg body weight with at least 60% of protein with high biological value and evaluation of the ability of care and replacement of CAPD at home.
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Kittiskulnam P, Chuengsaman P, Kanjanabuch T, Katesomboon S, Tungsanga S, Tiskajornsiri K, Praditpornsilpa K, Eiam-Ong S. Protein-Energy Wasting and Mortality Risk Prediction Among Peritoneal Dialysis Patients. J Ren Nutr 2021; 31:679-686. [PMID: 33642190 DOI: 10.1053/j.jrn.2020.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Protein-energy wasting (PEW) is defined as the loss of body protein and energy reserves associated with kidney disease. However, the extent to which PEW contributes to increased mortality among peritoneal dialysis (PD) patients remains unclear. METHODS This is a retrospective cohort study from 2012 to 2020. The PEW was diagnosed by applying at least 3 of the 4 following criteria: (1) altered serum biochemistry indicated by a serum albumin level of <3.5 g/L; (2) decreased body mass status identified by a body mass index (BMI) of <23 kg/m2 or <10% total body fat; (3) muscle wasting defined by the lean tissue index, calculated as a lean tissue mass normalized to the height-squared in the <10th percentile of the reference population; and (4) low dietary protein intake determined by the normalized protein equivalent of a total nitrogen appearance of <0.8 g/kg/day. The Malnutrition Inflammation Score (MIS) was also examined as an alternative tool for assessment of PEW. RESULTS The average age of the 555 participants was 57.5 ± 12.6 years. The prevalence of PEW was 27.3%, with 196 deaths observed during the mean follow-up of 25.5 months. Patients with PEW who fulfilled at least 3 of the 4 listed criteria had a higher risk of death in the unadjusted model (hazard ratio 1.61, 95% confidence interval 1.19-2.18, P = .002). However, these associations were attenuated after adjusting for potential confounders. Regarding the individual PEW criterion, decreased serum albumin and low muscle mass were significantly associated with mortality in the multivariable models. In contrast, decreased body mass and low protein intake were not associated with a higher risk of death. High MIS (≥5 points) and each one-point increase in the MIS were also significantly associated with higher risk of death in both unadjusted and adjusted models. CONCLUSIONS Among PD patients, the presence of PEW was not a better predictor of all-cause mortality than either the altered serum biochemistry (albumin) or low muscle mass criteria. The MIS performed well as an independent predictor of death and might be an option for assessment of PEW status in the PD population.
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Affiliation(s)
- Piyawan Kittiskulnam
- Department of Internal Medicine-Nephrology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Piyatida Chuengsaman
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Banphaeo, Thailand
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sirarat Katesomboon
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Banphaeo, Thailand
| | - Somkanya Tungsanga
- Department of Internal Medicine-Nephrology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krittaya Tiskajornsiri
- Banphaeo-Charoenkrung Peritoneal Dialysis Center, Banphaeo Dialysis Group, Banphaeo Hospital, Banphaeo, Thailand
| | - Kearkiat Praditpornsilpa
- Department of Internal Medicine-Nephrology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Somchai Eiam-Ong
- Department of Internal Medicine-Nephrology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Special Task Force for Activating Research in Renal Nutrition (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand.
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Xu XD, Han X, Yang Y, Li X. Comparative study on the efficacy of peritoneal dialysis and hemodialysis in patients with end-stage diabetic nephropathy. Pak J Med Sci 2020; 36:1484-1489. [PMID: 33235561 PMCID: PMC7674865 DOI: 10.12669/pjms.36.7.2901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Diabetic nephropathy is a serious threat to human health, and its incidence is on the rise. End-stage diabetic nephropathy (ESDN) requires extra investigation due to its complexity and severity, as well as serious concurrent diseases. Our objective was to compare the efficacy of hemodialysis (HD) and peritoneal dialysis (PD) in the treatment of ESDN. Methods Clinical data of 84 patients with ESDN admitted to our hospital from June 2016 to June 2018 were retrospectively analyzed. The patients were divided into an HD group that received hemodialysis and a PD group that received peritoneal dialysis. Their general conditions, biochemical indicators, residual renal function and incidence of complications were recorded and compared between the two groups. Results (1) No significant difference in diastolic blood pressure, systolic blood pressure, body weight, or urine output was detected between the two groups at the beginning of dialysis (P>0.05). (2) Compared to the PD group, the HD group had significantly lower total cholesterol (TC) and triglyceride (TG) (P<0.05), and significantly higher total protein (TP) and albumin (ALB) after treatment (P<0.05). (3) The two groups also showed significant difference in residual renal function after treatment (P<0.05). (4) The HD group had significantly higher systolic pressure than the PD group after treatment (P<0.05). And more cases of infection were observed in the PD group than the HD group (P<0.05). Conclusion Both HD and PD are used for treatment of ESDN, and can achieve similar calcium and phosphorus control. Compared to HD, PD has less adverse effect on hemodynamics and better preserves residual renal function, but is more likely to cause malnutrition and disorders of lipid metabolism. Therefore, choice of dialysis method should be based on specific conditions of each patient.
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Affiliation(s)
- Xiao-Dong Xu
- Xiao-dong Xu, Department of Medicine, Cangzhou Medical College, Hebei 061000, P. R. China
| | - Xue Han
- Xue Han, Department of Medicine, Cangzhou Medical College, Hebei 061000, P. R. China
| | - Yi Yang
- Yi Yang, Department of Medicine, Cangzhou Medical College, Hebei 061000, P. R. China
| | - Xu Li
- Xu Li, Dean's Office, Cangzhou Medical College, Hebei 061000, P. R. China
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Kiebalo T, Holotka J, Habura I, Pawlaczyk K. Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition. Nutrients 2020; 12:E1715. [PMID: 32521626 PMCID: PMC7352713 DOI: 10.3390/nu12061715] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.
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Affiliation(s)
- Thomas Kiebalo
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Jacqueline Holotka
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Ireneusz Habura
- Department of Nephrology, University Hospital of Karol Marcinkowski in Zielona Gora, 65-046 Zielona Gora, Poland;
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
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Liver transplantation in transthyretin amyloidosis: Characteristics and management related to kidney disease. Transplant Rev (Orlando) 2016; 31:115-120. [PMID: 27671053 DOI: 10.1016/j.trre.2016.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 08/23/2016] [Accepted: 09/09/2016] [Indexed: 11/20/2022]
Abstract
Orthotopic liver transplantation (LT) was implemented as the inaugural disease-modifying therapy for hereditary transthyretin (ATTR) amyloidosis, a systemic amyloidosis mainly affecting the peripheral nervous system and heart. The first approach to pharmacologic therapy was focused on the stabilization of the TTR tetramer; following that new advent LT was assumed as the second step of treatment, for those patients whose neuropathy becomes worse after a course of pharmacologic therapy. The renal disease has been ignored in hereditary ATTR amyloidosis. The low level of proteinuria or slight renal impairment does not suppose such a heavy glomerular and vascular amyloid deposition. Moreover, severity of renal deposits does not consistently parallel that of myelinated nerve fiber loss. These are pitfalls that limit the success of LT and suggest troublesome criteria for pharmacological therapy or LT. An algorithm of evaluation concerning renal disease and treatment options is presented and some bridges-to-decision are exposed. In stage 4 or 5 kidney disease, the approach remains to deliver combined or sequential liver-kidney transplantation in eligible patients. However, in the majority, hemodialysis is the only option even in the presence of a well-functioning liver graft. In this review, we highlight useful information to aid the transplant hepatologist in the clinical practice.
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Castrale C, Azar R, Piquet MA, Lobbedez T. [The specific nutritionnal care in peritoneal dialysis]. Nephrol Ther 2016; 12:198-205. [PMID: 27320370 DOI: 10.1016/j.nephro.2016.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/10/2023]
Abstract
Protein energy wasting is a major complication in peritoneal dialysis. It is leading to a poor quality of life and increasing mortality. Diagnosis must be early, according to criteria defined by the International society of renal nutrition and metabolism. It is necessary to appropriate the diagnostic tools with dialysis method. The nutritional care is difficult in peritoneal dialysis. Indeed, studies are limited and practical nutrition is complex. In this point of view, we propose to treat guidelines for protein energy wasting, in peritoneal dialysis patients.
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Affiliation(s)
- Cindy Castrale
- Service de néphrologie-hémodialyse, hôpital privé Saint-Martin, 18, rue des Roquemonts, 14050 Caen cedex 4, France.
| | - Raymond Azar
- Service de néphrologie, dialyse, centre hospitalier de Dunkerque, 130, avenue Louis-Herbeaux, BP 6367, 59385 Dunkerque cedex 1, France
| | - Marie-Astrid Piquet
- Unité transversale de nutrition clinique et métabolique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
| | - Thierry Lobbedez
- Centre universitaire des maladies rénales, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France
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Kwon YE, Kee YK, Yoon CY, Han IM, Han SG, Park KS, Lee MJ, Park JT, Han SH, Yoo TH, Kim YL, Kim YS, Yang CW, Kim NH, Kang SW. Change of Nutritional Status Assessed Using Subjective Global Assessment Is Associated With All-Cause Mortality in Incident Dialysis Patients. Medicine (Baltimore) 2016; 95:e2714. [PMID: 26886609 PMCID: PMC4998609 DOI: 10.1097/md.0000000000002714] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Subjective global assessment (SGA) is associated with mortality in end-stage renal disease (ESRD) patients. However, little is known whether improvement or deterioration of nutritional status after dialysis initiation influences the clinical outcome. We aimed to elucidate the association between changes in nutritional status determined by SGA during the first year of dialysis and all-cause mortality in incident ESRD patients. This was a multicenter, prospective cohort study. Incident dialysis patients with available SGA data at both baseline and 12 months after dialysis commencement (n = 914) were analyzed. Nutritional status was defined as well nourished (WN, SGA A) or malnourished (MN, SGA B or C). The patients were divided into 4 groups according to the change in nutritional status between baseline and 12 months after dialysis commencement: group 1, WN to WN; group 2, MN to WN; group 3, WN to MN; and group 4, MN to MN. Cox proportional hazard analysis was performed to clarify the association between changes in nutritional status and mortality. Being in the MN group at 12 months after dialysis initiation, but not at baseline, was a significant risk factor for mortality. There was a significant difference in the 3-year survival rates among the groups (group 1, 92.2%; group 2, 86.0%; group 3, 78.2%; and group 4, 63.5%; log-rank test, P < 0.001). Multivariate Cox regression analysis revealed that the mortality risk was significantly higher in group 3 than in group 1 (hazard ratio [HR] 2.77, 95% confidence interval [CI] 1.27-6.03, P = 0.01) whereas the mortality risk was significantly lower in group 2 compared with group 4 (HR 0.35, 95% CI 0.17-0.71, P < 0.01) even after adjustment for confounding factors. Moreover, mortality risk of group 3 was significantly higher than in group 2 (HR 2.89, 95% CI 1.22-6.81, P = 0.02); there was no significant difference between groups 1 and 2. The changes in nutritional status assessed by SGA during the first year of dialysis were associated with all-cause mortality in incident ESRD patients.
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Affiliation(s)
- Young Eun Kwon
- From the Department of Internal Medicine (YEK, YKK, C-YY, IMH, SGH, KSP, MJL, JTP, SHH, T-HY, S-WK), Yonsei University College of Medicine, Seoul; Department of Internal Medicine (YLK), Kyungpook National University School of Medicine, Daegu; Department of Internal Medicine (YSK), Seoul National University College of Medicine; Department of Internal Medicine (CWY), Catholic University of Korea College of Medicine, Seoul; and Department of Internal Medicine (N-HK), Chonnam National University Medical School, Gwangju, South Korea
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Does increased glucose exposure lead to increased body fat and reduced lean body mass in anuric peritoneal dialysis patients? Eur J Clin Nutr 2014; 68:1253-4. [DOI: 10.1038/ejcn.2014.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/08/2022]
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Zhao C, Luo Q, He F, Peng F, Xia X, Huang F, Yu X. Establishing HbA1c -mean blood glucose formulae for patients on continuous ambulatory peritoneal dialysis. Diabet Med 2014; 31:813-20. [PMID: 24628621 DOI: 10.1111/dme.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 11/24/2013] [Accepted: 03/09/2014] [Indexed: 10/25/2022]
Abstract
AIM To determine the relationship between HbA1c and mean blood glucose concentrations by using HbA1c -mean blood glucose formulae for people on continuous ambulatory peritoneal dialysis. METHODS A total of 305 people on continuous ambulatory peritoneal dialysis, including 13 people with Type 1 diabetes mellitus, 161 people with Type 2 diabetes mellitus and 131 people without diabetes, from a single peritoneal dialysis centre at the First Affiliated Hospital of Sun Yat-sen University, were enrolled between January 2006 and June 2011. Serum HbA1c concentration was measured quarterly and other laboratory variables, including blood glucose, were measured every month. The formulae were established using regression analysis and adjusted for other factors. The estimated blood glucose level calculated using our formulae was compared with that using previous formulae namely the Diabetes Control and Complications Trial and A1c -Derived Average Glucose formulae for people not on dialysis and the Hoshino formula for people on haemodialysis. RESULTS The HbA1c -mean blood glucose formulae obtained by linear regression analysis were: 1) mBGmmol/l = 0.107 × HbA1c (mmol/mol) + 1.764 [adjusted R(2) (Radj2) = 0.494]; 2) mBGmmol/l = 0.101 × HbA1c (mmol/mol) - 0.001 × Cr (μmol/l) + 2.850 (Radj2 = 0.507); 3) mBGmmol/l = 0.102 × HbA1c (mmol/mol) - 0.095 × Alb (g/l) + 5.394 (Radj2 = 0.521); and 4) mBGmmol/l = 0.099 × HbA1c (mmol/mol) - 0.001 × Cr (μmol/l)-0.084 × Alb (g/l) + 5.754 (Radj2 = 0.526), where mBG is mean blood glucose, Cr is serum creatinine and Alb is serum albumin. These new formulae performed as well as or better than previous formulae. CONCLUSIONS The relationship between HbA1c and mean blood glucose for people on continuous ambulatory peritoneal dialysis differs from that for people not on dialysis or for those on haemodialysis. Clinicians and patients can determine glycaemic control targets by applying our formulae.
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Affiliation(s)
- C Zhao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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