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Xing T, Xu Y, Li J, Wen L, Xu Q, Liang W, Liang P, Liu Y, Tan R, Liu Y, Zhong X. Associations between insulin-like growth factor-1 standard deviation score and overall nutritional parameters in patients with maintenance hemodialysis: a cross-sectional study. Int Urol Nephrol 2023; 55:2257-2266. [PMID: 36853448 DOI: 10.1007/s11255-023-03526-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: 01/05/2023] [Accepted: 02/17/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND This study investigated the association between insulin-like growth factor-1 and nutritional status indicators in patients undergoing maintenance hemodialysis (MHD). METHODS Patients undergoing MHD for > 3 months were included in this single-center cross-sectional study in March 2021. Clinical, demographic, and body mass data and blood samples were collected before the hemodialysis sessions. Serum insulin-like growth factor-1 (IGF-1) levels were measured using a radioimmunoassay, and serum IGF-1 standard deviation score (SDS) was calculated for MHD patients according to age and sex. The nutritional status of patients was assessed using serum albumin, serum prealbumin, handgrip strength, pinching strength, upper arm muscle circumference, lean body mass, phase angle, seven-point subjective global assessment (SGA) score, and geriatric nutritional risk index (GNRI). The patients were divided into groups according to tertiles of serum IGF-1 SDS levels. Spearman correlation analyses and univariate and multivariate binary logistic regression analyses were used to determine the association between serum IGF-1 SDS and nutritional status parameters. RESULTS A total of 155 MHD patients (male: female = 90:65) were enrolled in the study, with a median dialysis vintage of 28.0 (11.0, 55.0) months, and an average age of 66 (65.5 ± 13.0) years. The median of IGF-1 SDS was - 0.1 (- 0.6 to 0.6). Compared to patients with higher IGF-1 SDSs, patients with lower IGF-1 SDSs had lower levels of serum ceruloplasmin (341.0 [287.5, 416.0] vs 395.0 [327.0, 451.0] vs 409.0 [349.5, 507.5], p = 0.002), serum albumin (34.7 ± 3.0 vs 37.0 ± 3.1 vs 37.8 ± 2.6, p < 0.001), serum prealbumin (270.3 [233.7, 327.8] vs 326.0 [279.3, 355.6] vs 363.0 [324.2, 398.2], p < 0.001), handgrip strength (13.8 [10.0, 20.7] vs 17.7 [10.7, 22.5] vs 23.3 [16.6, 27.8], p < 0.001), pinch strength (4.6 [3.9, 6.0] vs 4.9 (3.9, 6.9) vs 6.5 [4.7, 8.7], p = 0.002), phase angle (3.3 [3.0, 3.8] vs 3.9 [3.4, 4.7] vs 4.3 [3.6, 5.2, p < 0.001), modified Creatinine Index (83.1 ± 19.7 vs 93.1 ± 23.4 vs 113.9 ± 24.3, p < 0.001), intracellular water (14.5 ± 4.4 vs 16.1 ± 4.9 vs 16.9 ± 4.4, p = 0.031), higher extracellular water (26.9 ± 5.8 vs 25.7 ± 5.5 vs 25.1 ± 3.1, p = 0.042), and higher malnutrition risk as defined by GNRI (49.0% vs 15.7% vs 11.5%, p < 0.001) and SGA (53.9% vs 23.5% vs 7.7%, p < 0.001). CONCLUSIONS Lower IGF-1 SDSs are independently associated with higher malnutrition risk in patients with MHD.
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Affiliation(s)
- Tingting Xing
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Yao Xu
- Department of Nephrology, The 2nd People's Hospital of Bijie, Bijie, Guizhou, People's Republic of China
| | - Jiaqi Li
- Department of Nephrology, South China Hospital of Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Luona Wen
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, Guangdong, People's Republic of China
| | - Weifeng Liang
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Pan Liang
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Yun Liu
- Department of Nephrology, The 2nd People's Hospital of Bijie, Bijie, Guizhou, People's Republic of China.
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China.
| | - Rongshao Tan
- Clinical Collage of Medicine, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China.
| | - Yan Liu
- Guangzhou Institute of Disease-Oriented Nutritional Research of Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, People's Republic of China
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, Guangdong, People's Republic of China
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Luo Y, Huang H, Wang Q, Lin W, Duan S, Zhou J, Huang J, Zhang W, Zheng Y, Tang L, Cao X, Yang J, Zhang L, Wang Y, Wu J, Cai G, Dong Z, Chen X. An Exploratory Study on a New Method for Nutritional Status Assessment in Patients with Chronic Kidney Disease. Nutrients 2023; 15:nu15112640. [PMID: 37299602 DOI: 10.3390/nu15112640] [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: 04/13/2023] [Revised: 05/20/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Malnutrition is a risk factor for disease progression and poor prognosis in chronic kidney disease (CKD). However, the complexity of nutritional status assessment limits its clinical application. This study explored a new method of nutritional assessment in CKD (stage 1-5) patients using the Subjective Global Assessment (SGA) as the gold standard and evaluated its applicability. The kappa test was used to analyze the consistency of the Renal Inpatient Nutrition Screening Tool (Renal iNUT) with SGA and protein-energy wasting. Logistic regression analysis was used to analyze the risk factors of CKD malnutrition and calculate the prediction probability of multiple indicators combined for the diagnosis of CKD malnutrition. The receiver operating characteristic curve of the prediction probability was drawn to evaluate its diagnostic efficiency. A total of 161 CKD patients were included in this study. The prevalence of malnutrition according to SGA was 19.9%. The results showed that Renal iNUT had a moderate consistency with SGA and a general consistency with protein-energy wasting. Age > 60 years (odds ratio, OR = 6.78), neutrophil-lymphocyte ratio > 2.62 (OR = 3.862), transferrin < 200 mg/dL (OR = 4.222), phase angle < 4.5° (OR = 7.478), and body fat percentage < 10% (OR = 19.119) were risk factors for malnutrition in patients with CKD. The area under the receiver operating characteristic curve of multiple indicators for the diagnosis of CKD malnutrition was 0.89 (95% confidence interval: 0.834-0.946, p < 0.001). This study demonstrated that Renal iNUT has good specificity as a new tool for the nutrition screening of CKD patients, but its sensitivity needs to be optimized. Advanced age, high neutrophil-lymphocyte ratio, low transferrin level, low phase angle, and low body fat percentage are risk factors for malnutrition in patients with CKD. The combination of the above indicators has high diagnostic efficiency in the diagnosis of CKD malnutrition, which may be an objective, simple, and reliable method to evaluate the nutritional status of patients with CKD.
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Affiliation(s)
- Yayong Luo
- Department of Nephrology, First Medical Center of Chinese PLA 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
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Hui Huang
- Department of Nephrology, First Medical Center of Chinese PLA 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
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Qian Wang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Wenwen Lin
- Department of Nephrology, First Medical Center of Chinese PLA 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
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
| | - Shuwei Duan
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Jianhui Zhou
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Jing Huang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Weiguang Zhang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Ying Zheng
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Li Tang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Xueying Cao
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Jian Yang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Li Zhang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Yong Wang
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Jie Wu
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Guangyan Cai
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Zheyi Dong
- Department of Nephrology, First Medical Center of Chinese PLA 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
| | - Xiangmei Chen
- Department of Nephrology, First Medical Center of Chinese PLA 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
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou 510006, China
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Hou YC, Liu YM, Liao MT, Zheng CM, Lu CL, Liu WC, Hung KC, Lin SM, Lu KC. Indoxyl sulfate mediates low handgrip strength and is predictive of high hospitalization rates in patients with end-stage renal disease. Front Med (Lausanne) 2023; 10:1023383. [PMID: 36817773 PMCID: PMC9932816 DOI: 10.3389/fmed.2023.1023383] [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: 08/19/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Background and aims Sarcopenia has a higher occurrence rate in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) than in the general population. Low handgrip strength-and not sarcopenia per se-is associated with clinical outcomes in patients with CKD, including cardiovascular mortality and hospitalization. The factors contributing to low handgrip strength are still unknown. Accordingly, this study aimed to determine whether uremic toxins influence low handgrip strength in patients with CKD. Materials and methods This cohort study lasted from August 2018 to January 2020. The participants were divided into three groups: the control group [estimated glomerular filtration rate (eGFR) ≥ 60 ml/min], an advanced CKD group (eGFR = 15-60 ml/min), and an ESRD group (under maintenance renal replacement therapy). All participants underwent handgrip strength measurement, dual-energy X-ray absorptiometry, and blood sampling for myokines (irisin, myostatin, and interleukin 6) and indoxyl sulfate. Sarcopenia was defined according to the Asian Working Group for Sarcopenia consensus as low appendicular skeletal muscle index (appendicular skeletal muscle/height2 of < 7.0 kg/m2 in men and < 5.4 kg/m2 in women) and low handgrip strength (< 28 kg in men and < 18 kg in women). Results Among the study participants (control: n = 16; CKD: n = 17; and ESRD: n = 42), the ESRD group had the highest prevalence of low handgrip strength (41.6 vs. 25% and 5.85% in the control and CKD groups, respectively; p < 0.05). The sarcopenia rate was similar among the groups (12.5, 17.6, and 19.5% for the control, CKD, and ESRD groups, respectively; p = 0.864). Low handgrip strength was associated with high hospitalization rates within the total study population during the 600-day follow-up period (p = 0.02). The predictions for cardiovascular mortality and hospitalization were similar among patients with and without sarcopenia (p = 0.190 and p = 0.094). The serum concentrations of indoxyl sulfate were higher in the ESRD group (227.29 ± 92.65 μM vs. 41.97 ± 43.96 μM and 6.54 ± 3.45 μM for the CKD and control groups, respectively; p < 0.05). Myokine concentrations were similar among groups. Indoxyl sulfate was associated with low handgrip strength in univariate and multivariate logistic regression models [univariate odds ratio (OR): 3.485, 95% confidence interval (CI): 1.372-8.852, p = 0.001; multivariate OR: 8.525, 95% CI: 1.807-40.207, p = 0.007]. Conclusion Handgrip strength was lower in the patients with ESRD, and low handgrip strength was predictive of hospitalization in the total study population. Indoxyl sulfate contributed to low handgrip strength and counteracted the benefits of myokines in patients with CKD.
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Affiliation(s)
- Yi-Chou Hou
- Division of Nephrology, Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yueh-Min Liu
- Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Min-Ter Liao
- Department of Pediatrics, Taoyuan Armed Forces General Hospital, Hsinchu, Taiwan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Cai-Mei Zheng
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Chien-Lin Lu
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wen-Chih Liu
- Division of Nephrology, Department of Internal Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Biology and Anatomy, National Defense Medical Center, Taipei City, Taiwan
| | - Kuo-Chin Hung
- Division of Nephrology, Department of Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Shyh-Min Lin
- Division of Radiology, Department of Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Kuo-Cheng Lu
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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A high neutrophil to lymphocyte ratio is associated with poor nutritional status in chronic kidney disease patients. Br J Nutr 2022; 128:1990-1996. [PMID: 35086576 DOI: 10.1017/s000711452100516x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We aimed to investigate the relationship between the neutrophil to lymphocyte ratio (NLR) and nutritional parameters in chronic kidney disease (CKD) patients. In this cross-sectional study, 187 non-dialysis CKD patients were enrolled. Daily dietary energy intake (DEI) and daily dietary protein intake (DPI) were assessed by 3-d dietary records. Protein-energy wasting (PEW) was defined as Subjective Global Assessment (SGA) class B and C. Spearman correlation analysis, logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed. The median NLR was 2·51 (1·83, 3·83). Patients with CKD stage 5 had the highest NLR level. A total of 19·3 % (n 36) of patients suffered from PEW. The NLR was positively correlated with SGA and serum P, and the NLR was negatively correlated with BMI, waist and hip circumference, triceps skinfold thickness, mid-arm muscle circumference, DPI and Hb. Multivariate logistic regression analysis adjusted for DPI, DEI, serum creatinine, blood urea nitrogen, uric acid and Hb showed that a high NLR was an independent risk factor for PEW (OR = 1·393, 95 % CI 1·078, 1·800, P = 0·011). ROC analysis showed that an NLR ≥ 2·62 had the ability to identify PEW among CKD patients, with a sensitivity of 77·8 %, a specificity of 62·3 % and an AUC of 0·71 (95 % CI 0·63, 0·81, P < 0·001). The NLR was closely associated with nutritional status. NLR may be an indicator of PEW in CKD patients.
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Yen CL, Fan PC, Chen JJ, Kuo G, Hsiao CC, Chen CY, Tu YR, Hsu HH, Chen YC, Chang CH. Ketoanalogues Supplemental Low Protein Diet Safely Decreases Short-Term Risk of Dialysis among CKD Stage 4 Patients. Nutrients 2022; 14:nu14194020. [PMID: 36235673 PMCID: PMC9571353 DOI: 10.3390/nu14194020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Rigid dietary controls and pill burden make a very-low protein (0.3−0.4 g/kg body weight per day), vegetarian diet supplemented with ketoanalogues of amino acids (sVLPD) hard to follow in the long-term. This study aimed to evaluate whether a ketoanalogue supplemental low-protein diet (sLPD) (0.6 g/kg body weight per day) could also reduce the risks of dialysis among CKD stage 4 patients. Methods: Patients aged >20 years with a diagnosis of stage 4 CKD who subsequently received ketosteril treatment, which is the most commonly used ketoanalogue of essential amino acids, between 2003 and 2018 were identified from the Chang Gung Research Database (CGRD). Then, these individuals were divided into two groups according to the continuation of ketosteril for more than three months or not. The primary outcome was ESKD requiring maintenance dialysis. Results: With one-year follow-up, the continuation group (n = 303) exhibited a significantly lower incidence of new-onset end-stage kidney disease (ESKD) requiring maintenance dialysis (6.8% vs. 10.4%, hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.41−0.94) in comparison to the discontinuation group (n = 238). Conclusions: This study demonstrated that initiating sLPDs since CKD stage 4 may additionally reduce the short-term risks of commencing dialysis without increasing CV events, infections, or mortality.
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Affiliation(s)
- Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Ching-Chung Hsiao
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Chao-Yu Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yi-Ran Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Correspondence: or ; Tel.:+886-3-328-1200 (ext. 8181)
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Wen L, Tang C, Liu Y, Jiang J, Zou D, Chen W, Xu S, Wang Y, Qiu J, Zhong X, Liu Y, Tan R. Effects of oral non-protein calorie supplements on nutritional status among maintenance hemodialysis patients with protein-energy wasting: a multi-center randomized controlled trial. Food Funct 2022; 13:8465-8473. [PMID: 35861176 DOI: 10.1039/d1fo03791a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Protein-energy wasting (PEW) is prevalent in maintenance hemodialysis (MHD) patients, and is one of the major risk factors for poor outcomes and death. This study aimed to investigate the effects of non-protein calorie supplements on the nutritional status of MHD patients with PEW. MHD patients with PEW were enrolled in this multi-center, open-label, randomized controlled trial. Then, they were randomly assigned to the intervention group to receive the non-protein calorie supplements containing 280 kcal of energy every day for 6 months or the control group to complete all aspects of the study without receiving supplements. Patients in both groups received dietary counselling from dietitians. Data on nutritional assessments, anthropometric measurements, blood analysis and dietary recall were collected at the baseline and at six months from both groups. Statistical analyses were performed using analysis of covariance (ANCOVA) adjusted for sex and baseline values. Ninety-two MHD patients completed the study. A significant increase in the subjective global assessment (SGA) score was found in the intervention group compared with the control group (4.88 ± 1.41 vs. 4.40 ± 1.16, p = 0.044). The ratio of PEW patients (diagnosed with SGA ≤5) in the intervention group (61.2%) was also significantly lower than that in the control group (83.7%) (p < 0.001). Moreover, significant improvements in body mass index (20.81 ± 2.46 kg m-2vs. 19.51 ± 2.60 kg m-2, p < 0.001), nutrition risk screening 2002 (2.45 ± 1.40 vs. 3.12 ± 1.37, p = 0.038), mid-upper arm circumference (23.30 ± 2.78 cm vs. 21.75 ± 2.87 cm, p = 0.001), and mid-arm muscle circumference (20.51 ± 2.32 cm vs. 19.06 ± 2.92 cm, p = 0.005) were observed in the intervention group compared with the control group. Patients in the intervention group took in more dietary energy than the control group (26.96 ± 4.75 kcal per kg body weight per day vs. 24.33 ± 2.68 kcal per kg body weight per day, p < 0.001). In conclusion, non-protein calorie supplements may improve the nutritional status of MHD patients with PEW.
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Affiliation(s)
- Luona Wen
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Chunrong Tang
- Department of Nephrology, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Yun Liu
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jie Jiang
- Department of Nephrology, Dongguan People's Hospital, Dongguan, China
| | - Dee Zou
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Wenxuan Chen
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Shilin Xu
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yuqi Wang
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Jingxian Qiu
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Xiaoshi Zhong
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Yan Liu
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nephrology, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China
| | - Rongshao Tan
- Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.,Department of Nutrition, Guangzhou Red Cross Hospital of Jinan University, Guangzhou, China.
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Widiasih E, Subagio HW, Lestariningsih L. The Role of Gut Dysbiosis in Malnutrition Mechanism in CKD-5 HD Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9870] [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
Patients with terminal stage chronic kidney disease who have undergone hemodialysis (PGK-5 HD) have a high risk of developing malnutrition, which is characterized by wasting protein-energy and micronutrient deficiencies. Studies show a high prevalence of malnutrition in CKD-5 HD patients. The pathogenic mechanisms of malnutrition in CKD-5 HD are complex and involve the interaction of several pathophysiological changes including decreased appetite and nutrient intake, hormonal disturbances, metabolic imbalances, inflammation, increased catabolism, and abnormalities associated with dialysis action. A clear understanding of the pathophysiological mechanisms involved in the development of malnutrition in CKD-5 HD is required to develop strategies and interventions that are appropriate, effective, and reduce negative clinical outcomes. This article is a review of the pathophysiological mechanisms of malnutrition in CKD-5 HD patients caused by chronic inflammation due to intestinal dysbiosis.
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Ramos-Acevedo S, Rodríguez-Gómez L, López-Cisneros S, González-Ortiz A, Espinosa-Cuevas Á. Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study. Front Nutr 2022; 9:881719. [PMID: 35662942 PMCID: PMC9161672 DOI: 10.3389/fnut.2022.881719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Estimating energy requirements (ER) is crucial for nutritional attention to chronic kidney disease (CKD) patients. Current guidelines recommend measuring ER with indirect calorimetry (IC) when possible. Due to clinical settings, the use of simple formulas is preferred. Few studies have modeled equations for estimating ER for CKD. Nevertheless, variables of interest such as nutritional status and strength have not been explored in these models. This study aimed to develop and validate a model for estimating REE in patients with CKD stages 3–5, who were not receiving renal replacement therapy (RTT), using clinical variables and comparing it with indirect calorimetry as the gold standard. Methods In this study 80 patients with CKD participated. Indirect calorimetry (IC) was performed in all patients. The calorimeter analyzed metabolic measurements every minute for 15 min after autocalibration with barometric pressure, temperature, and humidity. Bioelectrical Impedance Analysis (BIA) was performed. Fat-free mass (FFM) was registered among other bioelectrical components. Handgrip strength (HGS) was evaluated and an average of 3 repetitions was recorded. Nutritional status was assessed with the subjective global assessment (SGA). Patients categorized as B or C were then considered as having malnutrition. Results We analyzed 71 patients and 3 models were generated. Model 1a included FFM; Model 2a included weight; Model 3c included handgrip strength (HGS). All other variables were stepwise, computer-selected with a p < 0.01 significance level; Malnutrition was consistently associated with ER among other clinical variables in all models (p < 0.05). The model that included BIA-FFM had R2adjusted = 0.46, while the model that included weight (Kg) had an adjusted R2adjusted = 0.44. The models had moderate concordance, LC = 0.60–0.65 with the gold standard, whereas other energy expenditure estimation equations had LC = 0.36 and 0.55 with indirect calorimetry. Using these previously validated equations as a reference, our models had concordance values ranging from 0.66 to 0.80 with them. Conclusion Models incorporating nutritional status and other clinical variables such as weight, FFM, comorbidities, gender, and age have a moderate agreement with REE. The agreement between our models and others previously validated for the CKD patient is good; however, the agreement between the latter and IC measurements is moderate. The KDOQI lowest recommendation (25 Kcals/kg body weight) considering the 22% difference with respect to the IC for total energy expenditure rather than for REE.
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Affiliation(s)
- Samuel Ramos-Acevedo
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Programa de Maestría y Doctorado en Ciencias Médicas y Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luis Rodríguez-Gómez
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sonia López-Cisneros
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Ángeles Espinosa-Cuevas
- Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Health Care, Universidad Autónoma Metropolitana, Mexico City, Mexico
- *Correspondence: Ángeles Espinosa-Cuevas,
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Caldiroli L, Vettoretti S, Armelloni S, Mattinzoli D, Ikehata M, Molinari P, Alfieri C, Messa P, Castellano G. Possible Benefits of a Low Protein Diet in Older Patients With CKD at Risk of Malnutrition: A Pilot Randomized Controlled Trial. Front Nutr 2022; 8:782499. [PMID: 35198584 PMCID: PMC8860492 DOI: 10.3389/fnut.2021.782499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/22/2021] [Indexed: 12/13/2022] Open
Abstract
BackgroundCurrent guidelines do not clarify whether older patients with advanced chronic kidney disease (CKD) may benefit of low protein (LP) diet if they are at risk of malnutrition. We compared the effects of normocalorie/normoprotein (NP) and normocalorie/LP diet on nutritional status and metabolic complications related to the progression of kidney damage in these patients.MethodsThis pilot study had an open-label randomized-controlled design (ClinicalTrials.gov Id: NCT05015647). Thirty-five patients were treated for 6 months with two different diets (LP = 17) and (NP = 18). Malnutrition was assessed by the Malnutrition Inflammation Score and International Society of Renal Nutrition and Metabolism criteria. Renal function was assessed by creatinine and cystatin-C-based estimated glomerular filtration rate (eGFR).ResultsAt the end of the study, Malnutrition Inflammation Score was improved in both LP and NP groups (respectively: 3 ± 3 vs. 6 ± 1.5, p = 0.020 and 3 ± 2.5 vs. 6 ± 2, p = 0.012), prevalence of protein energy wasting syndrome decreased only in LP. LP group had higher eGFRcys-C (17 ± 6 vs. 12 ± 4 ml/min/1.73 m2; p < 0.05), lower serum urea (105 ± 65 vs. 138 ± 30 mg/dl; p < 0.05) and lower parathormone (68 ± 10 vs. 99 ± 61 ng/L; p < 0.05) than NP. Serum and urinary phosphorous did not change while fibroblast growth factor 23 (FGF23)-intact and FGF23 c-terminal increased in both groups [FGF23-intact in LP: 70 (48; 98) vs. 126 (90; 410) pg/ml, p < 0.01 and in NP: 86 (57; 194) vs. 143 (119; 186) pg/ml, p < 0.01; FGF23 c-terminal in LP: 77 (30.3; 112) vs. 111 (63; 384) RU/ml, p < 0.01 and in NP: 142 (56.6; 175) vs. 157 (76.7; 281) RU/ml, p < 0.01].ConclusionsLP diet has a favorable impact on nutritional status as much as NP diet with possible greater benefits on the progression of kidney disease and some of its metabolic complications.Clinical Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT05015647, identifier: NCT05015647.
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Affiliation(s)
- Lara Caldiroli
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- *Correspondence: Simone Vettoretti
| | - Silvia Armelloni
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Deborah Mattinzoli
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Masami Ikehata
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Paolo Molinari
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Carlo Alfieri
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giuseppe Castellano
- Unit of Nephrology, Dialysis and Renal Transplantation - Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Wong MMY, Zheng Y, Renouf D, Sheriff Z, Levin A. Trajectories of Nutritional Parameters Before and After Prescribed Oral Nutritional Supplements: A Longitudinal Cohort Study of Patients With Chronic Kidney Disease Not Requiring Dialysis. Can J Kidney Health Dis 2022; 9:20543581211069008. [PMID: 35070337 PMCID: PMC8771735 DOI: 10.1177/20543581211069008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The association between oral nutritional supplement use and nutritional parameters among patients with nondialysis chronic kidney disease (CKD-ND) with or at high risk of undernutrition/protein-energy wasting has not been previously studied. The definition of patient subgroups most likely to benefit from oral nutritional supplementation (ONS) is also an area where more research is needed. Objective: To assess nutritional parameter trajectories among patients with CKD-ND prescribed oral nutritional supplements in British Columbia, and to compare trajectories by nutritional phenotype. Design: Longitudinal cohort study, pre-post design. Setting: Multidisciplinary CKD clinics across British Columbia. Patients: A total of 3957 adult patients with CKD-ND, who entered multidisciplinary CKD clinics during 2010 to 2019, met criteria for oral nutritional supplement prescription based on dietitian assessment, and received ≥1 oral nutritional supplement prescription. Measurements: Longitudinal nutritional parameters, including body mass index (BMI), serum albumin, serum bicarbonate, serum phosphate, and neutrophil-to-lymphocyte ratio (NLR). Methods: Using linear mixed models, slopes for nutritional and inflammation parameters were assessed in the 2-year periods before and after the first oral nutritional supplement prescription. Hierarchical cluster analysis was applied to identify nutritional phenotypes using baseline data, and slope analysis was repeated by cluster. Results: In the pre-oral-nutritional-supplement period, declines in BMI (−0.87 kg/m2/year, 95% confidence interval [CI]: −0.99 to −0.75), albumin (−1.11 g/L/year, 95% CI: −1.27 to −0.95), and bicarbonate (−0.49 mmol/L/year; 95% CI: −0.59 to −0.39), and increases in NLR (+0.79/year; 95% CI: 0.60 to 0.98) and phosphate (+0.05 mmol/L/year; 95% CI: 0.04 to 0.06) were observed. Following oral nutritional supplement prescription, there were statistically significant increases in BMI slope (+0.91 kg/m2/year, P < .0001), albumin slope (+0.82 g/L/year, P < .0001), and phosphate slope (+0.02 mmol/L/year, P = .005), as well as a decline in NLR slope of −0.55/year ( P < .0001). There was no significant change in bicarbonate slope. Cluster analysis identified 5 distinct phenotypes. The cluster with the highest mean baseline NLR and lowest mean BMI demonstrated the greatest number of improvements in nutritional parameter slopes in the post-oral-nutritional-supplement period. Limitations: Possibility of residual confounding. Data on dietary intake, muscle mass, and nutritional scoring systems were not available in the registry. Conclusions: Among patients with CKD-ND prescribed oral nutritional supplements, there were improvements in nutrition/inflammation parameters over time following the first ONS prescription. The heterogeneity in response to ONS by cluster subgroup suggests an individualized approach to nutritional management may be beneficial.
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Affiliation(s)
- Michelle M. Y. Wong
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- BC Renal, Vancouver, BC, Canada
| | | | - Dani Renouf
- St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Zainab Sheriff
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Adeera Levin
- BC Renal, Vancouver, BC, Canada
- St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
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Wong MMY, Renouf D, Zheng Y, Sheriff Z, Levin A. Nutritional Status, Nutritional Phenotypes, and Oral Nutritional Supplement Prescription Patterns Among Patients With Non-Dialysis Chronic Kidney Disease in British Columbia. J Ren Nutr 2021; 32:414-422. [PMID: 34924262 DOI: 10.1053/j.jrn.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/25/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Management of protein-energy wasting and undernutrition with oral nutritional supplements (ONS) has not been systematically studied in the non-dialysis chronic kidney disease (CKD-ND) population. We aimed to describe nutritional status, identify phenotypes of patients prescribed ONS, and evaluate ONS prescription patterns among CKD-ND patients in British Columbia. DESIGN AND METHODS This observational study assessed adult CKD-ND patients who entered multidisciplinary CKD clinics during 2013-2018 in British Columbia. Descriptive statistics were used to describe baseline nutrition and inflammation parameters among patients prescribed ONS versus patients not prescribed ONS within 1 year of clinic entry. Hierarchical clustering method with consensus clustering was applied to identify phenotypes of patients prescribed ONS. Multivariable logistic regression was used to assess the associations between ONS prescription and health region/dietitian full-time equivalents per 1,000 CKD patients. RESULTS Of 15,859 CKD-ND patients, 9% of patients entering CKD clinics were prescribed ONS within 1 year of clinic entry, and these patients demonstrated lower baseline estimated glomerular filtration rate, body mass index (BMI), serum albumin, bicarbonate, as well as greater age, serum phosphate, and neutrophil-to-lymphocyte ratio compared with those not receiving ONS. Cluster analysis revealed 5 phenotypes of ONS users: cluster 1 had the highest mean neutrophil-to-lymphocyte ratio; cluster 2 had the lowest mean albumin; cluster 3 had the lowest mean BMI; cluster 4 had the highest mean BMI; and cluster 5 had the lowest mean bicarbonate. There was regional variability in ONS prescription, and an odds ratio for ONS prescription of 1.32 (95% confidence interval 1.16-1.50) for every 1-unit increase in dietitian full-time equivalents per 1,000 patients. Over 3 years of follow-up, overall ONS use among CKD-ND patients remained stable. CONCLUSIONS This study demonstrates appropriate prescribing of ONS to patients with suboptimal nutritional status, although regional variation exists. Patients receiving ONS represent a heterogenous group with phenotypes reflecting several clinical and biochemical features of the protein-energy wasting syndrome. These findings will assist with updating ONS policy, planning quality improvement initiatives, and informing dietitian resource allocation.
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Affiliation(s)
- Michelle M Y Wong
- Department of Medicine, University of British Columbia, Vancouver, BC; BC Renal, Vancouver, BC.
| | | | | | - Zainab Sheriff
- Division of Nephrology, University of British Columbia, Vancouver, BC
| | - Adeera Levin
- BC Renal, Vancouver, BC; St. Paul's Hospital, Vancouver, BC; Division of Nephrology, University of British Columbia, Vancouver, BC
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Estimates of malnutrition associated with chronic kidney disease patients globally and its contrast with India: An evidence based systematic review and meta-analysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Liu Y, Wang L, Li S, Xu S, Zhou D, Zhong X, Tan R, Liu Y. Associations Between Blood Trace Element Levels and Nutritional Status in Maintenance Hemodialysis. J Ren Nutr 2021; 31:661-668. [PMID: 33941438 DOI: 10.1053/j.jrn.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE(S) We aimed to investigate the associations between blood trace element levels and nutritional status in patients undergoing maintenance hemodialysis (MHD). METHODS This cross-sectional study included patients undergoing MHD who were treated at our center in September 2019. Clinical and demographic data and blood samples were collected before hemodialysis sessions, and the levels of manganese, lead, selenium, zinc, and copper were measured by inductively coupled plasma mass spectrometry. The Simplified Nutritional Appetite Questionnaire scale was used to assess patient appetite. Skinfold thickness, bicep circumference, upper arm muscle circumference, 7-point Subjective Global Assessment, Nutritional Risk Screening 2002 (NRS 2002), and Geriatric Nutritional Risk Index (GNRI) were used to assess patient nutritional status. Univariate and multivariate logistic regression analyses were performed to study the relationship between trace elements and nutritional indicators. RESULTS In total, 118 patients (64 males and 54 females) were included, with a median dialysis vintage of 34.0 months (16.0-54.5 months) and an average age of 63.20 ± 14.26 years. Malnourished patients, as defined by the GNRI, Subjective Global Assessment, and NRS 2002, accounted for 28.0%, 49.2%, and 26.3% of enrolled patients, respectively. The multivariate binary logistic regression showed that higher blood copper levels were independently associated with nutritional risk defined as GNRI ≤91.2 (odds ratio [OR] = 1.003, 95% confidence interval [CI] = 1.000-1.006; P = .020), whereas lower blood zinc levels (OR = 0.634, 95% CI = 0.439-0.916; P = .015), blood zinc < 4.220 mg/L (OR = 3.723, 95% CI = 1.274-10.879; P = .016), lower blood selenium levels (OR = 0.959, 95% CI = 0.929-0.990; P = .010), and blood selenium < 85 μg/L (OR = 5.568, 95% CI = 1.039-29.840; P = .045) were independently associated with a nutritional risk defined as NRS 2002 ≥ 3. CONCLUSION(S) Higher levels of blood copper and lower levels of blood zinc and selenium were independently associated with higher nutritional risk in MHD patients.
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Affiliation(s)
- Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China; Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China.
| | - Liangtao Wang
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Shuting Li
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Shilin Xu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Daoyuan Zhou
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Xiaoshi Zhong
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Rongshao Tan
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China; Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China; Guangzhou Institute of Disease-Oriented Nutritional Research, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, China
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Merga C, Girma M, Teshome MS. Protein-Energy Wasting and Associated Factors Among Chronic Kidney Disease Patients at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Int J Nephrol Renovasc Dis 2020; 13:307-318. [PMID: 33173325 PMCID: PMC7648527 DOI: 10.2147/ijnrd.s273874] [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: 07/25/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
Background Protein-energy wasting is a major issue in patients with chronic kidney disease (CKD), adversely affecting morbidity, mortality, functional activity, and quality of life. Assessment of nutritional status in CKD patients is important to ensure patient's normal protein stores and avoid metabolic complications. However, in Ethiopia, there were very few studies done to assess the prevalence of protein-energy wasting (PEW) and its associated factors among CKD patients. Objective To assess protein-energy wasting and associated factors among chronic kidney disease patients at adult OPD St. Paulo's Hospital Millennium Medical College, Addis Ababa Ethiopia. Materials and Methods An institution-based cross-sectional study was conducted from March to April 2019. Data were collected using a structured interviewer-administered questionnaire and anthropometric measurements, and laboratory data were collected from patient files. Data were entered into Epi-data version 3.1 and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were performed to identify associated factors. P values <0.05 were considered to declare statistical significance. Results In this study, 274 respondents were interviewed with a response rate of 100%. The prevalence of protein-energy wasting in CKD patients was 23.4%. Chronic kidney disease patients at age ≥65 years were seven times more likely to have protein-energy wasting as compared to patients aged 18-34 years [AOR=7.0, 95% (CI: 2.4, 20.5)]. Patients who had a history of anorexia were 5.2 times more likely to have protein-energy wasting as compared to those who had no history of anorexia [(AOR=5.2, 95% (CI: 2.7, 10.3)] and were significantly associated with the risk of having CKD. Conclusion The prevalence of protein-energy wasting among CKD patients was high and associated with age, physical activity, history of anorexia, and CKD stages. Interventions that address nutritional problems and lifestyle factors in CKD patients need to be implemented together with medical treatment.
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Affiliation(s)
- Chaltu Merga
- Department of Nutrition, Ambo University, Ambo, Ethiopia
| | - Meron Girma
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
| | - Melese Sinaga Teshome
- Department of Nutrition and Dietetics, Faculty of Public Health, Health Institute, Jimma University, Jimma, Ethiopia
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Yen CL, Fan PC, Lee CC, Kuo G, Tu KH, Chen JJ, Lee TH, Hsu HH, Tian YC, Chang CH. Advanced Chronic Kidney Disease with Low and Very Low GFR: Can a Low-Protein Diet Supplemented with Ketoanalogues Delay Dialysis? Nutrients 2020; 12:nu12113358. [PMID: 33142717 PMCID: PMC7694025 DOI: 10.3390/nu12113358] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/25/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous studies have demonstrated that dietary therapy can delay the initiation of dialysis, but little research has investigated whether patients with very poor renal function would benefit from a dietary therapy. METHODS This study was performed by using the Chang Gung Research Database (CGRD), which is based on the largest medical system in Taiwan. Patients with estimated glomerular filtration rates (eGFR) < 15 mL/min/1.73 m2 between 2001 and 2015 with more than 3 months of low-protein diet supplemented with ketoanalogues (sLPD) were extracted (Ketosteril group). We then assigned five patients without any sLPD to match one patient of the Ketosteril group (comparison group). Both groups were followed up for 1 year for the initiation of dialysis and rates of major adverse cardiac and cerebrovascular events (MACCEs). RESULTS The Ketosteril group (n = 547), compared with the comparison group (n = 2735), exhibited a lower incidence of new-onset dialysis (40.2% vs. 44.4%, subdistribution hazard ratio (SHR): 0.80, 95% confidence interval (CI): 0.70-0.91) and MACCEs (3.7% vs. 5.9%, HR: 0.61, 95% CI: 0.38-0.97). The beneficial effect of an sLPD did not differ in patients with a baseline eGFR < 5 mL/min/1.73 m2. CONCLUSION Even among patients with extremely low eGFR, sLPD treatment can safely delay the need for dialysis.
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Affiliation(s)
- Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Kun-Hua Tu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Tao-Han Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Hsiang-Hao Hsu
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Ya-Chun Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33341, Taiwan; (C.-L.Y.); (P.-C.F.); (C.-C.L.); (G.K.); (K.-H.T.); (J.-J.C.); (T.-H.L.); (H.-H.H.); (Y.-C.T.)
- College of Medicine, Chang Gung University, Taoyuan 33341, Taiwan
- Correspondence: or ; Tel.: +886-3-3281200 (ext. 8181) or +0033669733371
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Kosaka S, Ohara Y, Naito S, Iimori S, Kado H, Hatta T, Yanishi M, Uchida S, Tanaka M. Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2020; 21:357. [PMID: 32819288 PMCID: PMC7441609 DOI: 10.1186/s12882-020-02019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3–5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47–0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.
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Affiliation(s)
- Shiho Kosaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroshi Kado
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Tsuguru Hatta
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Masaaki Yanishi
- Kansai Medical University, 2-3-1 Shinmachi, Hirakata-city, Osaka, 573-1191, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Makoto Tanaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Kamimura MA, Nerbass FB. Nutritional assessment in chronic kidney disease: the protagonism of longitudinal measurement. ACTA ACUST UNITED AC 2020; 42:4-5. [PMID: 32227070 PMCID: PMC7213931 DOI: 10.1590/2175-8239-jbn-2020-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/31/2020] [Indexed: 11/24/2022]
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18
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Association between Albumin-Globulin Ratio and Mortality in Patients with Chronic Kidney Disease. J Clin Med 2019; 8:jcm8111991. [PMID: 31731708 PMCID: PMC6912628 DOI: 10.3390/jcm8111991] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/02/2019] [Accepted: 11/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Malnutrition and inflammation are highly prevalent and tightly regulated with each other in chronic kidney disease (CKD) patients. Inflammation can lead to malnutrition in patients with sufficient nourishment, while malnutrition may also induce an inflammatory response. This study investigated whether the albumin-globulin ratio (AGR) can predict the mortality risk in CKD patients. Methods: We enrolled 956 stage 3–5 CKD patients retrospectively at a medical center. Patients’ baseline characteristics including demographics, laboratory data, pharmacotherapy, and comorbidities were collected for statistical adjustments. The study patients were stratified into three AGR groups according to similar magnitudes of hazards for mortality as follows: low AGR group, AGR ≤ 1.0; moderate AGR group, 1.1 ≤ AGR < 1.3; high AGR group, AGR ≥1.3. Multivariate Cox proportional hazard analysis was performed to evaluate the association of the AGR with the study outcomes, including overall and cardiovascular disease (CVD) mortality. Results: During a median follow-up duration of 2.44 years, 108 (11.3%) deaths were recorded and 50 patients died from CVD. In adjusted model 1, the moderate AGR group was associated with hazard ratios (HR) of 0.57 (95% CI = 0.36–0.90, p = 0.016) and 0.52 (95% CI = 0.28–0.98, p = 0.043) for all-cause and CVD mortality compared with the low AGR group, respectively. The high AGR group was associated with HRs of 0.49 (95% CI = 0.27–0.90, p = 0.021) and 0.27 (95% CI = 0.1–0.74, p = 0.01) for all-cause and CVD mortality compared with the low AGR group, respectively. Similar results were obtained in the adjusted model 2 (inverse probability of the group weighted Cox model). In addition, the association between the AGR and mortality risk remained significant when the AGR was treated as a continuous variable. Conclusion: AGR is a significant biomarker predicting overall and cardiovascular mortality risk independent of various important factors amongst stage 3–5 CKD patients. We suggest that the AGR may be a simple and inexpensive measurement for detecting CKD patients at risk of mortality.
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Mckeaveney C, Noble H, de Barbieri I, Strini V, Maxwell AP, Reid J. Awareness, Understanding and Treatment Practices when Managing Cachexia in End-Stage Kidney Disease. J Ren Care 2019; 46:35-44. [PMID: 31642200 DOI: 10.1111/jorc.12301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cachexia is a wasting syndrome found within a range of chronic illnesses/life-limiting conditions, however awareness and understanding of cachexia amongst renal Health Care Professionals has not been investigated. OBJECTIVES To ascertain the awareness, understanding and treatment practices of Health Care Professionals who provide care for people with cachexia and end-stage renal disease. METHODS Health Care Professionals were recruited via the European Dialysis and Transplant Nurses Association/European Renal Care Association in September 2018. This was an exploratory study using a mixed-methods approach with those who provide care for patients with end-stage renal disease and cachexia. An online survey and two focus groups were conducted. Descriptive statistics and inductive thematic analysis were used to explore current knowledge and practices in renal cachexia. RESULTS A total of 93 participants from 30 countries completed the online survey. Twelve Health Care Professionals agreed to participate in the focus groups. Reduced appetite, weight loss and muscle loss in relation to cachexia were accurately described, but the percentage of weight loss was unknown. The importance of multi-professional collaboration was recognised, however, the current management of cachexia was wide-ranging. Quality of life, patient-clinician communication and specialist support for carers were regarded as vital. CONCLUSION Timely identification and management of cachexia are needed to improve the quality of life for patients and appropriately support families. In order for these goals to be achieved, there is a need to increase awareness and understanding of cachexia amongst renal nurses.
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Affiliation(s)
- Clare Mckeaveney
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | - Ilaria de Barbieri
- Healthcare Profession Department, Padua University Hospital, Padova, Italy
| | - Veronica Strini
- Clinical Research Unit, Padua University Hospital, Padova, Italy
| | - Alexander P Maxwell
- Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.,Centre for Public Health, Queens University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
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20
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Byham-Gray LD, Peters EN, Rothpletz-Puglia P. Patient-Centered Model for Protein-Energy Wasting: Stakeholder Deliberative Panels. J Ren Nutr 2019; 30:137-144. [PMID: 31447304 DOI: 10.1053/j.jrn.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Integrating the patient's voice into research prioritization is essential for solving problems that patients care the most about in terms of health, symptom management, and survival. We used deliberative processes for adapting the existing model of protein-energy wasting (PEW) to one that includes stakeholder priorities, addressing gaps from the initial concept. DESIGN AND METHODS From September 2015- to December 2017, two diverse, deliberative panels of stakeholders (one for patients and one for clinicians) were recruited from local communities and national networks and met four times to provide an insight into developing a patient-centered model for PEW. After each stakeholder meeting, the research team added the factors and outcomes that reached consensus, using a content analysis. The stakeholder members were then able to confirm what had been collected from an earlier panel discussion and offer additional feedback. The final model was approved by stakeholders. RESULTS There were eight patient and twelve clinician stakeholders who participated in the panels. Factors and outcomes were only added or modified to the existing model, but none were deleted from the original PEW model. Critical factors identified by the stakeholders were ones related to lifestyle, treatment, and psychosocial aspects. The most important outcomes selected by stakeholders were living longer, staying out of the hospital, and being able to do more. CONCLUSIONS The approved patient-centered model for PEW represents a testable model for researchers which incorporates the patient's voice. Garnering this insight should assist in the prioritization of projects for a maximal value to patients and their families by future investigators.
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Affiliation(s)
- Laura D Byham-Gray
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey.
| | - Emily N Peters
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey
| | - Pamela Rothpletz-Puglia
- Department of Clinical and Preventive Nutrition Sciences, Rutgers University, School of Health Professions, Newark, New Jersey
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21
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Messenger S, Bainbridge L, DaSilva L. Renal Dietitians' Perceptions of the Value of Subjective Global Assessment: A Mixed Methods Study. J Ren Nutr 2019; 30:e5-e13. [PMID: 31248658 DOI: 10.1053/j.jrn.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease. DESIGN AND METHODS A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients. RESULTS Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results. CONCLUSION The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate.
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Affiliation(s)
- Shelly Messenger
- Clinical Dietitian, Fraser Health Authority, Abbotsford, BC, Canada.
| | - Lesley Bainbridge
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liz DaSilva
- Research Dietitian, Fraser Health Authority, Surrey, BC, Canada
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Willingham FC, Speelman I, Hamilton J, von Fragstein G, Shaw S, Taal MW. Feasibility and effectiveness of pre-emptive rehabilitation in persons approaching dialysis (PREHAB). J Ren Care 2019; 45:9-19. [DOI: 10.1111/jorc.12262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Fiona C. Willingham
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine; School of Medicine, University of Nottingham; Nottingham UK
| | - Irene Speelman
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
| | - Joanne Hamilton
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
| | - Gillian von Fragstein
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
| | - Susan Shaw
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
| | - Maarten W. Taal
- Department of Renal Medicine; Derby Teaching Hospitals NHS Foundation Trust; Derby UK
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine; School of Medicine, University of Nottingham; Nottingham UK
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Carrero JJ, Thomas F, Nagy K, Arogundade F, Avesani CM, Chan M, Chmielewski M, Cordeiro AC, Espinosa-Cuevas A, Fiaccadori E, Guebre-Egziabher F, Hand RK, Hung AM, Ikizler TA, Johansson LR, Kalantar-Zadeh K, Karupaiah T, Lindholm B, Marckmann P, Mafra D, Parekh RS, Park J, Russo S, Saxena A, Sezer S, Teta D, Ter Wee PM, Verseput C, Wang AY, Xu H, Lu Y, Molnar MZ, Kovesdy CP. Global Prevalence of Protein-Energy Wasting in Kidney Disease: A Meta-analysis of Contemporary Observational Studies From the International Society of Renal Nutrition and Metabolism. J Ren Nutr 2018; 28:380-392. [DOI: 10.1053/j.jrn.2018.08.006] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 01/09/2023] Open
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Murtas S, Aquilani R, Deiana ML, Iadarola P, Secci R, Cadeddu M, Salis S, Serpi D, Bolasco P. Differences in Amino Acid Loss Between High-Efficiency Hemodialysis and Postdilution and Predilution Hemodiafiltration Using High Convection Volume Exchange-A New Metabolic Scenario? A Pilot Study. J Ren Nutr 2018; 29:126-135. [PMID: 30341035 DOI: 10.1053/j.jrn.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE The objective of the study was to quantify the loss of total amino acids (TAAs), nonessential amino acids, essential amino acids, and branched chain amino acids (BCAAs) produced by high-efficiency hemodialysis (HEHD), postdilution hemodiafiltration (HDFpost), and predilution hemodiafiltration (HDFpre) using high ultrafiltration volumes; and to define the specific AA losses registered in HEHD, HDFpost, and HDFpre; to identify a potential metabolic and nutritional decline into protein energy wasting; to compare AA analysis of arterial blood samples taken from healthy controls and patients with end-stage renal disease undergoing hemodialysis. DESIGN AND METHODS Identical dialysis monitors, membranes, and dialysate/infusate were used to homogenize extracorporeal body influence. Ten patients were recruited and randomized to receive treatment with HEHD, HDFpost, and HDFpre it was used on-line dialytic water methodologies (OL); patients' AA arterial concentrations were measured at the start and on completion of dialysis; TAA from the dialyzer filter was calculated, and baseline levels were subsequently compared with findings obtained 1 year later. Finally, the results obtained were compared with the data from a study of 8 healthy volunteers conducted using bioimpedance analysis and laboratory blood tests to assess nutritional status. RESULTS A higher convective dose results in a higher weekly loss of TAA, nonessential AAs, essential AAs, and BCAAs (HEHD: 15.7 g; HDFpost-OL: 16.1 g; HDFpre-OL: 16.3 g, P < .01). After 12 months, the same hemodialys patients showed a reduced body and water intracellular mass and reduced phase angle. Arterial concentrations of TAAs and BCAAs were lower than those detected in healthy subjects (P < .01). CONCLUSION The study shows that the AA losses in dialytic liquid are greater after high exchange volume HDF techniques, especially HDFpre. The AA losses are not metabolically compensated, so these increase the derangements of predialytic arterial plasma AA levels. Both AA losses and arterial AA perturbations further worsened body composition already after 12 months of additional dialysis.
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Affiliation(s)
- Stefano Murtas
- Territorial Department of Nephrology and Dialysis, ASSL Cagliari, Cagliari, Italy; Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Roberto Aquilani
- Territorial Department of Nephrology and Dialysis, ASSL Cagliari, Cagliari, Italy; Department of Biology and Biotechnology, University of Pavia, Pavia, Italy
| | - Maria Luisa Deiana
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Paolo Iadarola
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Romina Secci
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Mariella Cadeddu
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Stefano Salis
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Doriana Serpi
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy
| | - Piergiorgio Bolasco
- Former Director of Territorial, Department of Nephrology and Dialysis, ASL Cagliari, Cagliari, Italy; Member of Italian Society of Nephrology, Cagliari, Italy.
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Barril G, Nogueira A, Ruperto López M, Castro Y, Sánchez-Tomero JA. Influence of dietary protein intake on body composition in chronic kidney disease patients in stages 3-5: A cross-sectional study. Nefrologia 2018; 38:647-654. [PMID: 30293714 DOI: 10.1016/j.nefro.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION A controlled protein intake has shown beneficial effects to preserve renal function and nutritional status in chronic kidney disease (CKD) patients. This study aimed to analyze usual dietary protein intake and its potential contribution to body composition in CKD patients in stages 3-5. METHOD Cross-sectional study in 134 CKD patients in stages 3-5 (mean e-GFR: 19.4±8.7ml/min/1.73m2; males 68.7% and primary CKD etiology was diabetes mellitus, 35.8%). Demographic, clinical and nutritional parameters were evaluated. Normalized protein nitrogen appearance (nPNA), was used as a surrogate marker of dietary protein intake. The sample was classified into three nPNA groups (Gn): G1: <0.8g/kg/day; G2: 0.8-1g/kg/day and, G3: ≥1g/kg/day. Assessment of nutritional status using the malnutrition-inflammation score (MIS), anthropometric measures and laboratory parameters. Analysis of body composition and hydration status by bioelectrical impedance analysis (BIVA-101-RJL system). Statistical analysis by SPSS v.20. RESULTS Overall mean nPNA values were 0.91±0.23g of protein/kg BW/day and only 32.1% had a dietary protein intake <0.8g of protein/kg BW/day. Most of the CKD patients (65.5%) were in stages 4 or 5. Prevalence of protein-energy-wasting (PEW) syndrome measured by MIS was 15%. By analyzing differences between nPNA groups, body weight (BW), BMI and triceps-skinfold (TSF) thickness were significantly higher in the group with nPNA ≥1g/kg BW/day (G3), whereas a significant inverse relationship was found with the percentages of body cell mass (BCM%), fat-free mass (FFM%), muscle mass (MM%) and phase angle (PA) in the group with the lowest nPNA (G1). Analysis of gender among subjects showed significant differences with BW, FFM%, TSF and mid-arm muscle circumference (MAMC%). Linear regression analysis showed that resistance, BCM%, MM%, and serum albumin were significant predictors of nPNA as a surrogate marker of daily protein intake (R=0.51; R2=0.29; R2 adjusted=0.23; p<0.001). CONCLUSION Controlled protein intake is one of the cornerstones of treatment in CKD patients. A low protein intake in patients with CKD stages 3 and 4-5 was associated with loss of muscle mass in the advanced-CKD unit. The loss of muscle mass appears as an early indicator of nutritional comprised. Factors such, elderly age and loss of eGFR, showed lower protein intake and were associated with muscle loss, especially in women. Further longitudinal studies are required to evaluate the contribution of different protein intakes to uremic symptoms, nutritional status, body composition and CKD progression.
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Affiliation(s)
- Guillermina Barril
- Department of Nephrology, Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, C/ Diego de León n° 62, 28006 Madrid, Spain.
| | - Angel Nogueira
- Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, C/ Diego de León n° 62, 28006 Madrid, Spain
| | - Mar Ruperto López
- Human Nutrition and Dietetics Department, Faculty of Health Sciences, Universidad Alfonso X el Sabio, Avda. Universidad s/n, 28691 Villanueva de la Cañada, Madrid, Spain
| | - Yone Castro
- Orientation Department, Area of Investigation, Prodis Foundation, C/ Bulevar Indalecio Prieto 2, 28032 Madrid, Spain
| | - José Antonio Sánchez-Tomero
- Department of Nephrology, Advanced-chronic Kidney Disease Unit, Hospital Universitario de la Princesa, 28006 Madrid, Spain
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Does a Supplemental Low-Protein Diet Decrease Mortality and Adverse Events After Commencing Dialysis? A Nationwide Cohort Study. Nutrients 2018; 10:nu10081035. [PMID: 30096785 PMCID: PMC6115816 DOI: 10.3390/nu10081035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 12/20/2022] Open
Abstract
Background: A beneficial effect of a ketoanalogue-supplemented low-protein diet (sLPD) in postponing dialysis has been demonstrated in numerous previous studies. However, evidence regarding its effect on long-term survival is limited. Our study assessed the long-term outcomes of patients on an sLPD after commencing dialysis. Methods: This retrospective study examined patients with new-onset end-stage renal disease with permanent dialysis between 2001 and 2013, extracted from Taiwan’s National Health Insurance Research Database. Patients who received more than 3 months of sLPD treatment in the year preceding the start of dialysis were extracted. The outcomes studied were all-cause mortality, infection rate, and major cardiac and cerebrovascular events (MACCEs). Results: After propensity score matching, the sLPD group (n = 2607) showed a lower risk of all-cause mortality (23.1% vs. 27.6%, hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.70–0.84), MACCEs (19.2% vs. 21.5%, HR 0.86, 95% CI 0.78–0.94), and infection-related death (9.9% vs. 12.5%, HR 0.76, 95% CI 0.67–0.87) than the non-sLPD group did. Conclusion: We found that sLPD treatment might be safe without long-term negative consequences after dialysis treatment.
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Windahl K, Faxén Irving G, Almquist T, Lidén MK, van de Luijtgaarden M, Chesnaye NC, Voskamp P, Stenvinkel P, Klinger M, Szymczak M, Torino C, Postorini M, Drechsler C, Caskey FJ, Wanner C, Dekker FW, Jager KJ, Evans M. Prevalence and Risk of Protein-Energy Wasting Assessed by Subjective Global Assessment in Older Adults With Advanced Chronic Kidney Disease: Results From the EQUAL Study. J Ren Nutr 2018; 28:165-174. [PMID: 29459026 DOI: 10.1053/j.jrn.2017.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Prevalence and risk factors for protein-energy wasting (PEW) are poorly studied in the nondialysis, older population with advanced chronic kidney disease (CKD). Our aim was to evaluate the prevalence of PEW in advanced stage CKD patients aged greater than 65 years. Furthermore, we aimed to describe risk factors for PEW in the overall study population and among obese individuals. DESIGN Prospective observational cohort study. METHODS The EQUAL study, a European Quality Study on treatment in advanced chronic kidney disease, is a multicenter prospective observational cohort study in six European countries. We included patients aged ≥65 years with incident glomerular filtration rate <20mL/min/1.73m2 not on dialysis attending nephrology care. PEW was assessed by 7-point Subjective Global Assessment (7-p SGA). RESULTS In general, the study cohort (n = 1,334) was overweight (mean body mass index [BMI] 28.4 kg/m2). The majority of the patients had a normal nutritional status (SGA 6-7), 26% had moderate PEW (SGA 3-5), and less than 1% had severe PEW (SGA 1-2). Muscle wasting and loss of fat tissue were the most frequent alterations according to the SGA subscales, especially in those aged >80 years. The prevalence of PEW was higher among women, increased with age, and was higher in those with depression/dementia. PEW was the most common in those with underweight (BMI <22 kg/m2), 55% or normal weight (BMI 22-25 kg/m2), 40%. In obese individuals (BMI >30 kg/m2), 25% were diagnosed with protein wasting. Risk factors for SGA ≤5 in obese people were similar to those for the overall study population. CONCLUSION This European multicenter study shows that the prevalence of PEW is high in patients with advanced CKD aged >65 years. The risk of PEW increases substantially with age and is commonly characterized by muscle wasting. Our study suggests that focus on nutrition should start early in the follow-up of older adults with CKD.
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Affiliation(s)
- Karin Windahl
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Nutrition and Dietetics, Department of Orthopaedics, Danderyds Hospital, Stockholm, Sweden
| | - Gerd Faxén Irving
- Division of Clinical Geriatrics, Department of NVS, Karolinska Institutet, Stockholm, Sweden; Division of Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Tora Almquist
- Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - Maarit Korkeila Lidén
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Moniek van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Pauline Voskamp
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leidenthe, The Netherlands
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Claudia Torino
- Nephrology, Dialysis and Transplantation Unit and CNR-IFC Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Maurizio Postorini
- Nephrology, Dialysis and Transplantation Unit and CNR-IFC Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Christiane Drechsler
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Fergus J Caskey
- United Kingdom Renal Registry (UKRR), Southmead Hospital, Bristol, United Kingdom; Division of Population Health Sciences, Department of Medical School, University of Bristol, Bristol, United Kingdom
| | - Christoph Wanner
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leidenthe, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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Reid J, Noble HR, Adamson G, Davenport A, Farrington K, Fouque D, Kalantar-Zadeh K, Mallett J, McKeaveney C, Porter S, Seres DS, Shields J, Slee A, Witham MD, Maxwell AP. Establishing a clinical phenotype for cachexia in end stage kidney disease - study protocol. BMC Nephrol 2018; 19:38. [PMID: 29439674 PMCID: PMC5812213 DOI: 10.1186/s12882-018-0819-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 01/17/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Surveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD. METHODS A longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia. DISCUSSION Cachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education.
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Affiliation(s)
- Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast Medical Biology Centre, 97 Lisburn Rd, Belfast, BT9 7BL, UK.
| | - Helen R Noble
- School of Nursing and Midwifery, Queen's University Belfast Medical Biology Centre, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - Gary Adamson
- School of Psychology, Ulster University Magee Campus, Londonderry, BT48 7JL, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, Pond Street, London, NW3 2QG, UK
| | - Ken Farrington
- East and North Hertfordshire University NHS Trust, Lister Hospital, Coreys Mill Lane, Stevenage, SG1 4AB, UK
| | - Denis Fouque
- Department of Nephrology, Université de Lyon, UCBL, Carmen, Centre Hospitalier Lyon Sud, F-69495, Pierre-Bénite, France
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, Pediatrics and Public Health, University of California, Los Angeles, USA
| | - John Mallett
- School of Psychology, Ulster University Magee Campus, Londonderry, BT48 7JL, UK
| | - C McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast Medical Biology Centre, 97 Lisburn Rd, Belfast, BT9 7BL, UK
| | - S Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - David S Seres
- Columbia University Medical Centre, NY Presbyterian Hospital, New York, USA
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK
| | - Adrian Slee
- UCL, Faculty of Medical Sciences, Gower St, Bloomsbury, London, WC1E 6BT, UK
| | - Miles D Witham
- School of Medicine, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Alexander P Maxwell
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast and Regional Nephrology Unit, Belfast City Hospital, Belfast HSC Trust, Belfast, UK
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Dai L, Mukai H, Lindholm B, Heimbürger O, Barany P, Stenvinkel P, Qureshi AR. Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLoS One 2017; 12:e0186659. [PMID: 29211778 PMCID: PMC5718431 DOI: 10.1371/journal.pone.0186659] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 09/18/2017] [Indexed: 12/14/2022] Open
Abstract
Background The value of subjective global assessment (SGA) as nutritional assessor of protein-energy wasting (PEWSGA) in chronic kidney disease (CKD) patients depends on its mortality predictive capacity. We investigated associations of PEWSGA with markers of nutritional status and all-cause mortality in CKD patients. Methods In 1031 (732 CKD1-5 non-dialysis and 299 dialysis) patients, SGA and body (BMI), lean (LBMI) and fat (FBMI) body mass indices, % handgrip strength (% HGS), serum albumin, and high sensitivity C-reactive protein (hsCRP) were examined at baseline. The five-year all-cause mortality predictive strength of baseline PEWSGA and during follow-up were investigated. Results PEWSGA was present in 2% of CKD1-2, 16% of CKD3-4, 31% of CKD5 non-dialysis and 44% of dialysis patients. Patients with PEWSGA (n = 320; 31%) had higher hsCRP and lower BMI, LBMI, FBMI, %HGS and serum albumin. But, using receiver operating characteristics-derived cutoffs, these markers could not classify (by kappa statistic) or explain variations of (by multinomial logistic regression analysis) presence of PEWSGA. In generalized linear models, SGA independently predicted mortality after adjustments of multiple confounders (RR: 1.17; 95% CI: 1.11–1.23). Among 323 CKD5 patients who were re-assessed after median 12.6 months, 222 (69%) remained well-nourished, 37 (11%) developed PEWSGA de novo, 40 (12%) improved while 24 (8%) remained with PEWSGA. The latter independently predicted mortality (RR: 1.29; 95% CI: 1.13–1.46). Conclusions SGA, a valid assessor of nutritional status, is an independent predictor of all-cause mortality both in CKD non-dialysis and dialysis patients that outperforms non-composite nutritional markers as prognosticator.
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Affiliation(s)
- Lu Dai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Renal Department, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hideyuki Mukai
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Barany
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Abdul Rashid Qureshi
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
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Pérez-Torres A, González Garcia ME, San José-Valiente B, Bajo Rubio MA, Celadilla Diez O, López-Sobaler AM, Selgas R. Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics. Nefrologia 2017; 38:141-151. [PMID: 28755901 DOI: 10.1016/j.nefro.2017.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. OBJECTIVE To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). PATIENTS AND METHODS Cross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. RESULTS The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084-1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893-0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998-0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992-0.998). CONCLUSION Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.
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Affiliation(s)
| | | | | | | | - Olga Celadilla Diez
- Servicio de Nefrología, Hospital Universitario La Paz. IdiPAZ, Madrid, España
| | - Ana M López-Sobaler
- Departamento de Nutrición y Bromatología I, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, España
| | - Rafael Selgas
- Servicio de Nefrología, Hospital Universitario La Paz. IdiPAZ, Madrid, España
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Total kidney and liver volume is a major risk factor for malnutrition in ambulatory patients with autosomal dominant polycystic kidney disease. BMC Nephrol 2017; 18:22. [PMID: 28088190 PMCID: PMC5237538 DOI: 10.1186/s12882-016-0434-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 12/28/2016] [Indexed: 01/29/2023] Open
Abstract
Background In patients with autosomal dominant polycystic kidney disease (ADPKD), malnutrition may develop as renal function declines and the abdominal organs become enlarged. We investigated the relationship of intra-abdominal mass with nutritional status. Methods This cross-sectional study was performed at a tertiary hospital outpatient clinic. Anthropometric and laboratory data including serum creatinine, albumin, and cholesterol were collected, and kidney and liver volumes were measured. Total kidney and liver volume was defined as the sum of the kidney and liver volumes and adjusted by height (htTKLV). Nutritional status was evaluated by using modified subjective global assessment (SGA). Results In a total of 288 patients (47.9% female), the mean age was 48.3 ± 12.2 years and the mean estimated glomerular filtration rate (eGFR) was 65.3 ± 25.3 mL/min/1.73 m2. Of these patients, 21 (7.3%) were mildly to moderately malnourished (SGA score of 4 and 5) and 63 (21.7%) were at risk of malnutrition (SGA score of 6). Overall, patients with or at risk of malnutrition were older, had a lower body mass index, lower hemoglobin levels, and poorer renal function compared to the well-nourished group. However, statistically significant differences in these parameters were not observed in female patients, except for eGFR. In contrast, a higher htTKLV correlated with a lower SGA score, even in subjects with an eGFR ≥45 mL/min/1.73 m2. Subjects with an htTKLV ≥2340 mL/m showed an 8.7-fold higher risk of malnutrition, after adjusting for age, hemoglobin, and eGFR. Conclusions Nutritional risk was detected in 30% of ambulatory ADPKD patients with relatively good renal function. Intra-abdominal organomegaly was related to nutritional status independently from renal function deterioration. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0434-0) contains supplementary material, which is available to authorized users.
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Barreto Silva MI, Cavalieri VVDS, Lemos CCDS, Klein MRST, Bregman R. Body adiposity predictors of vitamin D status in nondialyzed patients with chronic kidney disease: A cross-sectional analysis in a tropical climate city. Nutrition 2017; 33:240-247. [DOI: 10.1016/j.nut.2016.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/16/2016] [Accepted: 06/16/2016] [Indexed: 01/27/2023]
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Santin FGDO, Bigogno FG, Dias Rodrigues JC, Cuppari L, Avesani CM. Concurrent and Predictive Validity of Composite Methods to Assess Nutritional Status in Older Adults on Hemodialysis. J Ren Nutr 2016; 26:18-25. [DOI: 10.1053/j.jrn.2015.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 01/02/2023] Open
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Reid J, Noble H, Davenport A, Farrington K, Fouque D, Porter S, Seres D, Shields J, Slee A, Witham MD, Wright M, Maxwell AP. DEFINING CACHEXIA IN A RENAL POPULATION. J Ren Care 2015; 41:79-80. [DOI: 10.1111/jorc.12129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Comparison of the malnutrition–inflammation score in chronic kidney disease patients and kidney transplant recipients. Int Urol Nephrol 2015; 47:1025-33. [DOI: 10.1007/s11255-015-0984-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/13/2015] [Indexed: 01/02/2023]
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Amparo FC, Kamimura MA, Molnar MZ, Cuppari L, Lindholm B, Amodeo C, Carrero JJ, Cordeiro AC. Diagnostic validation and prognostic significance of the Malnutrition-Inflammation Score in nondialyzed chronic kidney disease patients. Nephrol Dial Transplant 2014; 30:821-8. [PMID: 25523451 DOI: 10.1093/ndt/gfu380] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 11/19/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Malnutrition and inflammation are highly prevalent and intimately linked conditions in chronic kidney disease (CKD) patients that lead to a state of protein-energy wasting (PEW), the severity of which can be assessed by the Malnutrition-Inflammation Score (MIS). Here, we applied MIS and validated, for the first time, its ability to grade PEW and predict mortality in nondialyzed CKD patients. METHODS We cross-sectionally evaluated 300 CKD stages 3-5 patients [median age 61 (53-68) years; estimated glomerular filtration rate 18 (12-27) mL/min/1.73 m(2); 63% men] referred for the first time to our center. Patients were followed during a median 30 (18-37) months for all-cause mortality. RESULTS A worsening in MIS scale was associated with inflammatory biomarkers increase (i.e. alpha-1 acid glycoprotein, fibrinogen, ferritin and C-reactive protein) as well as a progressive deterioration in various MIS-independent indicators of nutritional status based on anthropometrics, dynamometry, urea kinetics and bioelectric impedance analysis. A structural equation model with two latent variables (assessing simultaneously malnutrition and inflammation factors) demonstrated good fit to the observed data. During a follow-up, 71 deaths were recorded; patients with higher MIS were at increased mortality risk in both crude and adjusted Cox models. CONCLUSIONS MIS appears to be a useful tool to assess PEW in nondialyzed CKD patients. In addition, MIS identified patients at increased mortality risk.
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Affiliation(s)
- Fernanda C Amparo
- Department of Nutrition, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Maria A Kamimura
- Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Miklos Z Molnar
- Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lilian Cuppari
- Nutrition Program, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | - Bengt Lindholm
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Celso Amodeo
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
| | - Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonio C Cordeiro
- Department of Hypertension and Nephrology, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
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Affiliation(s)
- Juan Jesús Carrero
- Division of Renal Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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