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Kim M, Park YW, Im DW, Jeong Y, Noh HJ, Yang SJ, Kang E, Ryu H, Kim J, Koo JR, Na KR, Seong EY, Oh KH. Association of Handgrip Strength and Nutritional Status in Non-Dialysis-Dependent Chronic Kidney Disease Patients: Results from the KNOW-CKD Study. Nutrients 2024; 16:2442. [PMID: 39125323 PMCID: PMC11314453 DOI: 10.3390/nu16152442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Handgrip strength (HGS) is suggested as an indirect assessment of nutritional status in chronic kidney disease (CKD) patients, but evidence is limited for non-dialysis-dependent CKD (NDD-CKD) patients. This cross-sectional study included 404 patients from the Phase II KoreaN Cohort Study for Outcome in Patients With CKD. HGS, measured twice in each hand, was the exposure, and malnutrition status was defined by a malnutrition-inflammation score (MIS) of 6 or higher. A logistic regression analysis adjusted for age, sex, diabetes mellitus (DM), hypertension, CKD stages, smoking, overhydration, education, and income status was used to assess malnutrition risk. The predictability of HGS for malnutrition was evaluated using the area under the curve (AUC). Patients with lower HGS were older, had a higher prevalence of DM, and lower estimated glomerular filtration rate. Higher HGS was significantly associated with lower malnutrition risk after adjustment (per 1 standard deviation increase, adjusted odds ratio, 0.47 [0.30-0.75]). Subgroup analyses showed no significant interaction between HGS and malnutrition risk across age, sex, DM, and CKD stage. HGS showed fair predictability for malnutrition in men (AUC 0.64 [0.46-0.83]) and women (AUC 0.71 [0.55-0.86]). In conclusion, HGS is a useful diagnostic indicator of malnutrition in NDD-CKD patients.
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Grants
- 2011E3300300, 2012E3301100, 2013E3301600, 2013E3301601, 2013E3301602, 2016E3300200, 2016E3300201, 2016E3300202, 2019E320100, 2019E320101, 2019E320102, 2022-11-007 Korea Disease Control and Prevention Agency
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Affiliation(s)
- Minsang Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.K.); (Y.-W.P.); (E.K.); (H.R.)
| | - Yeong-Won Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.K.); (Y.-W.P.); (E.K.); (H.R.)
| | - Dha Woon Im
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Uijeongbu 11759, Republic of Korea;
| | - Yujin Jeong
- Department of Biostatistics, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Hyo Jin Noh
- Department of Food and Nutrition, Seoul Women’s University, Seoul 01797, Republic of Korea; (H.J.N.); (S.J.Y.)
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women’s University, Seoul 01797, Republic of Korea; (H.J.N.); (S.J.Y.)
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.K.); (Y.-W.P.); (E.K.); (H.R.)
- Department of Transplantation Center, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.K.); (Y.-W.P.); (E.K.); (H.R.)
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul 03080, Republic of Korea;
| | - Ja-Ryong Koo
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
| | - Eun Young Seong
- Department of Internal Medicine & Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea;
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (M.K.); (Y.-W.P.); (E.K.); (H.R.)
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea
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de Waal D, Onuigbo M, Golper TA. Case Study: The Weighty Issue of Treatment Options for Obese Dialysis Patients. J Ren Nutr 2024:S1051-2276(24)00065-7. [PMID: 38685393 DOI: 10.1053/j.jrn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024] Open
Abstract
Obesity is a complex chronic disease and common comorbidity in kidney failure and is the leading causes of death and disability in this population. Guidelines do not specifically address the preferred weight management option(s) for obesity while on dialysis. Large body size is a limiting factor for consideration of a kidney transplantation. We report on a successful bariatric surgery with a young adult after 5.5 years on dialysis with hope for a future transplant. Success was demonstrated with progressive weight loss without adverse changes in renal clinical markers accompanied by improvements in exercise tolerance and health status thereby improving her suitability for a kidney transplant. Further studies and guidelines are needed to address weight loss options for those with obesity on dialysis and want to lose weight.
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Affiliation(s)
- Desiree de Waal
- Nephrology Services, University of Vermont Medical Center, Nephrology, Burlington, VT.
| | - Macaulay Onuigbo
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
| | - Thomas Alan Golper
- Division of Nephrology, Department of Medicine, University of Vermont Medical Center, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT
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Ibrahim AH, Kasim SA, Ezzat AA, Ibrahim NE, Hassan DA, Ibrahim AS, Abouelgreed TA, Abdo EM, Aboelsoud NM, Abdelmonem NM, Alnajem MT, Aboomar AA. Relation between myostatin levels and malnutrition and muscle wasting in hemodialysis patients. Arch Ital Urol Androl 2023; 95:11869. [PMID: 38117215 DOI: 10.4081/aiua.2023.11869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND AIM Malnutrition is one of the most troublesome comorbidities among hemodialysis patients (HD). Myostatin (MSTN) belongs to the transforming growth factor-β superfamily. In HD patients, MSTN effects are not limited to skeletal muscle growth. The present study aimed to assess MSTN levels in HD patients and its relation to various clinical and biochemical parameters. PATIENTS AND METHODS The present case control study included 60 patients on HD for at least three years. In addition, there were age and sex-matched healthy subjects who constitutes the control group. Nutritional status was evaluated using the malnutrition inflammation score (MIS). Muscle wasting in the present study was evaluated using the lean tissue index (LTI) as assessed by the body composition monitor (BCM). Rectus Femoris Muscle (RFM) thickness was also measured as indicator for nutritional status of patient. RESULTS The present study included 60 HD patients, and ageand sex-matched healthy controls. Patients expressed significantly higher myostatin levels when compared to controls [median (IQR): 221.3 (153.5-688.2) versus 144.8 (97.0-281.7), p < 0.001]. According to MIS, patients were classified into those with no/mild malnutrition (n = 22) and others with moderate/severe malnutrition (n = 38). Comparison between the two subgroups revealed that the former group had significantly lower myostatin levels [167.7 (150.3-236.3) versus 341.7 (160.9-955.9), p = 0.004]. According to LTI, patients were classified into those with muscle wasting (n = 23) and others without muscle wasting (n = 37). Comparative analysis showed that patients in the former group had significantly higher myostatin levels [775.1 (325.1-2133.7) versus 161.8 (142.6-302.3), p < 0.001]. CONCLUSIONS Myostatin seems to be a promising marker for identification of malnutrition and muscle wasting in HD patients.
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Affiliation(s)
- Amal H Ibrahim
- Department of Internal Medicine, Nephrology Unit, Al-Azhar University, Cairo.
| | - Sammar A Kasim
- Department of Internal Medicine, Nephrology Unit, Al-Azhar University, Cairo.
| | - Alshimaa A Ezzat
- Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Noha E Ibrahim
- Department of Microbial Biotechnology, Biotechnology Research Institute, National Research Centre (NRC), Giza.
| | - Donia A Hassan
- Department of Clinical Pathology, Al-Azhar University, Cairo.
| | - Amira Sh Ibrahim
- Department of Rheumatology and Rehabilitation, Faculty of Medicine for girls, Al-Azhar University, Cairo.
| | | | - Ehab M Abdo
- Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Naglaa M Aboelsoud
- Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | | | - Ahmed A Aboomar
- Department of internal medicine, Nephrology Unit, Faculty Medicine, Tanta University, Tanta.
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St-Jules DE, Lloyd L, Meade A, Biruete A, Kistler B, Carrero JJ. Deconstructing Disease-Related Malnutrition: A New Assessment Framework for Clinical Practice. J Ren Nutr 2023; 33:707-716. [PMID: 37116625 PMCID: PMC10603213 DOI: 10.1053/j.jrn.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/06/2023] [Accepted: 04/16/2023] [Indexed: 04/30/2023] Open
Abstract
Protein-energy wasting (PEW) is a key cause of functional impairment and poor health outcomes in people with chronic kidney disease. While PEW can be mitigated with nutrition therapy, it is a complex myriad of disorders with numerous interacting etiologies and corresponding presentations, which make it difficult to diagnose and manage in practice. A variety of scoring rubrics have been developed to facilitate malnutrition assessment. Although these tools have greatly benefited the recognition and treatment of PEW, the typical format of grading specified PEW indicators has the potential to overlook or overstate highly relevant individual-specific factors. This review presents a simple framework for malnutrition assessment that can be used to complement and evaluate conventional assessment tools. Unlike standard tools, which are designed to identify and rate malnutrition risk and severity, the malnutrition framework is conceptual model that organizes PEW assessment into three distinct, but interacting facets of PEW risk: nutrient balance, nutrition status, and malnutrition risk. The new framework encourages critical thinking about PEW risk that may help clinicians plan and interpret assessments to efficiently and effectively manage this condition.
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Affiliation(s)
- David E St-Jules
- Assistant Professor, Department of Nutrition, University of Nevada, Reno, Nevada.
| | - Lyn Lloyd
- Senior Renal Dietitian, Nutrition and Dietetics, Te Toka Tumai Auckland Hospital, Te Whatu Ora Health New Zealand
| | - Anthony Meade
- Advanced Renal Dietitian, Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Annabel Biruete
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette, and Division of Nephrology, Indiana University School of Medicine, Indianapolis
| | - Brandon Kistler
- Assistant Professor, Department of Nutrition Science, Purdue University, West Lafayette
| | - Juan-Jesus Carrero
- Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, and Division of Nephrology, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Sweden
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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease. Nutrients 2022; 14:nu14204297. [PMID: 36296981 PMCID: PMC9611115 DOI: 10.3390/nu14204297] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/30/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology according to the disease background, disease stage, and the treatment received. In CKD patients, the increased production of proinflammatory cytokines and oxidative stress lead to a proinflammatory milieu that is at least partially responsible for the increased morbidity and mortality in this patient population. New insights into the pathogenic role of innate immunity and the proinflammatory cytokine profile, characterized, for instance, by higher levels of IL-6 and TNF-α, explain some of the clinical and laboratory abnormalities observed in these patients. In this article, we will explore currently available nutritional-inflammatory biomarkers in distinct CKD populations (hemodialysis, peritoneal dialysis, transplantation) with a view to evaluating their efficacy as predictors of malnutrition and their involvement in the common proinflammatory process. Although there is a direct relationship between inflammatory-nutritional status, signs and symptoms [e.g., protein-energy wasting (PEW), anorexia], and comorbidities (e.g., atheromatosis, atherosclerosis), we are in need of clearly standardized markers for nutritional-inflammatory assessment to improve their performance and design appropriate bidirectional interventions.
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Bacharaki D, Petrakis I, Kyriazis P, Markaki A, Pleros C, Tsirpanlis G, Theodoridis M, Balafa O, Georgoulidou A, Drosataki E, Stylianou K. Adherence to the Mediterranean Diet Is Associated with a More Favorable Left Ventricular Geometry in Patients with End-Stage Kidney Disease. J Clin Med 2022; 11:jcm11195746. [PMID: 36233612 PMCID: PMC9571193 DOI: 10.3390/jcm11195746] [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: 08/11/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction. The aim of the study was to examine the impact of adherence to a Mediterranean-style diet (MD) on left ventricular hypertrophy (LVH) and cardiac geometry in chronic kidney disease patients on dialysis (CKD-5D), given the high prevalence of cardiovascular morbidity in this population. Methods. n = 127 (77 men and 50 women) CKD-5D patients (69 on hemodialysis and 58 on peritoneal dialysis) with a mean age of 62 ± 15 years were studied. An MD adherence score (MDS) (range 0−55, 55 representing maximal adherence) was estimated with a validated method. Echocardiographic LVH was defined by LV mass index (LVMI) > 95 g/m2 in women and >115 g/m2 in men. Based on LVMI and relative wall thickness (RWT), four LV geometric patterns were defined: normal (normal LVMI and RWT), concentric remodeling (normal LVMI and increased RWT > 0.42), eccentric LVH (increased LVMI and normal RWT), and concentric LVH (increased LVMI and RWT). Results. Patients with LVH (n = 81) as compared to patients with no LVH (n = 46) were older in age (66 ± 13 vs. 55 ± 16 years; p < 0.001) had lower MDS (24 ± 2.7 vs. 25 ± 4.3; p < 0.05) and higher malnutrition-inflammation score (5.0 ± 2.7 vs. 3.9 ± 1.9; p < 0.05), body mass index (27.5 ± 4.9 vs. 24.1 ± 3.5 kg/m2; p < 0.001), prevalence of diabetes (79% vs. 20%; p < 0.05), coronary artery disease (78% vs. 20%; p < 0.05) and peripheral vascular disease (78% vs. 20%; p < 0.01). In a multivariate logistic regression analysis adjusted for all factors mentioned above, each 1-point greater MDS was associated with 18% lower odds of having LVH (OR = 0.82, 95% CI: 0.69−0.98; p < 0.05). MDS was inversely related to LVMI (r = −0.273; p = 0.02), and in a multiple linear regression model (where LVMI was analyzed as a continuous variable), MDS emerged as a significant (Β = −2.217; p < 0.01) independent predictor of LVH. Considering LV geometry, there was a progressive decrease in MDS from the normal group (25.0 ± 3.7) to concentric remodeling (25.8 ± 3.0), eccentric (24.0 ± 2.8), and then concentric (23.6 ± 2.7) group (p < 0.05 for the trend). Conclusions. The greater adherence to an MD is associated with lesser LVH, an important cardiovascular disease risk factor; MD preserves normal cardiac geometry and may confer protection against future cardiac dysfunction in dialysis patients.
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Affiliation(s)
- Dimitra Bacharaki
- Nephrology Department, Attikon University Hospital, 12462 Athens, Greece
| | - Ioannis Petrakis
- Nephrology Department, University General Hospital of Heraklion, 71500 Iraklio, Greece
| | - Periklis Kyriazis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Anastasia Markaki
- Department of Nutrition and Dietetics, Sciences School of Health Science, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Christos Pleros
- Nephrology Department, University General Hospital of Heraklion, 71500 Iraklio, Greece
| | | | - Marios Theodoridis
- Department of Nephrology, Democritus University of Thrace, 68150 Alexandroupolis, Greece
| | - Olga Balafa
- Nephrology Department, University Hospital of Ioannina, 45500 Ioannina, Greece
| | | | - Eleni Drosataki
- Nephrology Department, University General Hospital of Heraklion, 71500 Iraklio, Greece
| | - Kostas Stylianou
- Nephrology Department, University General Hospital of Heraklion, 71500 Iraklio, Greece
- Correspondence:
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Kalantar-Zadeh K, Moore LW. Functional Nutrition, Naturopathic Nutrition, and Integrative and Holistic Renal Nutrition in Kidney Health and Value-Based Kidney Care Models. J Ren Nutr 2022; 32:493-497. [PMID: 35843458 DOI: 10.1053/j.jrn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange, CA, USA.
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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