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Chen PJ, Lu YC, Lu SN, Liang FW, Chuang HY. Association Between Osteoporosis and Adiposity Index Reveals Nonlinearity Among Postmenopausal Women and Linearity Among Men Aged over 50 Years. J Epidemiol Glob Health 2024:10.1007/s44197-024-00275-9. [PMID: 39046667 DOI: 10.1007/s44197-024-00275-9] [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: 03/23/2024] [Accepted: 07/06/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE Previous research shows conflicting views on the relationship between obesity and osteoporosis, partly due to variations in obesity classification and the nonlinear nature of these relationships. This study investigated the association between adiposity indices and osteoporosis, diagnosed using dual-energy X-ray absorptiometry (DXA), employing nonlinear models and offering optimal thresholds to prevent further bone mineral density decline. METHODS In 2019, a prospective study enrolled males over 50 years and postmenopausal women. Anthropometric measurements, blood biochemistry, and osteoporosis measured by DXA were collected. Associations between adiposity indices and osteoporosis were analyzed using a generalized additive model and segmented regression model. RESULTS The study included 872 women and 1321 men. Indices such as abdominal volume index (AVI), visceral adiposity index (VAI), waist circumference (WC), hip circumference, body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio (WHtR) were inversely associated with osteoporosis. In women, the relationship between the risk of osteoporosis and the adiposity indices was U-shaped, with thresholds of WC = 94 cm, AVI = 17.67 cm2, BMI = 25.74 kg/m2, VAI = 4.29, and WHtR = 0.61, considering changes in bone mineral density. Conversely, men exhibited a linear patterns for the inverse association. CONCLUSION The impact of obesity and adiposity on osteoporosis varies significantly between women and men. In postmenopausal women, the relationship is nonlinear (U-shaped), with both very low and very high adiposity linked to higher osteoporosis risk. In men over 50, the relationship is linear, with higher adiposity associated with lower osteoporosis risk. The study suggests that maintaining specific levels of adiposity could help prevent osteoporosis in postmenopausal women.
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Affiliation(s)
- Po-Ju Chen
- Department of Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yueh-Chien Lu
- Department of Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Sheng-Nan Lu
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Fu-Wen Liang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Yi Chuang
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Community Medicine, Kaohsiung Medical University Hospital, No. 100, Shih-Chuan 1st Road, Sanmin Dist., Kaohsiung, 80708, Taiwan.
- Ph.D. Program in Environmental and Occupational Medicine, College of Medicine, and Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Okamura K, Tanaka S, Kitamura H, Hiyamuta H, Tsuruya K, Nakano T, Kitazono T. Relationships of Weight Change from 20 Years of Age with the Risks of All-Cause and Cardiovascular Mortality in Patients with Chronic Kidney Disease. J Atheroscler Thromb 2024; 31:1072-1086. [PMID: 38267049 PMCID: PMC11224694 DOI: 10.5551/jat.64571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/28/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS Weight changes from a young age are known to be associated with poor life outcomes in the general population. However, little is known about the association between weight change from a young age and life expectancy in patients with chronic kidney disease (CKD). METHODS Data of 2,806 nondialysis CKD patients who participated in the Fukuoka Kidney Disease Registry (FKR) Study, a multicenter observational study, were analyzed. The primary outcome was all-cause death, whereas the secondary outcome was cardiovascular mortality. The covariate of interest was weight change, defined as the difference between body weight at study enrollment and at 20 years old. Cox proportional-hazards models were used to estimate the risks of mortality for participants with weight changes of ≥ 5 or <5 kg compared with those with stable weights. RESULTS During the 5-year observation period, 243 participants died from all causes and 62 from cardiovascular disease. The risk of all-cause mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.11; 95% confidence interval [CI], 1.52-2.93). Conversely, the risk of cardiovascular mortality in the weight-loss group was significantly higher than that in the stable-weight group (multivariable-adjusted hazard ratio, 2.48; 95% CI, 1.32-4.64). However, no significant association was observed between weight gain and the risks of all-cause and cardiovascular mortalities. CONCLUSION Weight loss from 20 years of age was found to be associated with higher risks of all-cause and cardiovascular mortalities in patients with CKD.
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Affiliation(s)
- Kazuhiro Okamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Hiroto Hiyamuta
- Department of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, Japan
| | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - for the Fukuoka Kidney Disease Registry (FKR) Study Collaboration Group
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
- Department of Internal Medicine, Faculty of Medicine, Division of Nephrology and Rheumatology, Fukuoka University, Fukuoka, Japan
- Department of Nephrology, Nara Medical University, Nara, Japan
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Altunok M, Çankaya E, Gözübüyük Kaplan H, Çınar E, Uyanık A, Sevinç C. The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients. Int Urol Nephrol 2024; 56:2379-2389. [PMID: 38431535 DOI: 10.1007/s11255-024-03988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI. METHODS The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared. RESULTS Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan-Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722-1.981] (p = 0.488)). CONCLUSION In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.
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Affiliation(s)
- Murat Altunok
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey.
| | - Erdem Çankaya
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | | | - Enes Çınar
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Abdullah Uyanık
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Can Sevinç
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Bersano-Reyes PA, Nieto G, Cana-Poyatos A, Guerrero Sanz P, García-Maset R, García-Testal A. Nutritional status and its relationship with COVID-19 prognosis in hemodialysis patients. NUTR HOSP 2024; 41:628-635. [PMID: 38666342 DOI: 10.20960/nh.04850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Introduction Introduction: among the groups more affected by the COVID-19 pandemic were patients undergoing chronic hemodialysis (HD) treatment due to their comorbidities, advanced age, impaired innate and adaptive immune function, and increased nutritional risk due to their underlying inflammatory state. All of these factors contribute to a higher risk of severe complications and worse outcomes compared to the general population when infected with SARS-CoV-2. Objective: the objective of this study was to describe the nutritional characteristics of and their potential association with the prognosis of COVID-19 in patients undergoing chronic HD treatment. Method: a descriptive, retrospective, observational design. All cases of COVID-19 in patients undergoing chronic treatment at the Hemodialysis Unit of Hospital de Manises, Valencia, Spain, from the start of the pandemic to before vaccination were included. Results: for that, 189 patients were studied, who received chronic HD treatment in the hospital unit, 22 patients were diagnosed with COVID-19 (12 %) in that period. The mean age was 71 years, 10 were women, the Charlson index was 6.59 points, diabetes mellitus 10, vintage HD 51.6 months, 2 patients had previously received a currently non-functioning kidney transplant, 16 had arteriovenous fistula as vascular access, and 6 had central vascular access. The mean dialysis session time was 220.14 minutes and the initial value of the single dose of the Kt/V pool was 1.7. 16 patients had body composition measurement, a strong association (p < 0.05) was identified between mortality and BMI, as well as mortality and FTI. Furthermore, the differences between deceased and surviving groups in the serum levels of various variables related to nutritional status were analyzed, finding significant differences with p < 0.05 in the value of triglycerides and ferritin. Conclusions: higher body mass index and higher body fat content, along with lower baseline levels of triglycerides and ferritin, were significantly associated with higher COVID-19 mortality in patients on chronic hemodialysis. These findings suggest that the initial nutritional status of these patients can significantly influence the prognosis of SARS-CoV-2 infection.
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Affiliation(s)
| | - Gema Nieto
- Department of Food Technology, Food Science, and Nutrition. Universidad de Murcia
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Karatisidis L, Zagoridis K, Mprotsis T, Misidou C, Pentidou A, Vrachiolias G, Bezirgianidou Z, Kontomanolis E, Spanoudakis E. Obese patients with atrial fibrillation are more efficiently protected from thrombosis under warfarin or xabans compared to non-obese patients; a systematic review and Meta-analysis of six randomized controlled trials. Thromb Res 2024; 238:88-96. [PMID: 38696925 DOI: 10.1016/j.thromres.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/29/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
INTRODUCTION Recommendations about proper anticoagulation in obese patients, body mass index (BMI) > 30 kg/m2, are not yet clearly defined. Obese patients were included in randomized controlled trials comparing new anticoagulants (NOACs) with warfarin in patients with atrial fibrillation or thromboembolism. METHODS We performed a medline search entering proper criteria and finally 6 post-hoc analysis of RCTs, reporting outcome according to BMI, were included in this meta-analysis. Two major outcomes were considered end points in our meta-analysis; thrombosis, including ischemic cerebral events (transient or not) and venous thrombosis (DVD) /pulmonary embolism (PE) and bleeding, including major bleeding and clinically relevant non-major bleeding. RESULTS In the NOACs treated group, thrombosis occurred less frequently in obese vs non-obese patients; RR and 95 % CI 0,75 (0,58-0,97), p = 0,03, while low heterogeneity was observed (I2= 40 %). In the warfarin treated subgroup there was statistically significant difference with less thrombotic events occurring in the obese vs non-obese patients; RR and (95 % CI) 0,80 (0,66-0,98), p = 0,03, and heterogeneity was low (I2 = 24 %). This protective effect called the obesity paradox is limited to obese patients anticoagulated for non-valvular atrial fibrillation (NVAF); RR (95 % CI) was 0,70 (0,58-0,85) p = 0,03 and I2 = 24 %. Bleeding events were similar under both NOACs and warfarin in obese vs non-obese analysis. CONCLUSIONS Obese patients anticoagulated for NVAF with either standard dose of xabans or INR guided warfarin are more efficiently protected against thrombosis compared to non-obese patients.
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Affiliation(s)
- Lazaros Karatisidis
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Konstantinos Zagoridis
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Theodoros Mprotsis
- Department of Biomathematics, University of Thessaly, School of Medicine, Greece
| | - Christina Misidou
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Aikaterini Pentidou
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Zoi Bezirgianidou
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Emmanouil Kontomanolis
- Department of Obstetric Gynecology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece
| | - Emmanouil Spanoudakis
- Department of Hematology, Democritus University of Thrace, Medical School, Alexandroupolis, Greece.
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Kushwaha R, Vardhan PS, Kushwaha PP. Chronic Kidney Disease Interplay with Comorbidities and Carbohydrate Metabolism: A Review. Life (Basel) 2023; 14:13. [PMID: 38276262 PMCID: PMC10817500 DOI: 10.3390/life14010013] [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: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/27/2024] Open
Abstract
Chronic kidney disease (CKD) poses a global health challenge, engendering various physiological and metabolic shifts that significantly impact health and escalate the susceptibility to severe illnesses. This comprehensive review delves into the intricate complexities of CKD, scrutinizing its influence on cellular growth homeostasis, hormonal equilibrium, wasting, malnutrition, and its interconnectedness with inflammation, oxidative stress, and cardiovascular diseases. Exploring the genetic, birth-related, and comorbidity factors associated with CKD, alongside considerations of metabolic disturbances, anemia, and malnutrition, the review elucidates how CKD orchestrates cellular growth control. A pivotal focus lies on the nexus between CKD and insulin resistance, where debates persist regarding its chronological relationship with impaired kidney function. The prevalence of insulin abnormalities in CKD is emphasized, contributing to glucose intolerance and raising questions about its role as a precursor or consequence. Moreover, the review sheds light on disruptions in the growth hormone and insulin-like growth factor axis in CKD, underscoring the heightened vulnerability to illness and mortality in cases of severe growth retardation. Wasting, a prevalent concern affecting up to 75% of end-stage renal disease (ESRD) patients, is analyzed, elucidating the manifestations of cachexia and its impact on appetite, energy expenditure, and protein reserves. Taste disturbances in CKD, affecting sour, umami, and salty tastes, are explored for their implications on food palatability and nutritional status. Independent of age and gender, these taste alterations have the potential to sway dietary choices, further complicating the management of CKD. The intricate interplay between CKD, inflammation, oxidative stress, and cardiovascular diseases is unraveled, emphasizing the profound repercussions on overall health. Additionally, the review extends its analysis to CKD's broader impact on cognitive function, emotional well-being, taste perception, and endothelial dysfunction. Concluding with an emphasis on dietary interventions as crucial components in CKD management, this comprehensive review navigates the multifaceted dimensions of CKD, providing a nuanced understanding essential for developing targeted therapeutic strategies.
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Affiliation(s)
- Radha Kushwaha
- Centre of Food Technology, University of Allahabad, Allahabad 211002, Uttar Pradesh, India;
| | - Pothabathula Seshu Vardhan
- Department of Chemistry, Sardar Vallabhbhai National Institute of Technology (SVNIT), Surat 395007, Gujarat, India;
| | - Prem Prakash Kushwaha
- Department of Biological, Geological, and Environmental Sciences, Cleveland State University, Cleveland, OH 44115, USA
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Hones KM, Hao KA, Cueto RJ, Wright JO, King JJ, Wright TW, Friedman RJ, Schoch BS. The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty. J Am Acad Orthop Surg 2023; 31:1165-1172. [PMID: 37656955 DOI: 10.5435/jaaos-d-23-00122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 07/24/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND An inverse relationship coined the "obesity paradox" has been propositioned, in which body mass index (BMI) may be contradictorily protective in patients undergoing surgery or treatment of chronic disease. This study sought to investigate the BMI associated with the lowest rate of medical complications after total shoulder arthroplasty (TSA). METHODS The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adults who underwent elective primary TSA between January 2012 and December 2020. Thirty-day postoperative medical complications were extracted, which included death, readmission, pneumonia, pulmonary embolism, renal failure, and cardiac arrest, among others. BMI was classified into five categories (underweight [BMI <18.5 kg/m 2 ], normal weight [BMI ≥18.5 and <25 kg/m 2 ], overweight [BMI ≥25 and <30 kg/m 2 ], obese [BMI ≥30 and <40 kg/m 2 ], and morbidly obese [BMI ≥40 kg/m 2 ]). We examined the risk of any 30-day postoperative complications and BMI categorically and on a continuous basis using multivariable logistic regression controlling for age, sex, procedure year, and comorbidities. RESULTS Of the 31,755 TSAs, 84% were White, 56% were female, and the average age of patients was 69.2 ± 9.3 years. Thirty-day postoperative medical complications occurred in 4.53% (n = 1,440). When assessed on a continuous basis, the lowest risk was in patients with a BMI between 30 and 35 kg/m 2 . Underweight individuals (BMI <18.5 kg/m 2 ) had the highest postoperative complication rates overall. The probability of medical complications increased with age and was greater for female patients. CONCLUSION The relationship between BMI and complication risk in TSA is nonlinear. A BMI between 30 and 35 kg/m 2 was associated with the lowest risk of medical complications after TSA, and BMI<18.5 kg/m 2 had the highest risk overall, indicating some protective aspects of BMI against 30-day medical complications. Thus, obesity alone should not preclude patients from TSA eligibility, rather surgical candidacy should be evaluated in the context of patients' overall health and likelihood of benefit from TSA. LEVEL OF EVIDENCE III, Retrospective Comparative Study.
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Affiliation(s)
- Keegan M Hones
- From the College of Medicine, University of Florida, Gainesville, FL (Hones, Hao, and Cueto), the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL (Jonathan O. Wright, King, and Thomas W. Wright), the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Friedman), and the Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL (Schoch)
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Dopierała M, Schwermer K, Hoppe K, Kupczyk M, Pawlaczyk K. Benefits of Preserving Residual Urine Output in Patients Undergoing Maintenance Haemodialysis. Int J Nephrol Renovasc Dis 2023; 16:231-240. [PMID: 37868106 PMCID: PMC10590073 DOI: 10.2147/ijnrd.s421533] [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: 07/24/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Chronic kidney disease is a widespread medical problem that leads to higher morbidity, mortality, and a decrease in the overall well-being of the general population. This is especially expressed in patients with end-stage renal disease (ESRD) undergoing maintenance haemodialysis. Several variables could be used to evaluate those patients' well-being and mortality risk. One of them is the presence of residual urine output. Materials and Methods The study was conducted on 485 patients treated with maintenance haemodialysis. After enrollment in the study, which consisted of medical history, physical examination, hydration assessment, and blood sampling, each patient was followed up for 24 months. We used residual urine output (RUO) as a measure of residual renal function (RRF). The entire cohort was divided into 4 subgroups based on the daily urinary output (<=100mL per day, >100mL to <=500mL, >500mL to <=1000mL and >1000mL). Results The data show that the mortality rate was significantly higher in groups with lower RUO, which was caused mainly by cardiovascular events. Also, patients with higher RUO achieved better sodium, potassium, calcium, and phosphate balance. They were also less prone to overhydration and had a better nutritional status. Preserved RRF also had a positive impact on markers of cardiovascular damage, such as NT-proBNP as well as TnT. Conclusion In conclusion, preserving residual urine output in ESRD patients undergoing maintenance haemodialysis is invaluable in reducing their morbidity and mortality rates and enhancing other favourable parameters of those patients.
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Affiliation(s)
- Mikołaj Dopierała
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Schwermer
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Hoppe
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Kupczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland
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Lee EH, Lee JA, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom JS, Song YG, Park SH, Kim JH. Association of body mass index and bloodstream infections in patients on extracorporeal membrane oxygenation: a single-centre, retrospective, cohort study. J Hosp Infect 2023; 140:117-123. [PMID: 37562593 DOI: 10.1016/j.jhin.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Obesity is associated with poor clinical outcomes in critically ill patients. However, under some clinical conditions, obesity has protective effects. Bloodstream infections (BSI) are among the most common nosocomial infections associated with extracorporeal membrane oxygenation (ECMO). BSI during ECMO is associated with higher mortality rates and poorer clinical outcomes. AIM To analyse whether body mass index (BMI) is associated with BSI during ECMO or with in-hospital mortality. METHODS All adult patients who had received ECMO support for >48 h were included in the analysis. The analysis of total duration of ECMO support, in-hospital mortality and BSI was stratified by BMI category. The Cox proportional hazards model was used to compare the risk of BSI among BMI categories. FINDINGS In total, 473 patients were enrolled in the study. The average age was 56.5 years and 65.3% were men. The total duration of ECMO was approximately 11.8 days, with a mortality rate of 47.1%. The incidence rates of BSI and candidaemia were 20.5% and 5.5%, respectively. The underweight group required ECMO for respiratory support, whereas the overweight and obese groups required ECMO for cardiogenic support (P<0.0001). No significant difference in BSI rate was found (P=0.784). However, after adjusting for clinical factors, patients in Group 4 (BMI 25.0-<30.0 kg/m2) exhibited lower mortality compared with patients in Group 2 (normal BMI) (P=0.004). CONCLUSION BMI was not associated with risk of BSI, but patients with higher BMI showed lower in-hospital mortality associated with ECMO support.
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Affiliation(s)
- E H Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J A Lee
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Ahn
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S J Jeong
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - N S Ku
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Y Choi
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J-S Yeom
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Y G Song
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S H Park
- Chaum Life Centre, CHA University, Seoul, South Korea.
| | - J H Kim
- Department of Internal Medicine and AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
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10
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Chu TW, Hsieh TH, Lin TY, Hung SC. Association of diabetic retinopathy with risk of developing cardiovascular diseases in patients undergoing hemodialysis: A population-based cohort study. Nutr Metab Cardiovasc Dis 2023; 33:1565-1573. [PMID: 37246078 DOI: 10.1016/j.numecd.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS While patients undergoing dialysis have substantially increased cardiovascular event rates compared with the general population, predicting individual risk remains difficult. Whether diabetic retinopathy (DR) is associated with cardiovascular diseases in this population is unclear. METHODS AND RESULTS We conducted a nationwide cohort study of 27,686 incident hemodialysis patients with type 2 diabetes who were enrolled in Taiwan's National Health Insurance Research Database between January 1, 2010, and December 31, 2014, and had follow-up data until December 31, 2015. The primary outcome was a composite of macrovascular events, including acute coronary syndrome (ACS), acute ischemic stroke, and peripheral artery disease (PAD). A total of 10,537 (38.1%) patients had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) to 9164 patients with DR (mean age, 63.5 years; 43.8% women) by propensity score. During a median follow-up of 2.4 years, 5204 patients in the matched cohort experienced a primary outcome. The presence of DR was associated with a higher risk of a primary outcome (subdistribution hazard ratio [sHR] 1.07; 95% CI, 1.01-1.13), which reflected a higher risk of acute ischemic stroke (sHR 1.26; 95% CI, 1.14-1.39) and PAD (sHR 1.14; 95% CI, 1.05-1.25) but not ACS (sHR 0.99; 95% CI, 0.92-1.06). CONCLUSIONS The presence of DR signifies an increased risk of acute ischemic stroke and PAD in hemodialysis patients with type 2 diabetes, independent of the known risk factors. These results highlight the need for more comprehensive cardiovascular assessment and management in hemodialysis patients with DR.
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Affiliation(s)
- Ting-Wen Chu
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Tsung-Han Hsieh
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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11
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Felipe de Oliveira Guedes F, Matias de Sousa I, Cunha de Medeiros GO, Gonzalez MC, Trussardi Fayh AP. Is there a difference in the parameters of the bioelectrical impedance obtained from devices from different manufacturers? A cross-sectional study in hospitalized cancer patients. Clin Nutr ESPEN 2023; 56:120-126. [PMID: 37344060 DOI: 10.1016/j.clnesp.2023.05.010] [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: 11/14/2022] [Revised: 05/02/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Cancer is a disease with high and increasing incidence rates in the world and its course tends to harm the body composition. Monitoring these body changes is very important. Therefore, it is essential to have reliable, accessible, and practical methods for evaluating body compartments. This study aims to evaluate the correlation and agreement of results for the bioelectrical impedance analysis (BIA) obtained from devices from different manufacturers. METHODS This is a single-center cross-sectional study including hospitalized patients with cancer. Two devices from different brands used for obtaining the BIA were used; both with a tetrapolar model and a single frequency (50 kHz). The results were evaluated for resistance (R) and reactance (Xc) and used to calculate the phase angle (PhA) and fat-free mass (FFM) indicators. Pearson and Spearman correlation tests and Bland-Altman plots were performed, with results expressed as bias and limits of agreement at 95% confidence intervals (95%CI). RESULTS We have included 116 patients, with a mean age of 60.8 ± 14.8, 51.7% were women. We have found very strong correlations between the measurements of R (rho = 0.971) and FFM (r = 0.979), and strong correlations for Xc (rho = 0.784) and PhA (rho = 0.768). However, the measurements did not agree between the methods. CONCLUSIONS Commercial brands of devices used for the BIA influence the results generated, a factor that must be considered when choosing the most appropriate method for this analysis.
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Affiliation(s)
| | - Iasmin Matias de Sousa
- Postgraduate Program in Health Sciences, Federal University of Rio Grande Do Norte, Natal, RN, Brazil
| | | | | | - Ana Paula Trussardi Fayh
- Postgraduate Program in Health Sciences, Federal University of Rio Grande Do Norte, Natal, RN, Brazil; PesqClin Lab, Onofre Lopes University Hospital, Brazilian Company of Hospital Services (EBSERH), Federal University of Rio Grande Do Norte, Natal, Brazil; Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande Do Norte, Natal, RN, Brazil.
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12
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Harhay MN, Kim Y, Milliron BJ, Robinson LF. Obesity Weight Loss Phenotypes in CKD: Findings From the Chronic Renal Insufficiency Cohort Study. Kidney Int Rep 2023; 8:1352-1362. [PMID: 37441488 PMCID: PMC10334404 DOI: 10.1016/j.ekir.2023.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Although people with chronic kidney disease (CKD) and obesity have important motivations to lose weight, weight loss is also associated with health risks. We examined whether patterns of change in systolic blood pressure (SBP), serum albumin level, and fat-free mass (FFM) can help to differentiate between healthy and high-risk weight loss in this population. Methods Using data from the Chronic Renal Insufficiency Cohort Study (CRIC), we estimated a joint multivariate latent class model with 6 classes to identify distinct trajectories of body mass index (BMI), albumin, and SBP among participants with obesity (BMI ≥30 kg/m2 at baseline), accounting for informative missingness from death. In a secondary analysis, we fit a 6-class model with BMI and FFM. Results Among 2831 participants (median baseline BMI 35.6, interquartile range [IQR] 32.4-40.0 kg/m2), median follow-up was 6.8 (IQR 4.8-12.9) years, median age was 61 (IQR 54-67) years, 53% were male, 50% were non-Hispanic Black, and 82% were trying to control or lose weight at baseline. Latent classes were associated with mortality risk (5-year cumulative incidence of mortality 6.8% and 1.5% in class 6 and 3, respectively). Class 6 had the highest mortality rate and was characterized by early, steep BMI loss, early serum albumin decline, and late SBP increase. In the secondary analysis, a class characterized by steep BMI and FFM loss was associated with the highest death risk. Conclusions Among adults with CKD and obesity, BMI loss with concomitant serum albumin or FFM loss was associated with a high risk of death.
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Affiliation(s)
- Meera N. Harhay
- Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
- Department of Medicine, University of Pennsylvania Transplant Institute, University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Yuna Kim
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Brandy-Joe Milliron
- Department of Nutrition Sciences, Drexel University College of Nursing and Health Professions, Philadelphia, PA
| | - Lucy F. Robinson
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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13
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Shen FC, Lin HYH, Tsai WC, Kuo IC, Chen YK, Chao YL, Niu SW, Hung CC, Chang JM. Non-insulin-based insulin resistance indices for predicting all-cause mortality and renal outcomes in patients with stage 1-4 chronic kidney disease: another paradox. Front Nutr 2023; 10:1136284. [PMID: 37255931 PMCID: PMC10225593 DOI: 10.3389/fnut.2023.1136284] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/26/2023] [Indexed: 06/01/2023] Open
Abstract
Non-insulin-based insulin resistance (IR) indices serve as the indicators of metabolic syndrome (MetS) but have limited value for predicting clinical outcomes. Whether the obesity paradox affects the predictive value of these indicators in patients with chronic kidney disease (CKD) remains unknown. We investigated whether MetS and non-insulin-based IR indices can predict all-cause mortality and renal outcomes in a prospective observational study with stage 1-4 CKD Asians (N = 2,457). These IR indices were associated with MetS. A Cox regression model including body mass index (BMI) revealed an association between MetS and renal outcomes. Among the IR indices, only high triglyceride-glucose (TyG) index was associated with adverse renal outcomes: the hazard ratio of Q4 quartile of the TyG index was 1.38 (1.12-1.70). All-cause mortality was marginally associated with MetS but not high IR indices. Low TyG and TyG-BMI indices as well as low BMI and triglyceride were paradoxically associated with increased risks of clinical outcomes. The triglyceride-to-high-density lipoprotein cholesterol ratio and metabolic score for IR indices were not associated with clinical outcomes. In conclusion, MetS and TyG index predict renal outcome and obesity paradox affects the prediction of IR indices in patients with stage 1-4 CKD.
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Affiliation(s)
- Feng-Ching Shen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hugo You-Hsien Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Chung Tsai
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Kong Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Lin Chao
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Wen Niu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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14
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Sun Y, Yan Y, Liao Y, Chu C, Guo T, Ma Q, Wang Y, Wang D, Jia H, Mu J. The new visceral adiposity index outperforms traditional obesity indices as a predictor of subclinical renal damage in Chinese individuals: a cross-sectional study. BMC Endocr Disord 2023; 23:78. [PMID: 37029402 PMCID: PMC10080835 DOI: 10.1186/s12902-023-01330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The new visceral adiposity index (NVAI) was superior to previous obesity indices in predicting cardiovascular diseases among Asians. Nevertheless, the utility of the NVAI for predicting chronic kidney disease is still unclear. The objective of this research was to explore the relationship between the NVAI and subclinical renal damage (SRD) and to investigate whether the NVAI outperforms other common obesity indices in predicting SRD in the Chinese population. METHODS Participants in this cross-sectional study were from the Hanzhong Adolescent Hypertension Cohort. The NVAI and seven other common obesity indices were calculated, including body mass index, waist circumference, lipid accumulation product, visceral adiposity index, Chinese visceral adiposity index, a body shape index and metabolic score for visceral fat. Logistic regression models revealed the association between NVAI and SRD. The odds ratio (OR) and the 95% confidence interval (CI) were calculated to show the association between the two variables. The predictive power of eight obesity indices for SRD was evaluated through the receiver operating characteristic curve and area under the curve (AUC). In addition, the net reclassification index (NRI) and integrated discrimination improvement (IDI) were also applied to compare the incremental predictive value for SRD of different obesity indices. RESULTS The median age of the 2358 subjects was 42.00 years. Across NVAI tertiles, the prevalence of SRD was 7.25%, 11.21%, and 21.60%, respectively. After adjusting for confounders, a high level of NVAI remained a risk factor for SRD. The ORs of the middle and top NVAI tertiles for SRD were 1.920 (95% CI: 1.322, 2.787) and 4.129 (95% CI: 2.750, 6.202), respectively. The AUC of the NVAI was 0.666 (95% CI: 0.647, 0.685), which was significantly larger than the AUC of any of the other obesity indicators. Moreover, the NRI and IDI were significantly improved when NVAI was added to the basic model for predicting SRD. Among eight obesity indices, NVAI had the highest NRI (0.392; 95% CI: 0.280, 0.503), and its IDI (0.021; 95% CI: 0.014, 0.027) was second only to that of the body mass index (0.023; 95% CI: 0.014, 0.032). CONCLUSIONS NVAI is independently and positively associated with SRD. Among the eight obesity indices, the NVAI shows the strongest predictive power for SRD in the Chinese population. The NVAI may be useful as an effective warning indicator of chronic kidney disease in Chinese adults.
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Affiliation(s)
- Yue Sun
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Yu Yan
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Yueyuan Liao
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Chao Chu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Tongshuai Guo
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Qiong Ma
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Yang Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Dan Wang
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Hao Jia
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China
| | - Jianjun Mu
- Department of Cardiology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, No.277, Yanta West Road, Xi'an, 710061, Shaanxi, China.
- Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, Shaanxi, China.
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15
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Koppe L, Mak RH. Is There a Need to "Modernize" and "Simplify" the Diagnostic Criteria of Protein-Energy Wasting? Semin Nephrol 2023; 43:151403. [PMID: 37541069 DOI: 10.1016/j.semnephrol.2023.151403] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
Protein energy wasting(PEW) is a term that most nephrologists used to define nutritional disorders in patients with acute kidney injury and chronic kidney disease. Although this nomenclature is well implemented in the field of nephrology, the use of other terms such as cachexia or malnutritionin the majority of chronic diseases can induce confusion regarding the definition and interpretation of these terms. There is ample evidence in the literature that the pathways involved in cachexia/malnutrition and PEW are common. However, in kidney diseases, there are pathophysiological conditions such as accumulation of uremic toxins, and the use of dialysis, which may induce a phenotypic specificity justifying the original term PEW. In light of the latest epidemiologic studies, the criteria for PEW used in 2008 probably need to be updated. The objective of this review is to summarize the main mechanisms involved in cachexia/malnutrition and PEW. We discuss the need to modernize and simplify the current definition and diagnostic criteria of PEW. We consider the interest of proposing a specific nomenclature of PEW for children and elderly patients with kidney diseases.
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Affiliation(s)
- Laetitia Koppe
- Department of Nephrology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France; University Lyon, Cardiovasculaire, Métabolisme, Diabète et Nutrition Laboratory, Institut National des Sciences Appliquées-Lyon, Institut National de la Santé et de la Recherche Médicale U1060, l'Institut National de Recherche Pour l'agriculture, l'alimentation et l'environnement (INRAE), Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital, University of California San Diego, La Jolla, California
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16
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Owusu-Bediako K, Mpody C, Iobst C, Tobias JD, Nafiu OO. Risk assessment of postoperative pneumonia in children with neurologic disorders and obesity. Paediatr Anaesth 2023; 33:160-166. [PMID: 36399010 DOI: 10.1111/pan.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Postoperative pneumonia increases the risk of postsurgical mortality, making it a serious healthcare-associated complication. Children with preoperative neuromuscular impairments have a higher risk of postoperative pneumonia. Obesity is also a risk factor for postoperative pulmonary complications, including pneumonia. Moreover, obesity is increasingly prevalent among children living with a neurological diagnosis. Whether obesity increases the risk of postoperative pneumonia among children with neurologic diseases remains largely unknown. Therefore, we assessed the risk of postoperative pneumonia among children with neurologic diagnoses based on their obesity status. METHODS We analyzed a retrospective cohort of children ≤18 years from the National Surgical Quality Improvement Program (2012-2019) database who underwent inpatient orthopedic surgery. We used Cox proportional regression model to estimate the hazard ratio for the association between neurologic disorders and postoperative pneumonia. In addition, we included an interaction term between body mass index and neurologic disorders to evaluate the moderating effect of obesity status and then performed stratified analyses to compare the magnitude of hazard ratios across body mass index subgroups. RESULTS A total of 60 745 children underwent inpatient orthopedic surgery during the study period, of whom 43.6% were healthy weight and 30.8% overweight/obese. The median age was 13 years (Interquartile range: 8-15). The incidence of postoperative pneumonia was higher among healthy weight patients with neurologic disorders than healthy weight patients without any neurologic disorders [Hazard ratio: 3.55 vs. 0.34]. Furthermore, the association between neurologic disorders and postoperative pneumonia was strongest among overweight patients than healthy weight or obese patients [Hazard ratio:11.88 vs. 9.45 vs. 4.40]. This observation was consistent across the various neurologic disorders analyzed. CONCLUSION Childhood obesity buffered the association between neurologic disorders and postoperative pneumonia, consistent with an 'obesity paradox'. Further research exploring the underlying mechanisms for the obesity paradox in children with neurologic disorders is warranted.
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Affiliation(s)
- Kwaku Owusu-Bediako
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christopher Iobst
- Department of Pediatric Orthopedic Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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17
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Berkman ER, Richardson KL, Clark JD, Dick AAS, Lewis-Newby M, Diekema DS, Wightman AG. An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy. Pediatr Nephrol 2023; 38:345-356. [PMID: 35488137 DOI: 10.1007/s00467-022-05572-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/10/2023]
Abstract
The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.
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Affiliation(s)
- Emily R Berkman
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kelsey L Richardson
- Division of Pediatric Nephrology, Oregon Health Sciences University, Portland, OR, USA
| | - Jonna D Clark
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - André A S Dick
- Division of Transplantation, Section of Pediatric Transplantation, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Mithya Lewis-Newby
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Cardiac Critical Care, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas S Diekema
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Aaron G Wightman
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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18
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Wu Y, Lv K, Hao X, Lv C, Lai W, Xia X, Pang A, Yuan Q, Song T. Waiting-List and early posttransplant prognosis among ethnoracial groups: Data from the organ procurement and transplantation network. Front Surg 2023; 10:1045363. [PMID: 36793312 PMCID: PMC9923172 DOI: 10.3389/fsurg.2023.1045363] [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: 09/15/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023] Open
Abstract
Background Racial/ethnic disparity in waiting-list mortality among candidates listed for kidney transplantation (KT) in the United States remains unclear. We aimed to assess racial/ethnic disparity in waiting-list prognosis among patients listed for KT in the United States in the current era. Methods We compared waiting-list and early posttransplant in-hospital mortality or primary nonfunction (PNF) among adult (age ≥18 years) white, black, Hispanic, and Asian patients listed for only KT in the United States between July 1, 2004 and March 31, 2020. Results Of the 516,451 participants, 45.6%, 29.8%, 17.5%, and 7.1% were white, black, Hispanic, and Asian, respectively. Mortality on the 3-year waiting list (including patients who were removed for deterioration) was 23.2%, 16.6%, 16.2%, and 13.8% in white, black, Hispanic, and Asian patients, respectively. The cumulative incidence of posttransplant in-hospital death or PNF after KT was 3.3%, 2.5%, 2.4%, and 2.2% in black, white, Hispanic, and Asian patients,respectively. White candidates had the highest mortality risk on the waiting list or of becoming too sick for a transplant, while black (adjusted hazard ratio, [95% confidence interval, CI], 0.67 [0.66-0.68]), Hispanic (0.59 [0.58-0.60]), and Asian (0.54 [0.52-0.55]) candidates had a lower risk. Black KT recipients (odds ratio, [95% CI] 1.29 [1.21-1.38]) had a higher risk of PNF or death before discharge than white patients. After controlling confounders, black recipients (0.99 [0.92-1.07]) had a similar higher risk of posttransplant in-hospital mortality or PNF as white patients than Hispanic and Asian counterparts. Conclusions Despite having a better socioeconomic status and being allocated better kidneys, white patients had the worst prognosis during the waiting periods. Black recipients and white recipients have higher posttransplant in-hospital mortality or PNF.
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Affiliation(s)
- Yangyang Wu
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Kaikai Lv
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Xiaowei Hao
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Chao Lv
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Wenhui Lai
- Graduate School, Hebei North University, Zhangjiakou, China
| | - Xinze Xia
- Graduate School, Shanxi Medical University, Taiyuan, China
| | - Aibo Pang
- Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Qing Yuan
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
| | - Tao Song
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China,Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China,Correspondence: Tao Song Qing Yuan
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ALATAŞ H, ARSLAN N, PEMBEGÜL İ. The relationship of dietary antioxidant capacity with laboratory and anthropometric measurements in hemodialysis patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1218704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Aim: Dietary antioxidant intake correlates with blood antioxidant content and protects against oxidative damage and related inflammatory complications. This study was conducted to examine the relationship between total antioxidant capacity of diet and effective factors with laboratory and anthropometric parameters in patients undergoing hemodialysis. Material and Method: The present case-control study consisted of 62 cases and 59 controls individuals who received hemodialysis treatment between the ages of 35-75. Dietary intake, sociodemographic data, medical history, and anthropometric measurements were collected from participants using a validated questionnaire. Results: Examining the association between dietary components and diet's total antioxidant capacity (dTAC) reveals a positive correlation between dietary protein (kg/avg), beta carotene (mcg/day), vitamin C (mg/day), vitamin E (mg/day), and polyunsaturated fatty acids (PUFA) (g/day) (p=0.002). The serum albumin, serum neutrophil to lymphocyte ratio and HDL-cholesterol have been reported to have a positive relationship with dTAC. And body mass ındex (BMI) and other anthropometric parameters were found to have a negative connection with dTAC (p=0.007). Conclusion: Total dietary antioxidant capacity is effective on anthropometric measurements and serum laboratory values. Increasing the antioxidant capacity of the diet in hemodialysis patients is important to prevent complications related to inflammation.
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Effects of a Combined Intradialytic Exercise Training Program on Functional Capacity and Body Composition in Kidney Transplant Candidates. J Funct Morphol Kinesiol 2023; 8:jfmk8010009. [PMID: 36648901 PMCID: PMC9844356 DOI: 10.3390/jfmk8010009] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023] Open
Abstract
Chronic kidney disease (CKD) leads to gradual muscle mass loss, which is strongly associated with lower functional capacity, which limits a patient’s daily activities. The aim of the present study is to examine the effects of a 4-month intradialytic exercise program on the functional capacity and body composition of kidney transplant (KT) candidates. Twenty-nine male patients on hemodialysis (HD) waiting for a kidney transplant, with a mean age of 53.86 ± 9.56 years old and BMI 27.11 ± 5.55 kg/m2, were randomly assigned into the following two groups: A (nA = 15 HD patients), who followed a 4-month intradialytic exercise program combining aerobic and resistance training, with a supervised, progressively increasing workload, and B (nB = 14 HD patients), who continued to receive usual care. At baseline and the end of the study, the KT candidates underwent a 6-min walking distance (6-MWD), and a 10-repetition sit-to-stand test (10-STS) to access physical function, a handgrip strength (HGS) test to evaluate the muscle strength of the non-fistula hand. Moreover, the bioelectrical impedance analysis (BIA) was performed to assess body composition indices, such as body fat (BF), body fat mass index (BFMI), fat-free mass index (FFMI), body cell mass (BCM), basal metabolic rate (BMR), extracellular water (ECW), intracellular water (ICW), total body water (TBW) and phase angle (PhA). Following the exercise program, group A showed favorable improvements in HGS (from 26.59 ± 9.23 to 28.61 ± 9.58 kg, p < 0.05) and 6-MWD (from 427.07 ± 7.66 to 468.16 ± 11.39 m, p < 0.05). Intergroup results from 6-MWD showed a statistically significant difference (Δp = 0.04), at the end of the study. Moreover, group A results from BIA revealed a significant increase of BMR by 2.4% (p < 0.05), ECW by 3.6% (p = 0.01), ICW by 3.8% (p = 0.01), TBW by 4.1% (p = 0.01), lean mass by 2.7% (p = 0.01), and PhA by 13.3% (p = 0.04), while a reduction in BF by 5.0% (p = 0.01) and BFMI by 6.6% (p = 0.03) was also noticed. At the end of the study, group A showed statistical differences in BMR (Δp = 0.01), BMR/BW (Δp = 0.01), dry lean (Δp = 0.01), and PhA (Δp = 0.03), compared to the group B. Linear regression analysis in group A after training showed positive correlations between HGS and both PhA (r = 0.52, p = 0.04) and FFMI (r = 0.64, p = 0.01), and a strong negative correlation between 6-MWT and BF (r = −0.61, p = 0.01). In conclusion, a 4-month intradialytic exercise program can enhance body composition and some physical parameters in HD patients awaiting kidney transplantation.
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21
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de Luca Corrêa H, Gadelha AB, Vainshelboim B, Dutra MT, Ferreira-Júnior JB, Deus LA, Neves RVP, Reis AL, de Araújo TB, Tzanno-Martins C, Tavares FS, Andrade RV, Dos Santos Rosa T. Could sarcopenia-related mortality in end-stage renal disease be underpinned by the number of hospitalizations and cardiovascular diseases? Int Urol Nephrol 2023; 55:157-163. [PMID: 35819667 DOI: 10.1007/s11255-022-03291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/26/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the association between sarcopenia with the number of all-cause mortality, hospitalizations, and cardiovascular diseases in patients with end-stage renal disease (ESRD). METHODS 247 patients with ESRD (women, n = 97) (66.6 ± 3.53 years) participated in this study. At baseline, all participants were measured with dual-energy X-ray absorptiometry and handgrip dynamometer and were prospectively followed up for 5 years. The European Working Group on Sarcopenia in Older People guidelines were utilized for Sarcopenia determination. Cox proportional hazard analysis adjusted for established risk factors was used to quantify the risk between Sarcopenia and all-cause mortality. RESULTS Sixty-five participants (26%) were determined to have Sarcopenia at baseline and 38 (15%) have died during the follow-up. At baseline, Participants with Sarcopenia had lower body mass index and fat-free mass index. Moreover, through the 5-year follow-up, sarcopenic patients had higher number of cardiovascular disease (56.9% vs. 12.6%) and hospitalizations (93.8% vs. 49.5%) (all P < 0.0001). Sarcopenia was associated with significantly higher risk of mortality, [Hazard ratio = 3.3, (95% CI: 1.6-6.9), P = 0.001]. CONCLUSION Sarcopenia may be a risk factor for hospitalizations, cardiovascular diseases, and all-cause mortality in patients with ESRD. These results provide support of the relevance in assessing sarcopenia in the clinical practice of chronic kidney disease and how muscle mass and strength may negatively impact the daily life of ESRD patients undergoing hemodialysis. Greater efforts at preventing muscle wasting and malfunctioning are needed through the worldwide healthcare system.
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Affiliation(s)
- Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil.
| | - André Bonadias Gadelha
- Serviço de Preparação Física/COSAU/DIGEP/SA/SG/Presidência da República, Zona Cívico-Administrativa, Brasília, DF, 70150-900, Brazil
- Seção de Educação Física, Colégio Militar de Brasília, Asa Norte, Brasília, DF, Brasil
| | - Baruch Vainshelboim
- Cardiovascular and Metabolic Disease Research Institute, Mountain View, CA, USA
| | - Maurílio Tiradentes Dutra
- Federal Institute of Education, Science and Technology of Brasilia, College of Physical Education, Brasília, Brazil
- College of Physical Education, University of Brasília, Brasília, DF, Brazil
| | | | - Lysleine Alves Deus
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Rodrigo Vanerson Passos Neves
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Thaís Branquinho de Araújo
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | | | | | - Rosângela Vieira Andrade
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasília, DF, Brazil
| | - Thiago Dos Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
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22
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Beberashvili I, Azar A, Khatib A, Abu Hamad R, Neheman A, Efrati S, Doenyas-Barak K. Sarcopenic Obesity Versus Nonobese Sarcopenia in Hemodialysis Patients: Differences in Nutritional Status, Quality of Life, and Clinical Outcomes. J Ren Nutr 2023; 33:147-156. [PMID: 35597322 DOI: 10.1053/j.jrn.2022.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/10/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Sarcopenia and sarcopenic obesity (SO) are linked to unfavorable prognosis in maintenance hemodialysis (MHD) populations. We tested whether nonobese sarcopenia and SO, as different stages of extreme protein-energy wasting, have different prognoses. METHODS In this prospective observational study, 261 MHD patients were recruited from October 2010 to April 2012 and followed until October 2020. Two definitions were used to diagnose sarcopenia: the European Working Group on Sarcopenia in Older People consensus and the Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium criteria. Obesity was determined as the percentage of total body fat, ≥27% for men and ≥38% for women. Data for all-cause and cardiovascular morbidity and mortality, baseline nutrition markers, inflammation and oxidative stress, adipokines, body composition parameters, handgrip strength, and quality of life (QoL) scores were measured. RESULTS According to European Working Group on Sarcopenia in Older People, 115 (44.1%) patients were sarcopenic and 120 (46.0%) according to FNIH definitions. Of them, 28.4% and 34.5% were SO, respectively. Higher levels of albumin, creatinine, uric acid, leptin, phase angle, better nutritional scores, and lower adiponectin levels characterized SO patients compared with nonobese sarcopenic patients regardless of indexing method. Better QoL scores were noted in SO compared with nonobese sarcopenic patients using the FNIH sarcopenia criteria. The hazard of all-cause death, cardiovascular death, and first cardiovascular event for patients with SO was lower compared with the nonobese patients after multivariate adjustments. Statistical significance of these associations disappeared after including fat mass in multivariate models. CONCLUSIONS MHD patients with SO have better nutritional status and prognosis for cardiovascular events, all-cause and cardiovascular disease mortality, and possibly better QoL compared with nonobese sarcopenic MHD patients. The better prognosis appears to be entirely due to the excess fat, which is protective in sarcopenic MHD patients similar to that described in the entire MHD population.
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Affiliation(s)
- Ilia Beberashvili
- Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel.
| | - Ada Azar
- Nutrition Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Amin Khatib
- Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Ramzia Abu Hamad
- Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Amos Neheman
- Urology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Shai Efrati
- Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
| | - Keren Doenyas-Barak
- Nephrology Division, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel
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Sex disparities in mortality among patients with kidney failure receiving dialysis. Sci Rep 2022; 12:18555. [PMID: 36329070 PMCID: PMC9633833 DOI: 10.1038/s41598-022-16163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/05/2022] [Indexed: 11/06/2022] Open
Abstract
Females are known to have a better survival rate than males in the general population, but previous studies have shown that this superior survival is diminished in patients on dialysis. This study aimed to investigate the risk of mortality in relation to sex among Korean patients undergoing hemodialysis (HD) or peritoneal dialysis (PD). A total of 4994 patients with kidney failure who were receiving dialysis were included for a prospective nationwide cohort study. Cox multivariate proportional hazard models were used to determine the association between sex and the risk of cause-specific mortality according to dialysis modality. During a median follow-up of 5.8 years, the death rate per 100 person-years was 6.4 and 8.3 in females and males, respectively. The female-to-male mortality rate in patients on dialysis was 0.77, compared to 0.85 in the general population. In adjusted analyses, the risk of all-cause mortality was significantly lower for females than males in the entire population (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.71-0.87, P < 0.001). No significant differences in the risk of cardiovascular and infection-related deaths were observed according to sex. The risk of mortality due to sudden death, cancer, other, or unknown causes was significantly lower for females than males in the entire population (HR 0.66, 95% CI 0.56-0.78, P < 0.001), in patients on HD (HR 0.75, 95% CI 0.62-0.90, P = 0.003), and in patients on PD (HR 0.49, 95% CI 0.34-0.70, P < 0.001). The survival advantage of females in the general population was maintained in Korean dialysis patients, which was attributed to a lower risk of noncardiovascular and noninfectious death.Trial registration: ClinicalTrials.gov Identifier: NCT00931970.
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24
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Yan LJ, Zeng YR, Chan-Shan Ma RN, Zheng Y. J-shaped association between the visceral adiposity index and all-cause mortality in patients with chronic kidney disease. Nutrition 2022; 103-104:111832. [PMID: 36162223 DOI: 10.1016/j.nut.2022.111832] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/23/2022] [Accepted: 08/12/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Visceral obesity, assessed using the visceral adiposity index (VAI), is related to mortality, but studies of populations with chronic kidney disease (CKD) are scarce. The aim of this study was to evaluate the relationship between VAI and all-cause mortality among individuals with CKD. METHODS We retrospectively explored the relationship between VAI and risk for all-cause death by analyzing the data of 4145 patients with CKD who participated in the National Health and Nutrition Examination Survey (NHANES) 2001-2006. Patients were followed until December 31, 2015. RESULTS After an average follow-up of 134.14 mo, 1034 (24.95%) deaths were recorded. Comparison of VAI quartiles with the reference showed an unstable association of VAI with all-cause mortality after adjusting for a wide range of potential confounders in Cox regression analysis. The correlation between VAI and mortality was J-shaped after applying the penalized spline method. Before the inflection point (VAI = 68.23), higher VAI had a protective effect against mortality (hazard ratio [HR], 0.47; 95% confidence interval [CI], 0.28-0.77). However, the risk for all-cause mortality gradually increased with the VAI (HR, 1.13; 95% CI, 1.05-1.21). CONCLUSION Visceral obesity may influence the rate of all-cause mortality in a nonlinear manner in populations with CKD. Risk for death was higher with visceral fat deficiency than with excessive visceral fat deposition.
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Affiliation(s)
- Li-Jun Yan
- Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College, Shantou City, China
| | - Yu-Ran Zeng
- Department of Hemodialysis, The First Affiliated Hospital of Shantou University Medical College, Shantou City, China
| | - R N Chan-Shan Ma
- Department of Gastroenterology Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, China
| | - Yang Zheng
- Department of Gastroenterology Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou City, China.
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25
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Rossing P, Caramori ML, Chan JC, Heerspink HJ, Hurst C, Khunti K, Liew A, Michos ED, Navaneethan SD, Olowu WA, Sadusky T, Tandon N, Tuttle KR, Wanner C, Wilkens KG, Zoungas S, de Boer IH. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2022; 102:S1-S127. [PMID: 36272764 DOI: 10.1016/j.kint.2022.06.008] [Citation(s) in RCA: 313] [Impact Index Per Article: 156.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
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26
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Tang X, Lei J, Li W, Peng Y, Wang C, Huang K, Yang T. The Relationship Between BMI and Lung Function in Populations with Different Characteristics: A Cross-Sectional Study Based on the Enjoying Breathing Program in China. Int J Chron Obstruct Pulmon Dis 2022; 17:2677-2692. [PMID: 36281228 PMCID: PMC9587705 DOI: 10.2147/copd.s378247] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/17/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To analyze the relationship between body mass index (BMI) and lung function, which may help optimize the screening and management process for chronic obstructive pulmonary disease (COPD) in the early stages. Patients and Methods In this cross-sectional study using data from the Enjoying Breathing Program in China, participants were divided into two groups according to COPD Screening Questionnaire (COPD-SQ) scores (at risk and not at risk of COPD) and three groups based on lung function (normal lung function, preserved ratio impaired spirometry [PRISm], and obstructive lung function). Results A total of 32,033 subjects were enrolled in the current analysis. First, in people at risk of COPD, overweight and obese participants had better forced expiratory volume in one second (FEV1; overweight: 0.33 liters (l), 95% confidence interval [CI]: 0.27 to 0.38; obesity: 0.31 L, 95% CI: 0.22 to 0.39) values than the normal BMI group. Second, among people with PRISm, underweight participants had a lower FEV1 (−0.56 L, 95% CI: −0.86 to −0.26) and forced vital capacity (FVC; −0.33 L, 95% CI: −0.55 to −0.11) than participants with a normal weight, and obese participants had a higher FEV1 (0.22 L, 95% CI: 0.02 to 0.42) and FVC (0.16 L, 95% CI: 0.02 to 0.30) than participants with a normal weight. Taking normal BMI as the reference group, lower FEV1 (−0.80 L, 95% CI: −0.97 to −0.63) and FVC (−0.53 L, 95% CI: −0.64 to −0.42) were found in underweight participants with obstructive spirometry, and better FEV1 (obesity: 0.26 L, 95% CI: 0.12 to 0.40) was found in obese participants with obstructive spirometry. Conclusion Being underweight and severely obese are associated with reduced lung function. Slight obesity was shown to be a protective factor for lung function in people at risk of COPD and those with PRISm.
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Affiliation(s)
- Xingyao Tang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Capital Medical University, Beijing, 10069, People’s Republic of China
| | - Jieping Lei
- National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China
| | - Wei Li
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Yaodie Peng
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,Peking University Health Science Center, Beijing, 10029, People’s Republic of China
| | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
| | - Ke Huang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China,Correspondence: Ke Huang; Ting Yang, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China, Tel +010-8420 6275, Email ;
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China,National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China,National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China,Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China
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27
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Shen FC, Chen ME, Wu WT, Kuo IC, Niu SW, Lee JJ, Hung CC, Chang JM, Hwang SJ. Normal weight and waist obesity indicated by increased total body fat associated with all-cause mortality in stage 3–5 chronic kidney disease. Front Nutr 2022; 9:982519. [PMID: 36185692 PMCID: PMC9523665 DOI: 10.3389/fnut.2022.982519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic kidney disease (CKD) demonstrate a survival benefit with a high body mass index (BMI); this is the obesity paradox. Central obesity has a higher prognostic value than BMI, even in those with normal weight. Whether total body fat percentage (TBF%) provides more information than BMI and waist circumference (WC) remains unknown. We included 3,262 Asian patients with stage 3–5 CKD and divided these patients by TBF% and waist-to-height ratio (WHtR) quartiles (Q1–Q4). TBF% was associated with BMI, WC, nutritional markers, and C-reactive protein. In all patients, BMI but not TBF% or WHtR demonstrated a survival paradox. In patients with BMI <25 kg/m2, but not in those with BMI ≥ 25 kg/m2, TBF% Q4 and WHtR Q4 were associated with all-cause mortality, with hazard ratios [HRs; 95% confidence intervals (CIs)] of 2.35 (1.31–4.22) and 1.38 (1.06–1.80), respectively. The HRs of TBF% Q4 for all-cause mortality were 2.90 (1.50–5.58) in patients with a normal WC and 3.81 (1.93–7.50) in patients with normal weight and normal WC (All P for interaction < 0.05). In conclusion, TBF% can predict all-cause mortality in patients with advanced CKD and a normal weight, normal WC, or both.
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Affiliation(s)
- Feng-Ching Shen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-En Chen
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Tsung Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Wen Niu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Chi-Chih Hung
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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28
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Yang Y, Zhang H, Lan X, Qin X, Huang Y, Wang J, Luo P, Wen Z, Li Y, Kong Y, Wan Q, Wang Q, Huang S, Liu Y, Liu A, Liu F, Yang S, Lu Y, Zhao Y, Chen J, Lei Z, He Y, Lin Z, Li Y, Liang M. Low BMI and high waist-to-hip ratio are associated with mortality risk among hemodialysis patients: a multicenter prospective cohort study. Clin Kidney J 2022; 16:167-175. [PMID: 36726444 PMCID: PMC9871844 DOI: 10.1093/ckj/sfac210] [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: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
Background Data are limited on the relationship between waist-to-hip ratio (WHR) and mortality risk among maintenance hemodialysis (MHD) patients. Moreover, the combined association of body mass index (BMI) and WHR with mortality remains uncertain. Therefore, we aimed to explore the individual and combined association of BMI and WHR with the all-cause and cardiovascular disease (CVD) mortality. Methods In this multicenter prospective cohort study, we enrolled 1034 MHD patients. The primary outcome was all-cause mortality and secondary outcome was CVD mortality. Multivariable Cox proportional hazards models were used to evaluate the individual and combined association of BMI and WHR with the risk of mortality. Results A nonlinear inverse relationship was found between BMI and risk of all-cause mortality (P for nonlinearity <.05). Being underweight (<18.5 kg/m2) was associated with higher all-cause mortality risk (HR 1.45; 95% CI 1.08-1.94) compared with normal weight (18.5-23.9 kg/m2), while being overweight (24-27.9 kg/m2; HR 0.96; 95% CI 0.70-1.31) and obese (≥28 kg/m2; HR 1.19; 95% CI 0.62-2.26) showed no significant differences. Of note, WHR was independently and positively associated with all-cause mortality (per standard deviation increase, HR 1.13; 95% CI 1.00-1.27). When analyzed jointly, patients with low BMI (<18.5 kg/m2) and high WHR (≥0.95) had the highest risk of all-cause mortality. Similar results were obtained for CVD mortality. Conclusions In patients undergoing hemodialysis from China, low BMI and high WHR were individually and jointly associated with higher risk of mortality. Our results emphasize that BMI and WHR may jointly affect the prognosis of MHD patients.
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Affiliation(s)
- Yaya Yang
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haixia Zhang
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaolei Lan
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Huang
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jieyu Wang
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pei Luo
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Wen
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumin Li
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yaozhong Kong
- Nephrology Department, the First People's Hospital of Foshan, Foshan, China
| | - Qijun Wan
- Nephrology Department, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qi Wang
- Nephrology Department, Huadu District People's Hospital of Guangzhou, Guangzhou, China
| | - Sheng Huang
- Nephrology Department, Southern Medical University Affiliated Nanhai Hospital, Foshan, China
| | - Yan Liu
- Nephrology Department, Guangzhou Red Cross Hospital, Medical College of Jinan University, Guangzhou, China
| | - Aiqun Liu
- Nephrology Department, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Fanna Liu
- Nephrology Department, Jinan University First Affiliated Hospital, Guangzhou, China
| | - Shenglin Yang
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yongxin Lu
- Nephrology Department, People's Hospital of Yuxi City, Yuxi, China
| | - Yanhong Zhao
- Nephrology Department, People's Hospital of Yuxi City, Yuxi, China
| | - Junzhi Chen
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihan Lei
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhuan He
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zizhen Lin
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Youbao Li
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Guangdong Provincial Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Nephrology Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- Correspondence to: Min Liang; E-mail:
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Rajput S, DeMartino R, Mendez B, Sharaf B. Liposuction to Improve Vascular Access in Hemodialysis Patients with Arteriovenous Fistulae. J Vasc Surg Cases Innov Tech 2022; 8:719-725. [DOI: 10.1016/j.jvscit.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 10/14/2022] Open
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Association between high preoperative body mass index and mortality after cancer surgery. PLoS One 2022; 17:e0270460. [PMID: 35802728 PMCID: PMC9269927 DOI: 10.1371/journal.pone.0270460] [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: 11/08/2021] [Accepted: 06/12/2022] [Indexed: 12/24/2022] Open
Abstract
Despite an association between obesity and increased mortality in the general population, obesity has been paradoxically reported with improved mortality of surgery and some types of cancer. However, this has not been fully investigated in patients undergoing cancer surgery. Using a cohort consisting of mostly Asian population, we enrolled 87,567 adult patients who underwent cancer surgery from March 2010 to December 2019. They were divided into three groups according to body mass index (BMI): 53,980 (61.6%) in the normal (18.5–25 kg/m2), 2,787 (3.2%) in the low BMI (<18.5 kg/m2), and 30,800 (35.2%) in the high BMI (≥25 kg/m2) groups. The high BMI group was further stratified into overweight (25–30 kg/m2) and obese (≥30 kg/m2) groups. The primary outcome was mortality during three years after surgery. Following adjustment by inverse probability weighting, mortality during three years after surgery was significantly lower in the high BMI group than the normal (4.8% vs. 7.0%; hazard ratio [HR], 0.69; confidence interval [CI], 0.64–0.77; p < 0.001) and low BMI (4.8% vs. 13.0%; HR: 0.38; CI: 0.35–0.42; p < 0.001) groups. The mortalities of the overweight and obese groups were lower than that of the normal group (7.0% vs. 5.0%; HR: 0.72; CI: 0.67–0.77; p < 0.001 and 7.0% vs. 3.3%; HR: 0.57; CI: 0.50–0.65; p < 0.001, respectively). This association was not observed in female patients and those undergoing surgery for breast and gynecological cancers. High BMI may be associated with decreased mortality after cancer surgery. Further investigations are needed for clinical application of our finding.
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Kempe K, Nelson PR, Mushtaq N, Kim H, Zamor K, Vang S, Pandit V, Randel M, Christie R, Jennings W. Autogenous Vascular Access in American Indians. Ann Vasc Surg 2022; 83:108-116. [PMID: 34954040 DOI: 10.1016/j.avsg.2021.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND American Indians (AI) or Alaska Natives, or in combination with another race, comprised 6.8 million individuals in 2010 and the population is expected to exceed 10 million in the current census. Diabetes is more common in AIs than in other races in the United States and is responsible for 69% of new onset end stage renal disease in AI patients. The incidence of obesity is also higher among AIs. As both diabetes and obesity make creating a successful autogenous vascular access more challenging, we reviewed our experience creating arteriovenous fistulas in AI patients. METHODS Our vascular access database was reviewed for consecutive new AI patients undergoing creation of a hemodialysis vascular access during a 10-year period. Each patient underwent ultrasound vessel mapping by the operating surgeon in addition to history and physical examination. The goal for initial cannulation was 4-6 weeks after access creation. Minimal AVF flow volume for cannulation was 500 mL/min with an outflow vein diameter of 6 mm. RESULTS 235 consecutive new AI patients were identified. All patients had an autogenous access constructed. The median age was 56 years (range, 15-89 years). Diabetes was present in 85% and 42% were female. Obesity was noted in 27% of the patients and 37% had previous vascular access operations. Primary patency at 12 and 24 months was 62% and 46%, respectively. Cumulative patency at 12 and 24 months was 96% and 94%, respectively. Female gender and previous access operations were associated with lower primary (P = 0.002 and 0.02, respectively) and cumulative patency (P = 0.01 and 0.04, respectively). Obesity was associated with lower cumulative access patency (P = 0.02). Overall, 74% of the access operations used the radial or ulnar artery for AVF inflow. Distal radial artery inflow AVFs were associated with longer patient survival (P = 0.01) and individuals with proximal radial inflow had longer survival when compared to brachial artery AVFs. Previous access operations were associated with shorter patient survival (P = 0.04). CONCLUSIONS Safe and functional arteriovenous fistulas can be created for American Indians despite a higher prevalence of vascular access risk factors such as diabetes and obesity.
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Affiliation(s)
- Kelly Kempe
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Nasir Mushtaq
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Tulsa, OK
| | - Hyein Kim
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Kimberly Zamor
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Steven Vang
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Viraj Pandit
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Mark Randel
- Eastern Oklahoma VA Health Care System, Department of Surgery, OK
| | - Ryan Christie
- University of Oklahoma School of Community Medicine, Tulsa, OK
| | - William Jennings
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community, Medicine, Tulsa, OK.
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Association between Body Mass Index and Renal Outcomes Modified by Chronic Kidney Disease and Anemia: The Obesity Paradox for Renal Outcomes. J Clin Med 2022; 11:jcm11102787. [PMID: 35628912 PMCID: PMC9144670 DOI: 10.3390/jcm11102787] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
Obesity-related nephropathy is associated with renal function progression. However, some studies have associated a high body mass index (BMI) with improved renal outcomes—this is referred to as the obesity paradox for renal outcomes, especially in relation to advanced chronic kidney disease (CKD). Central obesity can explain the obesity paradox in all-cause mortality. However, whether obesity or central obesity is associated with renal outcomes (renal replacement therapy or a 50% decline in the estimated glomerular filtration rate) in patients with advanced CKD remains unclear. Our study included 3605 Asian patients with CKD stages 1−5 divided into six groups according to their BMI (between 15 and 35 kg/m2). Through linear regression, BMI was positively associated with hemoglobin and albumin at CKD stages 4 and 5. In the competing risk Cox regression model, a high BMI (27.5−35 kg/m2) was associated with renal outcomes at CKD stages 1−3, but not stages 4 and 5. A high BMI was associated with renal outcomes in patients with hemoglobin ≥11 g/dL, but not <11 g/dL. A high waist-to-hip ratio was not associated with renal outcomes. We conclude that the CKD stage and anemia may explain the obesity paradox in renal outcomes in patients with CKD.
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Dialysis Care for US Military Veterans in Puerto Rico during the 2017 Atlantic Hurricane Season. Disaster Med Public Health Prep 2022; 17:e187. [PMID: 35514312 DOI: 10.1017/dmp.2022.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Patients with end stage kidney disease (ESKD) are at higher risk for increased mortality and morbidity due to disaster-related disruptions to care. We examine effects of Hurricanes Irma and Maria on access to dialysis care for US Department of Veterans Affairs (VA) ESKD patients in Puerto Rico. METHODS A retrospective, longitudinal cohort study was conducted among VA patients with at least 1 dialysis-related encounter between September 6, 2016, and September 5, 2018. The annual number of dialysis encounters, visits to an emergency department (ED), and the number of deaths pre- and post-hurricanes were compared. A random effects logistic regression model for correlated binary outcomes was fitted for predictors of mortality. Chi-square tests were for differences between pre- and post-hurricane visits. RESULTS The number of ED visits increased in post-hurricane period (1172 [5.7%] to 1195 [6.6%]; P < 0.001). ESKD-related ED visits increased from 200 (0.9%) to 227 (1.3%) (P < 0.05). Increase in mortality was associated with age (OR = 1.66; CI: 1.23-2.17), heart failure (OR = 2.07; CI: 1.26-3.40), chronic pulmonary disease (OR = 3.26; CI: 1.28-8.28), and sepsis (OR = 3.16; CI: 1.89-5.29). CONCLUSIONS There was an increase in dialysis services at the San Juan VA Medical Center post-Irma/Maria, and access to dialysis care at the non-VA clinics was limited. The role of VA dialysis centers in providing care during disasters warrants further investigation.
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Shu X, Lin T, Wang H, Zhao Y, Jiang T, Peng X, Yue J. Diagnosis, prevalence, and mortality of sarcopenia in dialysis patients: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 2022; 13:145-158. [PMID: 34989172 PMCID: PMC8818609 DOI: 10.1002/jcsm.12890] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023] Open
Abstract
There is no consensus on the prevalence of sarcopenia or its impact on mortality in end-stage renal disease patients undergoing dialysis. This review aimed to summarize the diagnostic criteria of sarcopenia and its prevalence and impact on the mortality of end-stage renal disease patients undergoing dialysis. Embase, MEDLINE, PubMed, and Cochrane Library were searched from inception to 8 May 2021 to retrieve eligible studies that assessed muscle mass by commonly used instruments, such as dual-energy X-ray absorptiometry, bioelectrical impedance analysis, magnetic resonance imaging, and body composition monitor. Two assessment tools matched to study designs were employed to evaluate study quality. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I2 test. Associations of sarcopenia with mortality were expressed as hazard ratio (HR) and 95% CI. The search identified 3272 studies, and 30 studies (6162 participants, mean age from 47.5 to 77.5 years) were analysed in this review. The risk of bias in the included studies was low to moderate. Twenty-two studies defined sarcopenia based on low muscle mass (LMM) plus low muscle strength and/or low physical performance, while eight studies used LMM alone. Muscle mass was assessed by different instruments, and a wide range of cut-off points were used to define LMM. Overall, sarcopenia prevalence was 28.5% (95% CI 22.9-34.1%) and varied from 25.9% (I2 = 94.9%, 95% CI 20.4-31.3%; combined criteria) to 34.6% (I2 = 98.1%, 95% CI 20.9-48.2%; LMM alone) (P = 0.247 between subgroups). The statistically significant differences were not found in the subgroups of diagnostic criteria (P > 0.05) and dialysis modality (P > 0.05). Additionally, the sarcopenia prevalence could not be affected by average age [regression coefficient 0.004 (95% CI: -0.005 to 0.012), P = 0.406] and dialysis duration [regression coefficient 0.002 (95% CI -0.002 to 0.005), P = 0.327] in the meta-regression. The pooled analyses showed that combined criteria of sarcopenia were related to a higher mortality risk [HR 1.82 (I2 = 26.3%, 95% CI 1.38-2.39)], as was LMM [HR 1.61 (I2 = 26.0%, 95% CI 1.31-1.99)] and low muscle strength [HR 2.04 (I2 = 80.4%, 95% CI 1.19-3.5)]. Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in dialysis patients and is linked to increased mortality. The standardization of sarcopenia diagnostic criteria would be beneficial, and future longitudinal studies are needed to investigate the prevalence and prognostic value of sarcopenia in dialysis patients.
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Affiliation(s)
- Xiaoyu Shu
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Taiping Lin
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Hui Wang
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Yanli Zhao
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Tingting Jiang
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xuchao Peng
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
| | - Jirong Yue
- Department of Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
- National Clinical Research Center for Geriatrics, West China HospitalSichuan UniversityChengduSichuanChina
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U-Shaped Association between Waist-to-Hip Ratio and All-Cause Mortality in Stage 3-5 Chronic Kidney Disease Patients with Body Mass Index Paradox. J Pers Med 2021; 11:jpm11121355. [PMID: 34945829 PMCID: PMC8703404 DOI: 10.3390/jpm11121355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/20/2022] Open
Abstract
The obesity paradox, referring to the association of high body mass index (BMI) with low all-cause mortality risk, is found in patients with chronic kidney disease (CKD). Central obesity is associated with metabolic syndrome and may have better prognostic value than BMI for all-cause mortality. Whether central obesity is associated with all-cause mortality in cases of obesity paradox in CKD patients remains unknown. We included 3262 patients with stage 3–5 CKD, grouped into five quintiles (Q1–5) by waist-to-hip ratio (WHR). Low WHR and BMI were associated with malnutrition and inflammation. In Cox regression, high BMI was not associated with all-cause mortality, but BMI < 22.5 kg/m2 increased the mortality risk. A U-shaped association between central obesity and all-cause mortality was found: WHR Q1, Q4, and Q5 had higher risk for all-cause mortality. The hazard ratio (95% confidence interval) of WHR Q5 and Q1 for all-cause mortality was 1.39 (1.03–1.87) and 1.53 (1.13–2.05) in male and 1.42 (1.02–1.99) and 1.28 (0.88–1.85) in female, respectively. Waist-to-height ratio and conicity index showed similar results. Low WHR or low BMI and high WHR, but not high BMI, are associated with all-cause mortality in advanced CKD.
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Li Y, Nguyen DV, Kürüm E, Rhee CM, Banerjee S, Şentürk D. Multilevel Varying Coefficient Spatiotemporal Model. Stat (Int Stat Inst) 2021; 11. [DOI: 10.1002/sta4.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yihao Li
- Department of Biostatistics University of California Los Angeles CA USA
| | - Danh V. Nguyen
- Department of Medicine University of California Irvine Orange CA USA
| | - Esra Kürüm
- Department of Statistics University of California Riverside CA USA
| | - Connie M. Rhee
- Department of Medicine University of California Irvine Orange CA USA
- Harold Simmons Center for Chronic Disease Research and Epidemiology University of California Irvine School of Medicine Orange CA USA
| | - Sudipto Banerjee
- Department of Biostatistics University of California Los Angeles CA USA
| | - Damla Şentürk
- Department of Biostatistics University of California Los Angeles CA USA
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Hornik B, Duława J, Durmała J. Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11952. [PMID: 34831708 PMCID: PMC8622865 DOI: 10.3390/ijerph182211952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/05/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022]
Abstract
Metabolic syndrome (MS) and anxiety disorders are common problems among hemodialysis patients (HD). However, there have been no studies defining the role of physical activity in reducing anxiety in HD patients with MS. This study was aimed to determine the effects on the severity of anxiety of a four-week rehabilitation program for HD patients, with or without metabolic syndrome (MS), planned and adapted to their abilities. The study was single-center, interventional, non-randomized, and prospective. Fifty-eight individuals completed the project (28 HD patients and 30 controls (C) with normal kidney function). Each group was divided into two subgroups with respect to MS. The mean age of the subjects in the HD and C groups was 56.9 ± 13.3 years (x¯ ± SD) and 61.5 ± 8.3 years (x¯ ± SD), respectively. Planned and adapted to the patient's abilities, the rehabilitation program based on physiotherapy was provided to each subject for 4 weeks. Baseline and post-intervention determined anxiety levels using the State-Trait Anxiety Inventory (STAI). The X1 scale tests state anxiety, and the X2 scale tests trait anxiety. Post-intervention, there was no significant difference in the intensity of state anxiety observed in HD patients compared to C with normal renal function, as observed before the program. After four weeks of regular physical activity planned and adapted to the patient's abilities in an inpatient ward, the level of state anxiety (X1) and trait anxiety (X2) lowered considerably in all HD patients (respectively: 35.1 ± 8.0 vs. 29.2 ± 5.0, p = 0.001 for X1 and 41.8 ± 9.1 vs. 38.1 ± 5.9, p = 0.008 for X2). The rehabilitation program significantly reduced the intensity of state anxiety (X1) in HD patients with MS (35.8 ± 7.9 vs. 29.2 ± 5.1; p = 0.01). The rehabilitation program helped to significantly reduce the intensity of trait anxiety (X2) in HD patients without MS (41.9 ± 10.7 vs. 36.9 ± 5.9; p = 0.04). Four-week physical activity planned and adapted to the patient's abilities reduces the intensity of anxiety in HD patients and controls with normal renal function. HD patients with MS benefit more in terms of reducing perceived state anxiety, and HD patients without MS in terms of reducing trait anxiety.
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Affiliation(s)
- Beata Hornik
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
- Diaverum, 40-635 Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, School of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
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Salerno S, Messana JM, Gremel GW, Dahlerus C, Hirth RA, Han P, Segal JH, Xu T, Shaffer D, Jiao A, Simon J, Tong L, Wisniewski K, Nahra T, Padilla R, Sleeman K, Shearon T, Callard S, Yaldo A, Borowicz L, Agbenyikey W, Horton GM, Roach J, Li Y. COVID-19 Risk Factors and Mortality Outcomes Among Medicare Patients Receiving Long-term Dialysis. JAMA Netw Open 2021; 4:e2135379. [PMID: 34787655 PMCID: PMC8600389 DOI: 10.1001/jamanetworkopen.2021.35379] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 12/18/2022] Open
Abstract
Importance There is a need for studies to evaluate the risk factors for COVID-19 and mortality among the entire Medicare long-term dialysis population using Medicare claims data. Objective To identify risk factors associated with COVID-19 and mortality in Medicare patients undergoing long-term dialysis. Design, Setting, and Participants This retrospective, claims-based cohort study compared mortality trends of patients receiving long-term dialysis in 2020 with previous years (2013-2019) and fit Cox regression models to identify risk factors for contracting COVID-19 and postdiagnosis mortality. The cohort included the national population of Medicare patients receiving long-term dialysis in 2020, derived from clinical and administrative databases. COVID-19 was identified through Medicare claims sources. Data were analyzed on May 17, 2021. Main Outcomes and Measures The 2 main outcomes were COVID-19 and all-cause mortality. Associations of claims-based risk factors with COVID-19 and mortality were investigated prediagnosis and postdiagnosis. Results Among a total of 498 169 Medicare patients undergoing dialysis (median [IQR] age, 66 [56-74] years; 215 935 [43.1%] women and 283 227 [56.9%] men), 60 090 (12.1%) had COVID-19, among whom 15 612 patients (26.0%) died. COVID-19 rates were significantly higher among Black (21 787 of 165 830 patients [13.1%]) and Hispanic (13 530 of 86 871 patients [15.6%]) patients compared with non-Black patients (38 303 of 332 339 [11.5%]), as well as patients with short (ie, 1-89 days; 7738 of 55 184 patients [14.0%]) and extended (ie, ≥90 days; 10 737 of 30 196 patients [35.6%]) nursing home stays in the prior year. Adjusting for all other risk factors, residing in a nursing home 1 to 89 days in the prior year was associated with a higher hazard for COVID-19 (hazard ratio [HR] vs 0 days, 1.60; 95% CI 1.56-1.65) and for postdiagnosis mortality (HR, 1.31; 95% CI, 1.25-1.37), as was residing in a nursing home for an extended stay (COVID-19: HR, 4.48; 95% CI, 4.37-4.59; mortality: HR, 1.12; 95% CI, 1.07-1.16). Black race (HR vs non-Black: HR, 1.25; 95% CI, 1.23-1.28) and Hispanic ethnicity (HR vs non-Hispanic: HR, 1.68; 95% CI, 1.64-1.72) were associated with significantly higher hazards of COVID-19. Although home dialysis was associated with lower COVID-19 rates (HR, 0.77; 95% CI, 0.75-0.80), it was associated with higher mortality (HR, 1.18; 95% CI, 1.11-1.25). Conclusions and Relevance These results shed light on COVID-19 risk factors and outcomes among Medicare patients receiving long-term chronic dialysis and could inform policy decisions to mitigate the significant extra burden of COVID-19 and death in this population.
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Affiliation(s)
- Stephen Salerno
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Joseph M. Messana
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Division of Nephrology, University of Michigan Health System, Ann Arbor
- Department of Health Policy and Management, University of Michigan, Ann Arbor
| | - Garrett W. Gremel
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Claudia Dahlerus
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Division of Nephrology, University of Michigan Health System, Ann Arbor
| | - Richard A. Hirth
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Department of Health Policy and Management, University of Michigan, Ann Arbor
| | - Peisong Han
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Department of Biostatistics, University of Michigan, Ann Arbor
| | - Jonathan H. Segal
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Division of Nephrology, University of Michigan Health System, Ann Arbor
| | - Tao Xu
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Dan Shaffer
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Amy Jiao
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Jeremiah Simon
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Lan Tong
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Karen Wisniewski
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Tammie Nahra
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Robin Padilla
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Kathryn Sleeman
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Tempie Shearon
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Sandra Callard
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Alexander Yaldo
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | - Lisa Borowicz
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
| | | | | | - Jesse Roach
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Yi Li
- University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor
- Department of Biostatistics, University of Michigan, Ann Arbor
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Choudhury D, Yalamanchili HB, Hasan A. Dialysis of the Obese Patient: Meeting Needs for a Growing Epidemic. Semin Nephrol 2021; 41:371-379. [PMID: 34715966 DOI: 10.1016/j.semnephrol.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Increasing population obesity and associated metabolic consequences has led to increased number of obese patients with chronic kidney disease and end-stage renal disease. While obesity is associated with increased cardiovascular morbidity and mortality, obese dialysis patients present a seeming paradox for survival benefit, given other acute intervening illnesses for those on dialysis with loss of lean body mass overtime. Challenges remain in providing adequate renal replacement options and therapy for this growing segment of obese patients on dialysis which are discussed in this article.
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Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA; Department of Medicine, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, VA.
| | - Hima Bindu Yalamanchili
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA; Department of Medicine, Division of Nephrology, Virginia Tech Carilion School of Medicine, Roanoke, VA
| | - Alia Hasan
- Department of Medicine, Division of Nephrology, Salem Veterans Affairs Health System, Salem, VA
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Maraj M, Hetwer P, Kuśnierz-Cabala B, Maziarz B, Dumnicka P, Kuźniewski M, Ceranowicz P. α 1-Acid Glycoprotein and Dietary Intake in End-Stage Renal Disease Patients. Nutrients 2021; 13:nu13113671. [PMID: 34835927 PMCID: PMC8621909 DOI: 10.3390/nu13113671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023] Open
Abstract
Management of end-stage renal disease (ESRD) patients requires monitoring each of the components of malnutrition–inflammation–atherosclerosis (MIA) syndrome. Restrictive diet can negatively affect nutritional status and inflammation. An acute-phase protein—α1-acid glycoprotein (AGP), has been associated with energy metabolism in animal and human studies. The aim of our study was to look for a relationship between serum AGP concentrations, laboratory parameters, and nutrient intake in ESRD patients. The study included 59 patients treated with maintenance hemodialysis. A 24 h recall assessed dietary intake during four non-consecutive days—two days in the post-summer period, and two post-winter. Selected laboratory tests were performed: complete blood count, serum iron, total iron biding capacity (TIBC) and unsaturated iron biding capacity (UIBC), vitamin D, AGP, C-reactive protein (CRP), albumin, prealbumin, and phosphate–calcium metabolism markers (intact parathyroid hormone, calcium, phosphate). Recorded dietary intake was highly deficient. A majority of patients did not meet recommended daily requirements for energy, protein, fiber, iron, magnesium, folate, and vitamin D. AGP correlated positively with CRP (R = 0.66), platelets (R = 0.29), and negatively with iron (R = −0.27) and TIBC (R = −0.30). AGP correlated negatively with the dietary intake of plant protein (R = −0.40), potassium (R = −0.27), copper (R = −0.30), vitamin B6 (R = −0.27), and folates (R = −0.27), p < 0.05. However, in multiple regression adjusted for confounders, only CRP was significantly associated with AGP. Our results indicate that in hemodialyzed patients, serum AGP is weakly associated with dietary intake of several nutrients, including plant protein.
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Affiliation(s)
- Małgorzata Maraj
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Kraków, Poland; (M.M.); (P.C.)
| | - Paulina Hetwer
- Faculty of Medicine, Dietetics, Jagiellonian University Medical College, Anny 12 St., 31-008 Kraków, Poland;
| | - Beata Kuśnierz-Cabala
- Chair of Clinical Biochemistry, Department of Diagnostics, Faculty of Medicine, Jagiellonian University Medical College, Skawińska 8 St., 31-066 Kraków, Poland;
- Correspondence: ; Tel.: +48-12-4332863
| | - Barbara Maziarz
- Chair of Clinical Biochemistry, Department of Diagnostics, Faculty of Medicine, Jagiellonian University Medical College, Skawińska 8 St., 31-066 Kraków, Poland;
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 St., 30-688 Kraków, Poland;
| | - Marek Kuźniewski
- Chair and Department of Nephrology, Faculty of Medicine, Jagiellonian University Medical College, Jakubowskiego 2 St., 30-688 Kraków, Poland;
| | - Piotr Ceranowicz
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Grzegórzecka 16 St., 31-531 Kraków, Poland; (M.M.); (P.C.)
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41
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Shimamoto S, Yamada S, Hiyamuta H, Arase H, Taniguchi M, Tsuruya K, Nakano T, Kitazono T. Association of the nutritional risk index for Japanese hemodialysis patients with long-term mortality: The Q-Cohort Study. Clin Exp Nephrol 2021; 26:59-67. [PMID: 34403008 DOI: 10.1007/s10157-021-02124-6] [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: 09/07/2020] [Accepted: 08/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Protein-energy wasting (PEW) is a risk factor for mortality in patients undergoing hemodialysis. Recently, a nutritional risk index for Japanese hemodialysis patients (NRI-JH) has been proposed as a surrogate index of PEW. However, no study has determined the association of the NRI-JH with long-term mortality in patients undergoing hemodialysis. Furthermore, the validity of the NRI-JH has not been confirmed. METHODS In total, 3046 patients undergoing hemodialysis and registered in the Q-Cohort Study were followed up for 10 years. The NRI-JH was calculated on the basis of body mass index and serum levels of albumin, total cholesterol, and creatinine. The patients were divided into four groups according to the NRI-JH scores: 0-3 (G1, n = 1343), 4-7 (G2, n = 1136), 8-10 (G3, n = 321), and 11-13 (G4, n = 246). We examined the association between the NRI-JH and the 4-year and 10-year risks of all-cause, cardiovascular, and infection-related deaths using the Cox proportional hazards model. RESULTS During the follow-up period, 647 patients died during the first 4 years, and 1503 patients died within 10 years. The 4-year prognosis was analyzed and compared with the lowest NRI-JH score group. Multivariable-adjusted hazard ratios (95% confidence intervals) for all-cause death were 1.93 (1.57-2.38), 2.68 (2.05-3.50), and 3.16 (2.40-4.16) in the G2, G3, and G4 groups, respectively. Similarly, a higher NRI-JH score was associated with an increased risk of cardiovascular and infection-related deaths. CONCLUSION A higher NRI-JH score was associated with an increased risk of long-term mortality in patients undergoing maintenance hemodialysis. TRIAL REGISTRATION The study protocol was registered in the University Hospital Medical Information Network (UMIN) clinical trial registry (UMIN ID: 000000556).
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Affiliation(s)
- Sho Shimamoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | | | | | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan.
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
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Li Q, Tong Y, Liu S, Yang K, Liu C, Zhang J. Association between body mass index and short-term mortality in patients with intra-abdominal infections: a retrospective, single-centre cohort study using the Medical Information Mart for Intensive Care database. BMJ Open 2021; 11:e046623. [PMID: 34389563 PMCID: PMC8365805 DOI: 10.1136/bmjopen-2020-046623] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to determine the relationship between the body mass index (BMI) and short-term mortality of patients with intra-abdominal infection (IAI) using the Medical Information Mart for Intensive Care (MIMIC-III) database. DESIGN Retrospective cohort study. SETTING Adult intensive care units (ICUs) at a tertiary hospital in the USA . PARTICIPANTS Adult IAI ICU patients from 2001 to 2012 in the MIMIC-III database. INTERVENTIONS In univariate analysis, we compared the differences in the characteristics of patients in each BMI group. Cox regression models were used to evaluate the relationships between BMI and short-term prognosis. PRIMARY AND SECONDARY OUTCOME MEASURES 90-day survival. RESULTS In total, 1161 patients with IAI were included. There were 399 (34.4%) patients with a normal BMI (<25 kg/m2), 357 (30.8%) overweight patients (25-30 kg/m2) and 405 (34.9%) obese patients (>30 kg/m2) who tended to be younger (p<0.001) and had higher Sequential Organ Failure Assessment scores (p<0.05). The mortality of obese patients at 90 days was lower than that of patients with a normal BMI (20.74% vs 23.25%, p<0.05), but their length of stay in the ICU was higher (4.9 days vs 3.6 days, p<0.001); however, their rate of mechanical ventilation utilisation was higher (61.48% vs 56.86%, p<0.05). In the Cox regression model, we also confirmed that BMI was a protective factor in patients with IAIs, and the adjusted mortality rate of patients with a higher BMI was 0.97 times lower than that of patients with a lower BMI (p<0.001, HR=0.97, 95% CI 0.96 to 0.99). CONCLUSIONS IAI patients with an overweight or obese status might have lower 90-day mortality than patients with a normal BMI.
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Affiliation(s)
- Qinglin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Sinan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kaibo Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Corlateanu A, Plahotniuc A, Corlateanu O, Botnaru V, Bikov A, Mathioudakis AG, Covantev S, Siafakas N. Multidimensional indices in the assessment of chronic obstructive pulmonary disease. Respir Med 2021; 185:106519. [PMID: 34175803 DOI: 10.1016/j.rmed.2021.106519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD), a very common disease, is the third leading cause of death worldwide. Due to the significant heterogeneity of clinical phenotypes of COPD there is no single method suitable for predicting patients' health status and outcomes, and therefore multidimensional indices, assessing different components of the disease, were developed and are recommended for clinical practice by international guidelines. Several indices have been widely accepted: BODE and its modifications, ADO, DOSE, CODEX, COTE. They differ in their composition and aim, while they are more accurate and better validated in specific settings and populations. We review the characteristics, strengths and limitations of these indices, and we discuss their role in routine management of patients with COPD, as well as in specific clinical scenarios, such as resuscitation and ceiling of care, or decisions to offer more invasive treatments. This analysis may help clinicians to use those indexes in a more practical and appropriate way.
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Affiliation(s)
- Alexandru Corlateanu
- Department of Internal Medicine, Division of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Stefan cel Mare street 165, 2004, Republic of Moldova.
| | - Alexandra Plahotniuc
- Department of Internal Medicine, Division of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Stefan cel Mare street 165, 2004, Republic of Moldova.
| | - Olga Corlateanu
- Department of Internal Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Stefan cel Mare street 165, 2004, Republic of Moldova.
| | - Victor Botnaru
- Department of Internal Medicine, Division of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Stefan cel Mare street 165, 2004, Republic of Moldova.
| | - Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK; North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Serghei Covantev
- Department of Internal Medicine, Division of Respiratory Medicine, State University of Medicine and Pharmacy "Nicolae Testemitanu", Chisinau, Stefan cel Mare street 165, 2004, Republic of Moldova.
| | - Nikolaos Siafakas
- University General Hospital, Dept. of Thoracic Medicine, Stavrakia, Heraklion, Crete, 71110 Heraklion, Greece.
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Corlateanu A, Plahotniuc A, Corlateanu O, Botnaru V, Bikov A, Mathioudakis AG, Covantev S, Siafakas N. Multidimensional indices in the assessment of chronic obstructive pulmonary disease. Respir Med 2021. [DOI: doi.org/10.1016/j.rmed.2021.106519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sanchez S, Teelucksingh S, Ali R, Bailey H, Legall G. Quality of Life and Health Status Among Patients Receiving Renal Replacement Therapy in Trinidad and Tobago, West Indies. Int J Nephrol Renovasc Dis 2021; 14:173-192. [PMID: 34135618 PMCID: PMC8199923 DOI: 10.2147/ijnrd.s302157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The determinants of quality of life for patients on renal replacement therapy vary across the world. The aim of this study is to determine the quality of life of patients on renal replacement therapy in Trinidad and Tobago and predictors thereof. PATIENTS AND METHODS This cross-sectional study took place over a 1-year period. Data were obtained from 530 out of 1383 patients meeting inclusion criteria (100 transplants, 80 peritoneal dialyses, 350 hemodialyses) using the survey instruments. Stratified random sampling with proportional allocation was used to select patients at hemodialysis centres. The Kidney Disease Quality of Life questionnaire (KDQOL-36), EuroQol and demographic questionnaires were administered via face-to-face interviews. SPSS24, STATA14 and MINITAB18 were used for descriptive and inferential data analysis. RESULTS Of the 530 patients, 52.5% were male, 37.5% were in the 56-65 years age group and 51.3% were of Indo-Trinbagonian descent. Hypertension (25.5%) and type 2 diabetes mellitus (62.0%) were reported as the main causes of kidney disease in the dialysis group. In the transplant category, chronic glomerulonephritis (45%) was the main aetiology of kidney disease. The KDQOL-36 domain scores and significantly associated variables included modality of renal replacement, Charlson's Comorbidity Index, ethnicity, income and employment status. Transplant patients had higher mean subcomponent Kidney Disease Quality of Life scores and performed better in the EuroQol than patients on dialysis. Patients on peritoneal dialysis had a better quality of life than hemodialysis patients. Among patients on hemodialysis, an arteriovenous fistula significantly impacted their quality of life. CONCLUSION Renal transplant recipients enjoy the best quality of life and health state among patients on renal replacement therapy in Trinidad and Tobago. Increasing patients' access to renal transplantation or peritoneal dialysis will markedly improve health status for the number of years of renal replacement therapy.
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Affiliation(s)
- Sharlene Sanchez
- Department of Medicine, North Central Regional Health Authority, Arima General Hospital, Arima, Trinidad and Tobago, West Indies
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Ronan Ali
- Department of Clinical Medical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago, West Indies
| | - Henry Bailey
- Department of Economics, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
| | - George Legall
- Department of Natural Sciences, University of the West Indies, St Augustine, Trinidad and Tobago, West Indies
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Ito K, Ookawara S, Imai S, Kakuda H, Bandai Y, Fueki M, Yasuda M, Kamimura T, Kiryu S, Wada N, Hamashima Y, Shindo M, Kobayashi T, Sanayama H, Kaku Y, Tanno K, Ohnishi Y, Iino N, Dezaki K, Kakei M, Tabei K, Morishita Y. Muscle mass evaluation using psoas muscle mass index by computed tomography imaging in hemodialysis patients. Clin Nutr ESPEN 2021; 44:410-414. [PMID: 34330498 DOI: 10.1016/j.clnesp.2021.04.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 04/01/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIMS The use of the psoas muscle mass index (PMI) using computed tomography (CT) has become a marker of interest to evaluate whole body muscle mass. However, in hemodialysis (HD) patients, reports about the clinical significance of psoas muscle evaluation are limited. We aimed to clarify the association between PMI and skeletal muscle mass index (SMI) using bioelectrical impedance analysis (BIA), and to investigate factors affecting PMI in HD patients. METHODS In this prospective observational study, to evaluate muscle mass, SMI was measured using BIA after HD, and PMI was measured by the manual trace method on routinely available CT scans. PMI measurement was assessed twice by two physicians to compute intra-rater and inter-rater reliability. The correlations between PMI and the clinical factors were evaluated using Pearson's correlation coefficient and a linear regression analysis. Variables with a p-value < 0.05 in the simple linear regression analysis were included in the multivariable linear regression analysis to identify the factors that affected PMI of the HD patients. RESULTS Fifty HD patients were recruited (31 males and 19 females; HD duration, 9.0 ± 8.8 years). The SMI was 6.10 ± 1.20 kg/m2, and the PMI was 4.79 ± 1.61 cm2/m2. Regarding the reliability of PMI measurements, intra-rater reliability [intra-class correlation (ICC) = 0.999] and inter-rater reliability (ICC = 0.998) were high in this study. The mean PMI of male patients was 5.40 ± 1.62 cm2/m2, while that of female patients was significantly lower (3.78 ± 0.98 cm2/m2; p < 0.001). The PMI was significantly and positively correlated with SMI (r = 0.630, p < 0.001), in addition to HD duration, body mass index (BMI), serum phosphate and serum creatinine (Cr). In the multivariate linear regression analysis by two models using SMI or BMI, they were respectively extracted as an independent factor associating with PMI, in addition to serum Cr and the difference of sex. CONCLUSIONS PMI assessed with CT positively correlated with SMI measured using BIA. PMI might be one of the methods for evaluating the muscle mass in HD patients, when CT scans are taken as part of routine care.
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Affiliation(s)
- Kiyonori Ito
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Sojiro Imai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Hideo Kakuda
- Department of Radiology, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yusaku Bandai
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Mariko Fueki
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Masatoshi Yasuda
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Tatsuya Kamimura
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Satoshi Kiryu
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Noriko Wada
- Department of Dialysis, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yuri Hamashima
- Department of Population Health Science, Bristol Medical School, University of Bristol, England, UK
| | - Mitsutoshi Shindo
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Tadanao Kobayashi
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Hidenori Sanayama
- Division of Neurology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshio Kaku
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keisuke Tanno
- Division of Radiology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasushi Ohnishi
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Noriaki Iino
- Division of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuya Dezaki
- Division of Integrative Physiology, Department of Physiology, Jichi Medical University, Tochigi, Japan; Department of Pharmacy, Iryo Sosei University, Fukushima, Japan
| | - Masafumi Kakei
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Kaoru Tabei
- Department of Internal Medicine, Minami-Uonuma City Hospital, Niigata, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Zhang J, Lu X, Li H, Wang S. Risk factors for mortality in patients undergoing peritoneal dialysis: a systematic review and meta-analysis. Ren Fail 2021; 43:743-753. [PMID: 33913381 PMCID: PMC8901278 DOI: 10.1080/0886022x.2021.1918558] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim Inconsistent investigations of the risk factors for all-cause mortality in patients undergoing peritoneal dialysis (PD) were reported. The present meta-analysis aimed to assess the impact of some clinical characteristics on the risk of mortality in PD patients. Methods PubMed and Embase were systematically searched for studies evaluating the risk factors for all-cause mortality in PD patients. Hazard ratio (HR) and 95% confidence interval (CI) were derived using a random-effect or fixed-effect model considering the heterogeneity across studies. Result A total of 26 studies were included in this meta-analysis in accordance with the inclusion and exclusion criteria. Age, primary cardiovascular diseases, diabetes mellitus, and high level of alkaline phosphatase showed significant positive associations with elevated risk of all-cause and cardiovascular mortality in PD patients, while hemoglobin acted as a benefit factor. Furthermore, early onset of peritonitis, high peritoneal transport status, elevated body mass index and high-sensitivity C-reactive protein could also considerably increase the risk of all-cause mortality. The absolute serum level of magnesium, potassium, and uric acid required to improve survival in PD patients should be verified further. Conclusions Multiple factors could affect the risk of mortality in PD patients.
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Affiliation(s)
- Jialing Zhang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiangxue Lu
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Han Li
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shixiang Wang
- Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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48
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Navarrete JE, Tong DC, Cobb J, Rahbari-Oskoui FF, Hosein D, Caberto SC, Lea JP, Franch HA. Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population. Am J Nephrol 2021; 52:190-198. [PMID: 33827078 PMCID: PMC8089403 DOI: 10.1159/000514752] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. METHODS From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. RESULTS Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age >65 years (RR 13.7, CI: 1.9-100.7), C-reactive protein >100 mg/dL (RR 8.3, CI: 1.1-60.4), peak D-dimer >3,000 ng/mL (RR 4.3, CI: 1.03-18.2), bilirubin >1 mg/dL (RR 3.9, CI: 1.5-10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2-9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3-10.1). CONCLUSION In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.
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Affiliation(s)
- José E. Navarrete
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David C. Tong
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jason Cobb
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Darya Hosein
- Clinical Research Coordinator I, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sheryl C. Caberto
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Medical Subspecialties Service Line, Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
| | - Janice P. Lea
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Harold A. Franch
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Medical Subspecialties Service Line, Atlanta Department of Veterans Affairs Medical Center, Decatur, Georgia, USA
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49
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Spaggiari M, Di Cocco P, Tulla K, Kaylan KB, Masrur MA, Hassan C, Alvarez JA, Benedetti E, Tzvetanov I. Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure. Am J Transplant 2021; 21:1525-1534. [PMID: 32976702 DOI: 10.1111/ajt.16322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
Patients with obesity have limited access to kidney transplantation, mainly due to an increased incidence of surgical complications, which could be reduced with selective use of robotic-assisted surgery. This prospective randomized controlled trial compares the safety and efficacy of combining robotic sleeve gastrectomy and robotic-assisted kidney transplant to robotic kidney transplant alone in candidates with class II or III obesity. Twenty candidates were recruited, 11 were randomized to the robotic sleeve gastrectomy and robotic-assisted kidney transplant group and 9 to the robotic kidney transplant group. At 12-month follow-up, change in body mass index was -8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (P = .0041). Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups. Length of surgery was longer in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group (405 minutes vs. 269 minutes, p = .00304) without increase in estimated blood loss (120 ml vs. 117 ml, p = .908) or incidence of surgical complications. Combined robotic-assisted kidney transplant and sleeve gastrectomy is safe and effective compared to robotic-assisted kidney transplant alone.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kiara Tulla
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kerim B Kaylan
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mario A Masrur
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Chandra Hassan
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jorge A Alvarez
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
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Sex Difference in the Association between Physical Activity and All-Cause Mortality in Ambulatory Patients with Chronic Kidney Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073698. [PMID: 33916240 PMCID: PMC8036673 DOI: 10.3390/ijerph18073698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023]
Abstract
(1) Background: The purpose of this article was to investigate the association between self-reported physical activity (PA) and all-cause mortality in ambulatory patients with chronic kidney disease (CKD), stage 4–5 including maintenance dialysis. (2) Methods: Ambulatory patients with CKD (eGFR < 30 mL/min/1.73 m2) with conservative treatment or chronic dialysis were included. PA was assessed using the Saltin–Grimby Physical Activity Level Scale. A Cox proportional hazards regression model––adjusted for age, sex, plasma–albumin, body mass index, socioeconomic status, and treatment––was applied. (3) Results: Participants (n = 374) were followed 39 ± 15 months from entry to death or censoring. Throughout the study period of 39 months, 156 deaths (42%) were registered. Regarding physical activity, 128 (34%) of the participants were inactive, 212 (57%) were moderately active, and 34 (9%) were highly or vigorously active. Moderate PA was associated with a decreased mortality risk in women (n = 150) compared to inactivity (HR 0.27 (0.15; 0.51), p < 0.001), whereas a high/vigorous level of PA was not significantly associated with mortality risk compared to inactivity. In men (n = 224), the associations between PA levels and mortality risk were not significant. (4) Conclusions: Moderate PA was associated with reduced all-cause mortality in ambulatory women with stage 4–5 CKD with or without maintenance dialysis treatment. Physical activity was not significantly associated with mortality in men.
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