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Yang Y, Li Q, Qiu W, Zhang H, Qiu Y, Yuan J, Zha Y. Trajectory of mid-arm subcutaneous fat, muscle mass predicts mortality in hemodialysis patients independent of body mass index. Sci Rep 2024; 14:14005. [PMID: 38890351 PMCID: PMC11189518 DOI: 10.1038/s41598-024-64728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
Although decreasing body mass index (BMI) is associated with higher mortality risk in patients undergoing hemodialysis (HD), BMI neither differentiates muscle and fat mass nor provides information about the variations of fat distribution. It remains unclear whether changes over time in fat and muscle mass are associated with mortality. We examined the prognostic significance of trajectory in the triceps skinfold (TSF) thickness and mid-upper arm circumference (MUAC). In this multicenter prospective cohort study, 972 outpatients (mean age, 54.5 years; 55.3% men) undergoing maintenance HD at 22 treatment centers were included. We calculated the relative change in TSF and MUAC over a 1-year period. The outcome was all-cause mortality. Kaplan-Meier, Cox proportional hazard analyses, restricted cubic splines, and Fine and Gray sub-distribution hazards models were performed to examine whether TSF and MUAC trajectories were associated with all-cause mortality. During follow-up (median, 48.0 months), 206 (21.2%) HD patients died. Compared with the lowest trajectory group, the highest trajectories of TSF and MUAC were independently associated with lower risk for all-cause mortality (HR = 0.405, 95% CI 0.257-0.640; HR = 0.537; 95% CI 0.345-0.837; respectively), even adjusting for BMI trajectory. Increasing TSF and MUAC over time, measured as continuous variables and expressed per 1-standard deviation decrease, were associated with a 55.7% (HR = 0.443, 95% CI 0.302-0.649), and 97.8% (HR = 0.022, 95% CI 0.005-0.102) decreased risk of all-cause mortality. Reduction of TSF and MUAC are independently associated with lower all-cause mortality, independent of change in BMI. Our study revealed that the trajectory of TSF thickness and MUAC provides additional prognostic information to the BMI trajectory in HD patients.
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Affiliation(s)
- Yuqi Yang
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Qian Li
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Wanting Qiu
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Helin Zhang
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Yuyang Qiu
- School of Basic Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Zhongshan East Road, Guiyang, China.
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Levy S, Attia A, Omar M, Langford N, Vijay A, Jeon H, Galvani C, Killackey MT, Paramesh AS. Collaborative Approach Toward Transplant Candidacy for Obese Patients with End-Stage Renal Disease. J Am Coll Surg 2024; 238:561-572. [PMID: 38470035 DOI: 10.1097/xcs.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND An elevated BMI is a major cause of transplant preclusion for patients with end-stage renal disease (ESRD). This phenomenon exacerbates existing socioeconomic and racial disparities and increases the economic burden of maintaining patients on dialysis. Metabolic bariatric surgery (MBS) in such patients is not widely available. Our center created a collaborative program to undergo weight loss surgery before obtaining a kidney transplant. STUDY DESIGN We studied the outcomes of these patients after MBS and transplant surgery. One hundred eighty-three patients with ESRD were referred to the bariatric team by the transplant team between January 2019 and June 2023. Of these, 36 patients underwent MBS (20 underwent Roux-en-Y gastric bypass and 16 underwent sleeve gastrectomy), and 10 underwent subsequent transplantation, with another 15 currently waitlisted. Both surgical teams shared resources, including dieticians, social workers, and a common database, for easy transition between teams. RESULTS The mean starting BMI for all referrals was 46.4 kg/m 2 and was 33.9 kg/m 2 at the time of transplant. The average number of hypertension medications decreased from 2 (range 2 to 4) presurgery to 1 (range 1 to 3) postsurgery. Similarly, hemoglobin A1C levels improved, with preoperative averages at 6.2 (range 5.4 to 7.6) and postoperative levels at 5.2 (range 4.6 to 5.8) All transplants are currently functioning, with a median creatinine of 1.5 (1.2 to 1.6) mg/dL (glomerular filtration rate 46 [36.3 to 71]). CONCLUSIONS A collaborative approach between bariatric and transplant surgery teams offers a pathway toward transplant for obese ESRD patients and potentially alleviates existing healthcare disparities. ESRD patients who undergo MBS have unique complications to be aware of. The improvement in comorbidities may lead to superior posttransplant outcomes.
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Affiliation(s)
- Shauna Levy
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Abdallah Attia
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Nicole Langford
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Adarsh Vijay
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Hoonbae Jeon
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Carlos Galvani
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Anil S Paramesh
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
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Molfino A, Imbimbo G, Picconi O, Tartaglione L, Amabile MI, Lai S. Muscularity and adiposity are differently associated with inflammatory and nutritional biomarkers among patients on hemodialysis and peritoneal dialysis. Eur J Intern Med 2024; 122:109-112. [PMID: 37981526 DOI: 10.1016/j.ejim.2023.11.015] [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: 05/22/2023] [Revised: 11/02/2023] [Accepted: 11/10/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Nutritional alterations are prevalent in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). We aimed at evaluating whether body composition parameters in HD vs PD are differently associated with nutritional and inflammatory biomarkers. METHODS Body composition was assessed by bioimpedance analysis. Neutrophil to lymphocyte ratio (NLR), serum albumin and C-reactive protein were used as nutritional and inflammatory biomarkers. Multivariable linear regression analysis was used to determine association(s) of body composition parameters with biomarkers. RESULTS We enrolled a total of 108 patients, 58 on HD and 50 on PD. Fat free mass percent was higher in HD patients than PD (p = 0.006) and higher extracellular water (ECW)/intracellular water (ICW) in HD compared to PD patients (p = 0.023), as well as fat mass index was greater in PD than HD (p = 0.004). In HD patients, albumin positively correlated with fat free mass (r = 0.42; p = 0.001) and ICW/h2 (r = 0.31; p = 0.02). In PD, NLR positively correlated with fat mass (r = 0.36; p = 0.01), fat mass index (r = 0.37; p = 0.01) and ECW (r = 0.41; p = 0.005), and negatively correlated with fat free mass percent (r = -0.30; p = 0.04) and ICW percent (r = -0.34; p = 0.02). By linear regression analysis, in HD fat free mass index was associated with albumin and the absence of diabetes. In PD, the association of fat free mass index was present with NLR. Regarding adiposity, in HD we found no association of ECW/ICW with NLR and CRP, whereas in PD the ECW/ICW was associated with NLR. CONCLUSION Inflammation drives body composition changes with differences according to the type of dialysis, as expressed by the modulation of some circulating biomarkers.
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Affiliation(s)
- Alessio Molfino
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
| | - Giovanni Imbimbo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Orietta Picconi
- National HIV/AIDS Center, Istituto Superiore di Sanità, Rome, Italy
| | - Lida Tartaglione
- Division of Nephrology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Silvia Lai
- Division of Nephrology, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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Zimmermann S, Mathew A, Schöppe R, Mangova G, Biemann R, Surov A, Meyer HJ, Isermann B. Fat tissue quantity, waist circumference or waist-to-hip ratio in patients with chronic kidney disease: A systematic review and meta-analysis. Obes Res Clin Pract 2024; 18:81-87. [PMID: 38582736 DOI: 10.1016/j.orcp.2024.03.007] [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: 01/03/2024] [Revised: 01/13/2024] [Accepted: 03/23/2024] [Indexed: 04/08/2024]
Abstract
The BMI predicts mortality and cardiovascular disease (CVD) in the general population, while in patients with end-stage chronic kidney disease (CKD) a high BMI is associated with improved survival, a phenomenon referred to as the "obesity paradox". While BMI is easy to determine and helps to categorize patients, it does not differentiate between fat tissue, lean tissue and bone mass. As the BMI may be altered in CKD, e.g. by muscle wasting, we determined in this meta-analysis (i) the association of mortality with fat tissue quantity in CKD and (ii) the association of mortality with abdominal obesity (as measured by waist circumference (WC) or waist-to-hip ratio (WHR)) in CKD. We systematically reviewed databases for prospective or retrospective cohort studies. In eleven studies with 23,523 patients the association between mortality and high fat tissue quantity in CKD was calculated. The pooled hazard ratio (HR) for this association in the CKD group in the dialysis group 0.91 (CI 0.84- 0.98, p = 0.01) which is comparable to the HR for the association with BMI. The HR in patients without dialysis was 0.7 (95% CI 0.53- 0.93, p = 0.01), suggesting a better risk prediction of high fat tissue content with mortality as compared to higher BMI with mortality in patients with CKD without dialysis. Importantly, both BMI and fat tissue quantity in CKD are described by the "obesity paradox": the higher the fat tissue content or BMI, the lower the mortality risk. In thirteen studies with 55,175 patients the association between mortality and high WC or WHR in CKD (with or without dialysis) was calculated. We observed, that the HR in the WHR group was 1.31 (CI 1.08-1.58, p = 0.007), whereas the overall hazard ratio of both groups was 1.09 (CI 1.01-1.18, p = 0.03), indicating that a higher abdominal obesity as measured by WHR is associated with higher mortality in CKD. Our analysis suggests gender-specific differences, which need larger study numbers for validation. This meta-analysis confirms the obesity paradox in CKD using fat tissue quantity as measure and further shows that using abdominal obesity measurements in the routine in obese CKD patients might allow better risk assessment than using BMI or fat tissue quantity. Comparable to the overall population, here, the higher the WHR, the higher the mortality risk.
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Affiliation(s)
- Silke Zimmermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany.
| | - Akash Mathew
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Robert Schöppe
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gyulten Mangova
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Ronald Biemann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University, Bochum, Germany
| | - Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
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Shen Y, Su X, Yu Z, Yan H, Ma D, Xu Y, Yuan J, Ni Z, Gu L, Fang W. Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study. Front Med (Lausanne) 2024; 11:1342344. [PMID: 38449887 PMCID: PMC10915053 DOI: 10.3389/fmed.2024.1342344] [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: 11/21/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Background Whether sarcopenic obesity had unfavorable effect on survival of peritoneal dialysis (PD) patients is unknown. We aimed to investigate the association between sarcopenic obesity and survival in PD patients. Methods This was a prospective observational study. Eligible PD patients from November 2016 to December 2017 were enrolled and followed until August 31, 2023. Sarcopenia was defined following the recommendations of the Asian Working Group for Sarcopenia (AWGS) as low appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Obesity was defined using the percentage of body fat (PBF). Survival analysis was conducted using the Kaplan-Meier and log-rank test. The Cox regression and the cumulative incidence competing risk (CICR) analyzes were used to investigate the association between sarcopenic obesity and all-cause mortality. Results A total of 223 patients were enrolled with 133 (59.6%) males, a median age of 57.5 (44.6, 65.7) years, a median dialysis vintage of 20.3 (6.4, 57.7) months and 48 (21.5%) who had comorbid diabetes mellitus. Among them, 46 (20.6%) patients were sarcopenic, and 25 (11.2%) patients were diagnosed with sarcopenic obesity. After followed up for 51.6 (25.6, 73.9) months, the Kaplan-Meier curve showed the sarcopenic obesity (log-rank = 13.527, p < 0.001) group had significant lower survival rate compared to the nonsarcopenic non-obesity group. For multivariate analysis, the CICR method showed patients with sarcopenic obesity had significantly higher mortality rate (HR: 2.190, 95% CI: 1.011-4.743, p = 0.047) compared to those with nonsarcopenic non-obesity. Conclusion Sarcopenia is not uncommon in PD patients, with a considerable proportion having sarcopenic obesity. There is a significant association between sarcopenic obesity and an increased risk of mortality in PD patients.
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Affiliation(s)
- Yiwei Shen
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Xinyu Su
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Dahua Ma
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Yimei Xu
- Jiangsu Hengrui Pharmaceuticals Co., Ltd., Shanghai, China
| | - Jiangzi Yuan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
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Tian M, Yuan J, He P, Yu F, Long C, Zha Y. Lean-to-fat tissue ratio as a risk factor for cognitive impairment in patients undergoing maintenance hemodialysis. J Psychosom Res 2023; 174:111464. [PMID: 37757523 DOI: 10.1016/j.jpsychores.2023.111464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVE The relationship between body mass index (BMI) and cognitive impairment (CI) remains controversial, and no research has been done to explore the effect of lean-to-fat (L/F) tissue ratio on the risk of CI in patients undergoing maintenance hemodialysis (MHD) so far. This study aimed to explore the effect of L/F tissue ratio on the risk of incident CI in patients undergoing MHD. METHODS In this observational cohort study, 3356 patients were recruited and followed up for a median of 2 years. Global cognitive function was measured using Mini-Mental State Examination score. Lean tissue mass (LTM) and fat tissue mass (FTM) were analyzed using body composition monitor based on bioimpedance spectroscopy (BCM-BIS), and L/F tissue ratio was calculated by LTM divided by FTM. Hazard ratios (HRs) for incident CI were determined by Cox regression. RESULTS The median age of the cohort was 55 years, and 68.7% patients were less educated. During the follow-up period, 1249 patients (37.2%) experienced incident CI. Patients with lower L/F tissue ratios had significantly higher risks of CI (HR 1.51, 95% confidence interval 1.24-1.84; p < 0.001) than those with higher L/F tissue ratios. The association between L/F tissue ratio and incident CI persisted in all subgroups stratified by sex, age, education status, especially in older and less educated participants. Both in all our patients and subgroups, BMI and CI occurrence were not independently relevant. CONCLUSION The L/F tissue ratio rather than BMI was an independent risk factor of incident cognitive impairment in patients undergoing MHD.
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Affiliation(s)
- Maolu Tian
- School of Medicine, Guizhou University, Guiyang, China; Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Jing Yuan
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China
| | - Pinghong He
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Fangfang Yu
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Changzhu Long
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Renal Division, Department of Medicine, Guizhou Provincial People's Hospital, Guiyang, China; NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, China.
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Echefu G, Stowe I, Burka S, Basu-Ray I, Kumbala D. Pathophysiological concepts and screening of cardiovascular disease in dialysis patients. FRONTIERS IN NEPHROLOGY 2023; 3:1198560. [PMID: 37840653 PMCID: PMC10570458 DOI: 10.3389/fneph.2023.1198560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/10/2023] [Indexed: 10/17/2023]
Abstract
Dialysis patients experience 10-20 times higher cardiovascular mortality than the general population. The high burden of both conventional and nontraditional risk factors attributable to loss of renal function can explain higher rates of cardiovascular disease (CVD) morbidity and death among dialysis patients. As renal function declines, uremic toxins accumulate in the blood and disrupt cell function, causing cardiovascular damage. Hemodialysis patients have many cardiovascular complications, including sudden cardiac death. Peritoneal dialysis puts dialysis patients with end-stage renal disease at increased risk of CVD complications and emergency hospitalization. The current standard of care in this population is based on observational data, which has a high potential for bias due to the paucity of dedicated randomized clinical trials. Furthermore, guidelines lack specific guidelines for these patients, often inferring them from non-dialysis patient trials. A crucial step in the prevention and treatment of CVD would be to gain better knowledge of the influence of these predisposing risk factors. This review highlights the current evidence regarding the influence of advanced chronic disease on the cardiovascular system in patients undergoing renal dialysis.
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Affiliation(s)
- Gift Echefu
- Division of Cardiovascular Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Ifeoluwa Stowe
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA, United States
| | - Semenawit Burka
- Department of Internal Medicine, University of Texas Rio Grande Valley, McAllen, TX, United States
| | - Indranill Basu-Ray
- Department of Cardiology, Memphis Veterans Affairs (VA) Medical Center, Memphis, TN, United States
| | - Damodar Kumbala
- Nephrology Division, Renal Associates of Baton Rouge, Baton Rouge, LA, United States
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Shi B, Ying T, Xu J, Wyburn K, Laurence J, Chadban SJ. Obesity is Associated With Delayed Graft Function in Kidney Transplant Recipients: A Paired Kidney Analysis. Transpl Int 2023; 36:11107. [PMID: 37324221 PMCID: PMC10261700 DOI: 10.3389/ti.2023.11107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Obesity is increasingly prevalent among candidates for kidney transplantation. Existing studies have shown conflicting post-transplant outcomes for obese patients which may relate to confounding bias from donor-related characteristics that were unaccounted for. We used ANZDATA Registry data to compare graft and patient survival between obese (BMI >27.5 kg/m2 Asians; >30 kg/m2 non-Asians) and non-obese kidney transplant recipients, while controlling for donor characteristics by comparing recipients of paired kidneys. We selected transplant pairs (2000-2020) where a deceased donor supplied one kidney to an obese candidate and the other to a non-obese candidate. We compared the incidence of delayed graft function (DGF), graft failure and death by multivariable models. We identified 1,522 pairs. Obesity was associated with an increased risk of DGF (aRR = 1.26, 95% CI 1.11-1.44, p < 0.001). Obese recipients were more likely to experience death-censored graft failure (aHR = 1.25, 95% CI 1.05-1.49, p = 0.012), and more likely to die with function (aHR = 1.32, 95% CI 1.15-1.56, p = 0.001), versus non-obese recipients. Long-term patient survival was significantly worse in obese patients with 10- and 15-year survival of 71% and 56% compared to 77% and 63% in non-obese patients. Addressing obesity is an unmet clinical need in kidney transplantation.
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Affiliation(s)
- Bree Shi
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
| | - Tracey Ying
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Josephine Xu
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Department of Transplant Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kate Wyburn
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jerome Laurence
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Department of Transplant Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steven J Chadban
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Serrano E, Shenoy P, Martinez Cantarin MP. Adipose tissue metabolic changes in chronic kidney disease. IMMUNOMETABOLISM (COBHAM (SURREY, ENGLAND)) 2023; 5:e00023. [PMID: 37128293 PMCID: PMC10144329 DOI: 10.1097/in9.0000000000000023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/04/2023] [Indexed: 05/03/2023]
Abstract
Adipose tissue is a complex organ whose functions go beyond being an energy reservoir to sustain proper body energy homeostasis. Functioning as an endocrine organ, the adipose tissue has an active role in the body's metabolic balance regulation through several secreted factors generally termed as adipokines. Thus, adipose tissue dysregulation in chronic kidney disease (CKD) can have a deep impact in the pathophysiology of diseases associated with metabolic dysregulation including metabolic syndrome, insulin resistance (IR), atherosclerosis, and even cachexia. CKD is a progressive disorder linked to increased morbidity and mortality. Despite being characterized by renal function loss, CKD is accompanied by metabolic disturbances such as dyslipidemia, protein energy wasting, chronic low-grade inflammation, IR, and lipid redistribution. Thus far, the mechanisms by which these changes occur and the role of adipose tissue in CKD development and progression are unclear. Further understanding of how these factors develop could have implications for the management of CKD by helping identify pharmacological targets to improve CKD outcomes.
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Affiliation(s)
- Eurico Serrano
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Prashamsa Shenoy
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Paula Martinez Cantarin
- Division of Nephrology, Department of Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- *Correspondence: Maria Paula Martinez Cantarin, E-mail:
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Klement RJ, Joos FT, Reuss-Borst MA, Kämmerer U. Measurement of body composition by DXA, BIA, Leg-to-leg BIA and near-infrared spectroscopy in breast cancer patients - comparison of the four methods. Clin Nutr ESPEN 2023; 54:443-452. [PMID: 36963892 DOI: 10.1016/j.clnesp.2023.02.013] [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: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND & AIMS Body composition plays a crucial role in therapy adherence and the prognosis of cancer patients. The aim of this work was to compare four measurement methods for determining body composition regarding their validity, reliability and practicability in order to be able to draft a practical recommendation as to which method is most suitable as a standard measurement method in oncology. METHODS Fat mass (FM) and fat-free mass (FFM) was estimated for 100 breast cancer patients with ages of 18-70 years during a defined 20-week inpatient and outpatient rehabilitation process after primary therapy or follow-up rehabilitation. The four methods used were dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), leg-to-leg BIA and near-infrared spectroscopy (NIRS). At baseline (t0) and after 20 weeks (t20) the agreement between the four body composition analysis methods was quantified by pairwise method comparisons using Bland-Altman bias and limits of agreement estimates, t-tests and Lin's concordance correlation coefficients (CCCs). RESULTS CCCs and Bland-Altman plots indicated that DXA and BIA, DXA and NIRS as well as BIA and NIRS showed an excellent agreement concerning FM estimation at both time points (CCC>0.9). In contrast, no methods agreed with a CCC higher than 0.9 with respect to FFM estimation. However, most estimates were also significantly different between two methods, except for BIA and NIRS which yielded comparable FFM and FM estimates at both time points, albeit with large 95% limits of agreement intervals. The agreement between DXA and BIA was best in the lowest BMI tertile and worsened as BMI increased. Significant differences were also found for FFM changes measured with DXA versus BIA (mean difference -0.4 kg, p = 0.0049), DXA versus to Leg-to-leg BIA (-0.6 kg, p = 0.00073) and for FM changes measured with DXA versus Leg-to-leg BIA (0.5 kg, p = 0.0011). CONCLUSIONS For accurate and valid body composition estimates, Leg-to-leg BIA cannot be recommended due to its significant underestimation of FM or significant overestimation of FFM, respectively. BIA and NIRS results showed good agreement with the gold standard DXA. Therefore both measurement methods appear to be very well suitable to assess body composition of oncological patients and should be used more frequently on a routine basis to monitor the body composition of breast cancer patients.
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Affiliation(s)
- Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany.
| | - Fabian T Joos
- Department of Anesthesiology, Regional Clinic Holding RKH GmbH - Ludwigsburg, Germany.
| | - Monika A Reuss-Borst
- Hescuro Clinics, Center for Rehabilitation and Prevention, Bad Bocklet, Germany.
| | - Ulrike Kämmerer
- Department of Obstetrics and Gynecology, University Hospital of Würzburg, Würzburg, Germany.
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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: 15] [Impact Index Per Article: 15.0] [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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12
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Foshati S, Askari G, Bagherniya M, Mortazavi M, Moeinzadeh F, Taheri S, Heidari Z, Rouhani MH. Association between nutritional, inflammatory and oxidative status (NIOS) and risk of adverse outcomes in patients on haemodialysis (HD): the NIOS-HD prospective cohort study protocol. BMJ Open 2022; 12:e064367. [PMID: 36127112 PMCID: PMC9490610 DOI: 10.1136/bmjopen-2022-064367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The mortality of patients on chronic haemodialysis is 10-30 times greater than that of the general population and over 60% of these individuals die within the first 5 years of beginning haemodialysis. Although causes for excessive mortality in haemodialysis patients are not clearly defined, it seems that nutrition, inflammation and oxidative stress play key roles in this regard. Until now, no cohort study has focused on the association between nutritional, inflammatory or oxidative status and risk of complications and adverse outcomes in Iranian haemodialysis patients. Therefore, we sought to fill this gap and designed the Nutritional, Inflammatory, and Oxidative Status in Hemodialysis (NIOS-HD) prospective cohort study to determine the association of dietary factors, malnutrition, anthropometric indices, body composition, inflammation and oxidative stress with quality of life, dialysis access infections, hospitalisation, potential years of life lost and mortality in adults on maintenance haemodialysis in Isfahan, Iran. METHODS AND ANALYSIS The sample size of this cohort was estimated to be 300 participants. At baseline, demographic, medical and dialysis-related data of eligible patients will be recorded. In addition, participants will undergo anthropometric measurements, malnutrition assessment and body composition analysis. Also, their dietary intake and quality of life will be evaluated through interviewer-administered questionnaires. Moreover, their fasting blood samples will be collected and stored for biochemical assays including transthyretin, albumin, serum amyloid A, pentraxin-3, trimethylamine N-oxide, myeloperoxidase, paraoxonase-1 and superoxide dismutase. After baseline evaluation, patients will be followed up to 3 years to update exposure information (except biochemical assays) and measure adverse outcomes. Finally, collected data will be analysed using descriptive and inferential statistics. ETHICS AND DISSEMINATION The NIOS-HD is in agreement with the Declaration of Helsinki and has been approved by the Ethics Committee of Isfahan University of Medical Sciences (reference number: IR.MUI. RESEARCH REC.1399.605). Findings of this study will be published in academic journals.
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Affiliation(s)
- Sahar Foshati
- Nutrition and Food Security Research Center, Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagherniya
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firouzeh Moeinzadeh
- Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahram Taheri
- Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Hossein Rouhani
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Sethi S, Sethi N, Makkar V, Kaur S, Sohal PM. Malnutrition-Inflammation Score: A Valid Tool to Assess Nutritional Status in Patient with End-stage Renal Disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:559-565. [PMID: 37929549 DOI: 10.4103/1319-2442.388197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Nutritional assessment is a basic and necessary process in the nutritional management of dialysis patients. Malnutrition is a prevalent complication in patients on maintenance hemodialysis (HD). The study aimed to evaluate its relationship with the duration of dialysis, demographic and socioeconomic profile of HD patients, and to assess malnutrition inflammation score (MIS) in HD patients. In this descriptive-analytical study, 153 HD patients were selected with random sampling. All the patients were interviewed and the MIS of the patients was recorded. Evaluate the relationship of malnutrition with the duration of dialysis, demographic and socioeconomic profile of HD patients, and to assess MIS in HD patients. Patients were followed up for 3 months. Data were analyzed with Chi-square and t-tests and Pearson correlation coefficient. A total of 153 patients were studied, 53 (34.64%) patients had good nutritional status and 100 (65.35%) patients had malnutrition. The mean of patients MIS score was 10.71 ± 5.14. Malnutrition rates in males and females were not significantly different. There was a positive and significant relationship between age and MIS score (P = 0.035). There was also a significant correlation between the level of education and MIS score (P = 0.042). The mean dialysis duration was 25.52 ± 2 6.27 months. There was a significant difference in the duration of dialysis in mild to severely malnourished patients (P = 0.002). A significant correlation between MIS score and the serum calcium and serum iron results (r = 0.402). The rise in serum prealbumin level was significantly greater at 3 months. MIS score is the best tool to assess nutritional status in patients with ESRD undergoing HD, because it can recognize various degrees of malnutrition that may remain undetected by a single laboratory assessment. The correlation between MIS score and age and dialysis period was significant.
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Affiliation(s)
- Suman Sethi
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nitin Sethi
- Department of Plastic and Cosmetic Surgery, Fortis Hospital, Ludhiana, Punjab, India
| | - Vikas Makkar
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Simran Kaur
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Preet M Sohal
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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14
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Hsiao YH, Chang CH, Hung PH, Huang TY. Correlations among lean tissue index, physical activity, clinical parameters, diet quality, and nutritional status in patients receiving haemodialyses. J Ren Care 2022; 49:101-109. [PMID: 35689500 DOI: 10.1111/jorc.12425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/15/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Poor diet quality and malnutrition accelerate protein and energy depletion. This can result in a diminished lean tissue index (LTI) and an inability to perform daily activities, both of which increase the risk of falls and affect the quality of life. OBJECTIVE This study investigated the correlations among LTI, physical activity (PA), clinical parameters, diet quality, and nutritional status. METHODS A cross-sectional study design was employed. Participants in stable conditions receiving haemodialyses were enroled. LTI was measured using a body composition monitor. Three-day dietary records and demographic and clinical parameters were collected. RESULTS In total, 104 patients receiving haemodialyses were recruited (53.8% men, aged 57.7 ± 11.78 years; dialysis duration, 7.3 ± 6.04 years). LTI was not associated with diet quality; LTI was positively correlated with sex and negatively correlated with age, dialysis duration, and fat tissue index (FTI); and lean tissue index was positively correlated with PA. Among patients with a normal LTI, the odds ratio for low-FTI was 31.04 times higher than that for high-FTI. In total, 80.8% of the participants had poor diet quality, which was mainly attributed to their excessive intake of saturated fatty acids and insufficient fruit intake. CONCLUSIONS Although diet quality was unrelated to the LTI, the results indicated that most patients receiving haemodialyses had poor diet quality. Therefore, this topic merits further investigation.
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Affiliation(s)
- Ya-Hsin Hsiao
- Department of Nursing, Diatmanson Medical Foundation Chaiyi Christian Hospital, Chiayi City, Taiwan
| | - Chia-Hao Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
| | - Peir-Haur Hung
- Department of Medical, Diatmanson Medical Foundation Chaiyi Christian Hospital, Chiayi City, Taiwan
| | - Tsuey-Yuan Huang
- Department of Cardiology and Nursing, Chang Gung Memorial Hospital, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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15
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Adipose and serum zinc alpha-2-glycoprotein (ZAG) expressions predict longitudinal change of adiposity, wasting and predict survival in dialysis patients. Sci Rep 2022; 12:9087. [PMID: 35641588 PMCID: PMC9158927 DOI: 10.1038/s41598-022-13149-6] [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: 12/01/2021] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
There were limited data on adipose and serum zinc alpha-2-glycoprotein (ZAG) expression and its association with body composition in patients with advanced chronic kidney disease (CKD). This study aimed to quantify adipose and serum ZAG expression and evaluate their association with body composition and its longitudinal change, together with mortality in incident dialysis patients. We performed a single-center prospective cohort study. Patients who were planned for peritoneal dialysis were recruited. ZAG levels were measured from serum sample, subcutaneous and pre-peritoneal fat tissue obtained during peritoneal dialysis catheter insertion. Body composition and functional state were evaluated by bioimpedance spectroscopy and Clinical Frailty Scale respectively at baseline and were repeated 1 year later. Primary outcome was 2-year survival. Secondary outcomes were longitudinal changes of body composition. At baseline, the average adipose and serum ZAG expression was 13.4 ± 130.0-fold and 74.7 ± 20.9 µg/ml respectively. Both adipose and serum ZAG expressions independently predicted adipose tissue mass (ATM) (p = 0.001, p = 0.008, respectively). At 1 year, ATM increased by 3.3 ± 7.4 kg (p < 0.001) while lean tissue mass (LTM) remained similar (p = 0.5). Adipose but not serum ZAG level predicted change in ATM (p = 0.007) and LTM (p = 0.01). Serum ZAG level predicted overall survival (p = 0.005) and risk of infection-related death (p = 0.045) after adjusting for confounders. In conclusion, adipose and serum ZAG levels negatively correlated with adiposity and predicted its longitudinal change of fat and lean tissue mass, whilst serum ZAG predicted survival independent of body mass in advanced CKD patient.
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16
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Moromizato T, Sakaniwa R, Miyauchi T, So R, Iso H, Iseki K. Long-term weight loss as a predictor of mortality in haemodialysis patients. J Epidemiol 2022; 33:390-397. [PMID: 35283398 PMCID: PMC10319526 DOI: 10.2188/jea.je20210389] [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: 09/03/2021] [Accepted: 01/17/2022] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Serial weight decrease can be a prognostic predictor in chronic haemodialysis (HD) patients. We investigated the impact of long-term post-HD body weight (BW) changes on all-cause mortality among HD patients. METHODS This longitudinal cohort study and post-hoc analysis evaluated participants of a previous randomised controlled trial conducted between 2006 and 2011 who were followed up until 2018. Weight change slopes were generated with repeated measurements every 6 months during the trial for patients having ≥5 BW measurements. Participants were categorised into four groups based on quartiles of weight change slopes; the median weight changes per 6 months were -1.02 kg, -0.25 kg, +0.26 kg, and +0.86 kg. Cox proportional hazard regression was used to evaluate differences in subsequent survival among the four groups. BW trajectories were plotted with a backward time-scale and multilevel regression analysis to visualise the difference in BW trajectories between survivors and non-survivors. RESULTS Among the 461 patients, 404 were evaluated, and 168 (41.6%) died within a median follow-up period of 10.2 years. The Cox proportional hazard regression adjusted for covariates and baseline BW showed that a higher rate of weight loss was associated with higher mortality. The hazard ratios were 2.02 (1.28-3.20), 1.77 (1.10-2.85), 1.00 (reference), and 1.11 (0.67-1.83) for the first, second, third (reference), and fourth quartiles, respectively. BW trajectories revealed a significant decrease in BW in non-survivors. CONCLUSIONS Weight loss elucidated by serial BW measurements every 6 months is significantly associated with higher mortality among HD patients.
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Affiliation(s)
- Takuhiro Moromizato
- Renal and Rheumatology Division, Internal Medicine Department, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Shimajiri, Okinawa, Japan
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takamasa Miyauchi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna School of Medicine, Kawasaki, Japan
| | - Ryuhei So
- Okayama Psychiatric Medical Center, Okayama, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Urasoe, Okinawa, Japan
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17
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Elezi B, Topi S, Abazaj E. Profile of Obesity and Comorbidities and their Correlation among Hemodialysis Patients, Elbasan. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Nowadays, obesity is an enormous problem in the public health of undeveloped countries and developing countries. Being overweight, especially obesity in internal organs contributes to increased risk of metabolic and cardiovascular complications in patients with chronic kidney disease. There is no complete data available in our country on the correlation between obesity and comorbidity diseases among persons undergoing dialysis. So we do not know how BMI affects Diabetic or Cardio Vascular Disease (CVD) patients among dialysis patients. We, therefore, undertook this study to evaluate the association of obesity with mobility in hemodialysis patients at the Elbasan dialysis center.
METHODOLOGY: This cross-sectional study was performed in 160 patients who have undergone the dialysis process at Elbasan Dialysis Center for three years (2016-2018). A standardized questionnaire was adopted to obtain data from all patients. The subjects were divided a priory into 4 categories based on the body mass index (BMI) (underweight <19, normal 19-25, pre-obese 25-30 and obese ≥30 kg/m2). Software SPSS version 20.0 is used to analyze and evaluate the data. Kaplan-Meier estimate were used to find the correlation between BMI with their prognostic abilities like cardiovascular disease and Diabetes Mellitus Type 2. We have considered statistically significant every p value less than 0.05.
RESULT: Over all 160 patients, the men presented the highest number of cases compared to female 73.1% and 26.9% respectively. The mean age resulted 52.7 ± 15.6 years and age groups 50-59 years old and 60-69 years old with 29.4% and 34.3% respectively were the most frequent in this study. About the category of BMI index 8.8% patients resulted underweight, 45% were in normal weight, 28.2% were pre-obese and 6.6% were obese. We observed significant correlations between BMI and some of the demographic data such as: gender, age, place of residence, educational level, smoking and alcohol consumption for p <0.05. Changes in patient survival rates between BMI with DMT2 and cardiovascular disease are not statistically significant (long range p> 0.05). In terms of mortality, a strong significant correlation was observed with the age of 50-69 years and with the index of hemoglobin, urea and creatinine after dialysis with p value <0.05.
CONCLUSION: In the paradoxical epidemiology, the overweight becomes chronic on hemodialysis patients and serves as a protective factor which is associated with better survival, but we weren`t found significant association between the BMI and some of the variables analyzed. This study presents a small number of chronic patients on hemodialysis center in Elbasan city. There is a need to better understand the reverse epidemiological causes in individuals on dialysis, which can help us improve the poor outcome in this population.
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Delgado C, Chiang JM, Kittiskulnam P, Sheshadri A, Grimes B, Segal M, Kaysen GA, Johansen KL. Longitudinal Assessment of Body Composition and Its Association With Survival Among Participants of the ACTIVE/ADIPOSE Study. J Ren Nutr 2021; 32:396-404. [PMID: 34930665 DOI: 10.1053/j.jrn.2021.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 08/16/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The importance of muscle wasting as a predictor of mortality in the hemodialysis population is not clear. Lack of association of muscle mass with survival in some studies could be related to reliance on single measures or to incorporation of excess extracellular water (ECW) into estimates of muscle mass. We examined changes in body composition over a 2-year period and the association of body composition with survival. DESIGN AND METHODS We analyzed data from 325 adults receiving hemodialysis in the Bay Area. We estimated ECW, intracellular water (ICW), and fat mass by whole-body bioimpedance spectroscopy (BIS) at 0, 12, and 24 months from enrollment. We used linear mixed modeling to examine changes in body mass index and BIS-derived estimates of body composition and Cox modeling with BIS-derived estimates as time-varying independent variables to examine associations between body composition and survival in multivariable analyses. RESULTS Body mass index declined over time. Considering individual components of body composition, ICW declined (-0.09 kg/m2 per year, 95% confidence interval -0.14 to -0.04), but fat mass and ECW did not change significantly. There were 120 deaths over a median of 5.2 years. The relationship between ICW and mortality was not linear such that the association was steeper at low values of ICW, whereas higher ICW was associated with better survival that was relatively stable above 9 kg/m2. Higher ECW was associated with higher mortality, and fat mass was not associated with survival. These associations were independent of markers of inflammation and nutritional status. CONCLUSIONS ICW declined over 2 years in this cohort, whereas fat mass and ECW remained relatively stable. Higher ICW was associated with better survival, but higher fat mass was not. Higher ECW was associated with worse survival. These results suggest that muscle mass may predict survival among patients on hemodialysis.
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Affiliation(s)
- Cynthia Delgado
- Division of Nephrology, University of California, San Francisco and Nephrology Section, San Francisco VA Medical Center, San Francisco, California, USA.
| | - Janet M Chiang
- Division of Endocrinology, University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
| | | | - Anoop Sheshadri
- Division of Nephrology, University of California, San Francisco and Nephrology Section, San Francisco VA Medical Center, San Francisco, California, USA
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco California, USA
| | - Mark Segal
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco California, USA
| | - George A Kaysen
- Department of Medicine, Division of Nephrology, University of California, Davis, Davis, California, USA; Department of Biochemistry and Molecular Medicine University of California, Davis, Davis, California, USA
| | - Kirsten L Johansen
- Department of Medicine, Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Intradialytic nutrition and quality of life in Chilean older patients in hemodialysis with protein-energy wasting. Int Urol Nephrol 2021; 54:1947-1955. [PMID: 34860339 PMCID: PMC9262769 DOI: 10.1007/s11255-021-03077-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The study assessed the impact of intradialytic oral nutritional supplementation on the quality of life in patients receiving hemodialysis and diagnosed with protein energy wasting. METHODS A pre-test post-test quasi-experimental study was conducted before and after 3 months of intradialytic oral nutritional supplementation on 109 older hemodialysis patients. We measured before and after 3 months of intradialytic oral nutritional supplementation, the quality of life score, the burden of kidney disease, three quality of life scales and the mental and physical health status using KDQoL-SF™ 1.3, body composition and biochemical parameters of nutritional condition. RESULTS The mean age of the patients was 69.4 ± 3.4 years, 59% were male, and the time on dialysis was 63.5 ± 52.6 months. Comparing the baseline with month 3 of intradialytic oral nutritional supplementation, we observed to better quality of life. In contrast to malnutrition, score, specifically increased significantly score of symptoms/problems list related to hemodialysis, sexual function, social and cognitive function, sleep, pain, energy/fatigue and general state of health. Significant changes were also found in nutritional status, energy intake and body composition indicators. After 3 months of intradialytic oral nutritional supplementation, we observed a nutritional status recovery in one or more indicators in 92% of the patients. CONCLUSION Our findings indicate that 3 months of intradialysis oral nutritional supplementation improves the components of physical and mental quality of life and nutritional status in older patients receiving hemodialysis diagnosed with loss of protein energy. These results are relevant to improve the experience of patients with protein energy loss receiving hemodialysis.
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Is malnutrition a determining factor of health-related quality of life in hemodialysis patients? A cross-sectional design examining relationships with a comprehensive assessment of nutritional status. Qual Life Res 2021; 31:1441-1459. [PMID: 34748139 DOI: 10.1007/s11136-021-03018-6] [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] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify relationships between health-related quality of life (HRQOL) and nutritional status in hemodialysis (HD) patients. METHOD Secondary data from a cross-sectional survey was utilized. HRQOL was assessed for 379 HD patients using the generic Short Form 36 (SF-36) and disease-specific Kidney-Disease Quality of Life-36 (KDQOL-36). Malnutrition was indicated by malnutrition inflammation score (MIS) ≥ 5, and presence of protein-energy wasting (PEW). The individual nutritional parameters included the domains of physical status, serum biomarkers, and dietary intake. Multivariate associations were assessed using the general linear model. RESULTS MIS ≥ 5 was negatively associated with SF-36 scores of physical functioning (MIS < 5 = 73.4 ± 8.0 SE vs MIS ≥ 5 = 64.6 ± 7.7 SE, P < 0.001), role-limitation-physical (MIS < 5 = 65.3 ± 14.3 SE vs MIS ≥ 5 = 52.9 ± 14.0 SE, P = 0.006), general health (MIS < 5 = 53.7 ± 7.5 SE vs MIS ≥ 5 = 47.0 ± 7.1 SE, P = 0.003), and PCS-36 (MIS < 5 = 40.5 ± 3.3 SE vs MIS ≥ 5 = 35.9 ± 3.1 SE, P < 0.001); and KDQOL-36 score of symptoms/problems (MIS < 5 = 78.9 ± 5.6 SE vs MIS ≥ 5 = 74.8 ± 5.4 SE, P = 0.022), but not with PEW by any tool. Of individual nutritional parameters, underweight (68.1 ± 5.4 SE, P = 0.031), normal weight (63.8 ± 2.8 SE, P = 0.023), and overweight (64.3 ± 2.9 SE, P = 0.003) patients had significantly higher physical functioning scores compared to obese patients (44.8 ± 5.5 SE). Serum albumin levels were positively associated with physical functioning (P = 0.041) score. HGS was also positively associated with physical functioning (P = 0.036), and vitality (P = 0.041) scores. Greater dietary phosphorus intakes were significantly associated with lower scores for role limitation-physical (P = 0.008), bodily pain (P = 0.043), and PCS-36 (P = 0.024). CONCLUSION Malnutrition diagnosis by MIS, but not PEW, indicated associations with HRQOL in HD patients. Individual nutritional parameters that related to higher HRQOL were BMI < 30 kg/m2, better dietary phosphorus control, greater muscle strength and higher visceral protein pool.
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Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis. Nutrients 2021; 13:nu13061895. [PMID: 34072922 PMCID: PMC8226793 DOI: 10.3390/nu13061895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.
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22
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Yaseri M, Alipoor E, Hafizi N, Maghsoudi-Nasab S, Shivappa N, Hebert JR, Hosseinzadeh-Attar MJ. Dietary Inflammatory Index Is a Better Determinant of Quality of Life Compared to Obesity Status in Patients With Hemodialysis. J Ren Nutr 2020; 31:313-319. [PMID: 32952007 DOI: 10.1053/j.jrn.2020.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/29/2020] [Accepted: 07/26/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the relationships among obesity, anthropometries, and the dietary inflammatory index (DII) with different aspects of quality of life (QoL) in patients undergoing hemodialysis. DESIGN AND METHODS In 83 patients representing a range of body weights, QoL (based on short form 36), DII (extracted from dietary recalls), malnutrition-inflammation score, and anthropometric measurements were assessed. RESULTS Obese patients had lower physical health score (mean difference [MD] 9.1, 95% confidence interval [CI] 0.3-17.8, P = .04), physical functioning (MD 10.5, 95% CI 0.7-20.2, P = .04), and bodily pain scores (MD 16.0, 95% CI 3.6-28.4, P = .01) than normal weight group. Patients with abdominal obesity and those with the highest body fat percentage had also lower QoL in many aspects, irrespective of body mass index. The physical (MD 13.2, 95% CI 2.05-24.3, P = .02) and mental (MD 18.4, 95% CI 7.51-29.2, P = .001) health scores, and physical functioning (MD 13.5, 95% CI 1.8-25.2, P = .02), role-physical (MD 25.8, 95% CI 3.0-48.6, P = .03), role-emotional (MD 22.1, 95% CI 5.4-52.8, P = .02), vitality (MD 18.4, 95% CI 7.6-29.3, P = .001), mental health (MD 11.7, 95% CI 3.06-20.4, P = .009), and social functioning (MD 14.2, 95% CI 1.13-27.2, P = .03) were considerably lower in patients with the highest versus the lowest DII. QoL did not differ between normal-weight and obese patients with low DII (P = .26), and between normal-weight and obese patients with high DII (P = .13). Obese patients with low DII also had better QoL than normal-weight subjects with high DII scores. CONCLUSIONS A diet with higher proinflammatory potential was associated with decreased QoL, irrespective of obesity status. Adherence to a low-DII diet might protect against some obesity-associated complications, a finding that needs further investigations.
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Affiliation(s)
- Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Alipoor
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Nadia Hafizi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Maghsoudi-Nasab
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics and the Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina; Department of Nutrition, Connecting Health Innovations, LLC, Columbia, South Carolina
| | - James R Hebert
- Department of Epidemiology and Biostatistics and the Cancer Prevention and Control Program, University of South Carolina, Columbia, South Carolina; Department of Nutrition, Connecting Health Innovations, LLC, Columbia, South Carolina
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Primary Prevention Research Center (CPPRC), Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Sabatino A, D'Alessandro C, Regolisti G, di Mario F, Guglielmi G, Bazzocchi A, Fiaccadori E. Muscle mass assessment in renal disease: the role of imaging techniques. Quant Imaging Med Surg 2020; 10:1672-1686. [PMID: 32742960 DOI: 10.21037/qims.2020.03.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Muscle wasting is a frequent finding in patients with chronic kidney disease (CKD), especially in those with end-stage kidney disease (ESKD) on chronic dialysis. Muscle wasting in CKD is a main feature of malnutrition, and results principally from a vast array of metabolic derangements typical of the syndrome, that converge in determining reduced protein synthesis and accelerated protein catabolism. In this clinical setting, muscle wasting is also frequently associated with disability, frailty, infections, depression, worsened quality of life and increased mortality. On these grounds, the evaluation of nutritional status is crucial for an adequate management of renal patients, and consists of a comprehensive assessment allowing for the identification of malnourished patients and patients at nutritional risk. It is based essentially on the assessment of the extent and trend of body weight loss, as well as of spontaneous dietary intake. Another key component of this evaluation is the determination of body composition, which, depending on the selected method among several ones available, can identify accurately patients with decreased muscle mass. The choice will depend on the availability and ease of application of a specific technique in clinical practice based on local experience, staff resources and good repeatability over time. Surrogate methods, such as anthropometry and bioimpedance analysis (BIA), represent the most readily available techniques. Other methods based on imaging modalities [dual-energy X-ray absorptiometry (DXA), magnetic resonance imaging (MRI), and whole body computed tomography (CT)] are considered to be the "gold standard" reference methods for muscle mass evaluation, but their use is mainly confined to research purposes. New imaging modalities, such as segmental CT scan and muscle ultrasound have been proposed in recent years. Particularly, ultrasound is a promising technique in this field, as it is commonly available for bedside evaluation of renal patients in nephrology wards. However, more data are needed before a routine use of ultrasound for muscle mass evaluation can be recommended in clinical practice.
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Affiliation(s)
- Alice Sabatino
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Claudia D'Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Regolisti
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.,UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca di Mario
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.,UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Fiaccadori
- Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.,UO Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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Kalantar-Zadeh K, Joshi S, Schlueter R, Cooke J, Brown-Tortorici A, Donnelly M, Schulman S, Lau WL, Rhee CM, Streja E, Tantisattamo E, Ferrey AJ, Hanna R, Chen JL, Malik S, Nguyen DV, Crowley ST, Kovesdy CP. Plant-Dominant Low-Protein Diet for Conservative Management of Chronic Kidney Disease. Nutrients 2020; 12:E1931. [PMID: 32610641 PMCID: PMC7400005 DOI: 10.3390/nu12071931] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) affects >10% of the adult population. Each year, approximately 120,000 Americans develop end-stage kidney disease and initiate dialysis, which is costly and associated with functional impairments, worse health-related quality of life, and high early-mortality rates, exceeding 20% in the first year. Recent declarations by the World Kidney Day and the U.S. Government Executive Order seek to implement strategies that reduce the burden of kidney failure by slowing CKD progression and controlling uremia without dialysis. Pragmatic dietary interventions may have a role in improving CKD outcomes and preventing or delaying dialysis initiation. Evidence suggests that a patient-centered plant-dominant low-protein diet (PLADO) of 0.6–0.8 g/kg/day composed of >50% plant-based sources, administered by dietitians trained in non-dialysis CKD care, is promising and consistent with the precision nutrition. The scientific premise of the PLADO stems from the observations that high protein diets with high meat intake not only result in higher cardiovascular disease risk but also higher CKD incidence and faster CKD progression due to increased intraglomerular pressure and glomerular hyperfiltration. Meat intake increases production of nitrogenous end-products, worsens uremia, and may increase the risk of constipation with resulting hyperkalemia from the typical low fiber intake. A plant-dominant, fiber-rich, low-protein diet may lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation and slow CKD progression, along with reducing cardiovascular risk. PLADO is a heart-healthy, safe, flexible, and feasible diet that could be the centerpiece of a conservative and preservative CKD-management strategy that challenges the prevailing dialysis-centered paradigm.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA;
| | | | - Joanne Cooke
- Kansas City VA Medical Center, Kansas City, MO 64128, USA;
| | - Amanda Brown-Tortorici
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | | | - Sherry Schulman
- UCI Health Susan Samueli Center Integrative Health Institute, Irvine, CA 92626, USA; (S.S.); (S.M.)
| | - Wei-Ling Lau
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Connie M. Rhee
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Elani Streja
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Ekamol Tantisattamo
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Antoney J. Ferrey
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Ramy Hanna
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Joline L.T. Chen
- Tibor Rubin VA Long Beach Healthcare System, Long Beach, CA 90822, USA;
| | - Shaista Malik
- UCI Health Susan Samueli Center Integrative Health Institute, Irvine, CA 92626, USA; (S.S.); (S.M.)
| | - Danh V. Nguyen
- Department of Medicine, Division of Nephrology Hypertension and Kidney Transplantation, University of California Irvine (UCI), Orange, CA 90286, USA; (A.B.-T.); (W.-L.L.); (C.M.R.); (E.S.); (E.T.); (A.J.F.); (R.H.); (D.V.N.)
| | - Susan T. Crowley
- VA Connecticut Healthcare System, West Haven, CT 06516, USA;
- Division of Nephrology, Yale University School of Medicine, New Haven, CT 06516, USA
| | - Csaba P. Kovesdy
- Division of Nephrology, University of Tennessee Health Sciences Center, Memphis, TN 38163, USA;
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Hefzollah F, Boushehri SN, Mahmudpour M. Effect of high bicarbonate hemodialysis solution on biochemical parameters and anthropometric indices. Hemodial Int 2020; 24:317-322. [PMID: 32419310 DOI: 10.1111/hdi.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Protein energy wasting is an adverse consequence of renal failure, which is correlated with increased mortality and morbidity. Metabolic acidosis has a major role in the development of protein energy wasting in hemodialysis patients. Every effort that could ameliorate this catabolic state would be beneficial to stabilize body composition. The aim of this study was to investigate the possible beneficial effects of high bicarbonate dialysis on anthropometric indices and biochemical parameters of nutrition. METHODS Fifty-six hemodialysis patients were randomly enrolled in two groups: an intervention group that underwent hemodialysis for 6 months with high bicarbonate dialysate concentration (36 mmol/L, N = 26) and a control group that underwent hemodialysis using a bicarbonate dialysate concentration of 30 mmol/L (N = 30). Biochemical parameters of nutrition and weight, body mass index (BMI), total body water, percent body fat, and other anthropometric indices were measured at the beginning and the end of the trial. FINDINGS At the end of the 6 month evaluation period, plasma levels of albumin, phosphorus, K, calcium, and bicarbonate showed no significant changes. Body weight and BMI increased significantly in high bicarbonate arm but did not change significantly in the control group. Percent body fat in the arms and legs did not change in intervention arm, but decreased significantly in the controls. DISCUSSION The results suggest that higher bicarbonate dialysis can have beneficial effects on nutritional status and might protect against loss of fat mass.
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Affiliation(s)
- Farnaz Hefzollah
- Department of Internal Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Saeid Najafpour Boushehri
- Department of Nutrition, School of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mehdi Mahmudpour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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Diwan TS, Cuffy MC, Linares-Cervantes I, Govil A. Impact of obesity on dialysis and transplant and its management. Semin Dial 2020; 33:279-285. [PMID: 32277512 DOI: 10.1111/sdi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is increasing to unprecedented levels, including in the end-stage kidney disease population, where upwards of 60% of kidney transplant patients are overweight or obese. Obesity poses additional challenges to the care of the dialysis patient, including difficulties in creating vascular access and inserting Tenckhoff catheters, higher rates of catheter malfunction and peritonitis, the need for longer and/or more frequent dialysis (or peritoneal dialysis [PD] exchanges) to achieve adequate clearance, increased metabolic complications particularly with PD, and obesity is a barrier to kidney transplantation. In this article, we review special considerations in performing PD, hemodialysis and transplant in the obese patient, as well as the evidence behind medical and surgical management of obesity in dialysis patients.
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Affiliation(s)
- Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Madison C Cuffy
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Ivan Linares-Cervantes
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amit Govil
- Division of Nephrology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Sheshadri A, Kittiskulnam P, Lai JC, Johansen KL. Effect of a pedometer-based walking intervention on body composition in patients with ESRD: a randomized controlled trial. BMC Nephrol 2020; 21:100. [PMID: 32178648 PMCID: PMC7074998 DOI: 10.1186/s12882-020-01753-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients. In a secondary analysis, we investigated the effect of this intervention on body composition. METHODS Sixty dialysis patients were randomized to standard care or a 6-month program consisting of 3 months of pedometers and weekly step count targets and 3 months of post-intervention follow-up. We obtained bioelectrical impedance spectroscopy (BIS) data on 54 of these patients (28 control, 26 intervention) and used linear mixed-modeling (adjusted for sex and dialysis modality) to estimate differences in change in total-body muscle mass (TBMM) adjusted for height2, fat mass (kg), and body mass index (BMI) (kg/m2) between control and intervention groups. RESULTS The median age of participants was 57.5 years (53-66), and 76% were men. At baseline, there was no significant difference between groups in age, BMI, race, or body composition, but there were more men in the intervention group. After 3 months, patients in the intervention group increased their average daily steps by 2414 (95% CI 1047, 3782) more than controls (p < 0.001), but there were no significant differences in body composition. However, at 6 months, participants in the intervention had a significantly greater increase from baseline in TBMM of 0.7 kg/m2 (95% CI 0.3, 1.13), decrease in fat mass (- 4.3 kg [95% CI -7.1, - 1.5]) and decrease in BMI (- 1.0 kg/m2 [95% CI -1.8, - 0.2]) relative to controls. In post-hoc analysis, each increase of 1000 steps from 0 to 3 months was associated with a 0.3 kg decrease in fat mass (95% CI 0.05, 0.5) from 0 to 6 months, but there was no dose-response relationship with TBMM/ht2 or BMI. CONCLUSION A pedometer-based intervention resulted in greater decreases in fat mass with relative preservation of muscle mass, leading to a greater decrease in BMI over time compared with patients not in the intervention. These differences were driven as much by worsening in the control group as by improvement in the intervention group. Step counts had a dose-response relationship with decrease in fat mass. TRIAL REGISTRATION ClinicalTrials.gov (NCT02623348). 02 December 2015.
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Affiliation(s)
- Anoop Sheshadri
- Division of Nephrology, Department of Medicine, University of California, San Francisco, USA.
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA.
| | - Piyawan Kittiskulnam
- Division of Internal Medicine-Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Special Task Force for Activating Research in Renal Nutrition, (Renal Nutrition Research Group), Office of Research Affairs, Chulalongkorn University, Bangkok, Thailand
| | - Jennifer C Lai
- Division of Gastroenterology/Hepatology, Department of Medicine, University of California, San Francisco, USA
| | - Kirsten L Johansen
- Division of Nephrology, Hennepin County Medical Center, Minneapolis, MN, USA
- Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
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de Abreu AM, Wilvert LC, Wazlawik E. Comparison of Body Mass Index, Skinfold Thickness, and Bioelectrical Impedance Analysis With Dual-Energy X-Ray Absorptiometry in Hemodialysis Patients. Nutr Clin Pract 2020; 35:1021-1028. [PMID: 32141138 DOI: 10.1002/ncp.10481] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Malnutrition is a consistent finding in hemodialysis (HD) patients and is associated with high mortality. The aim was to compare nutrition status indicators using dual-energy x-ray absorptiometry (DXA) as reference in HD patients. METHODS Observational cross-sectional study with 42 patients, 55.8 years (±14.6) old, 60% male, HD 2-3 times per week for ≥3 months. HD ranged from 3 months to 28 years (median, 17.3; interquartile range, 8.73-39.0). We used body mass index (BMI) and fat mass (FM) by skinfold thickness (SFT), bioelectrical impedance analysis (BIA), and DXA. Statistical analyses used Bland-Altman plots, Lin's concordance correlation coefficient, the paired t-test, and Pearson or Spearman correlation. P < .05 was significant. RESULTS SFT and DXA presented the lowest prevalence of malnutrition (2.4%) and BMI the highest (28.6%). BMI, BIA FM, and SFT FM presented strong positive correlations with DXA FM (r = 0.915; r = 0.976; r = 0.910, P < .001, respectively). BIA FM and fat-free mass (FFM) demonstrated substantial agreement with DXA values (ρ = 0.974 and 0.960, P < .001). Thus, the measurement procedures used, SFT and BIA, underestimated %FM (-4.65% and -2.13%) and overestimated FFM (3.12 kg and 1.0 kg) according to DXA. No differences were found between mean values of BIA FM and DXA (P = .178). CONCLUSIONS Compared with DXA, BIA was the most appropriate nutrition indicator for measuring body composition.
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Affiliation(s)
- Aline Miroski de Abreu
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Luana Cristina Wilvert
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Elisabeth Wazlawik
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Beaudreuil S, Iglicki F, Ledoux S, Elias M, Obada ENN, Hebibi H, Durand E, Charpentier B, Coffin B, Durrbach A. Efficacy and Safety of Intra-gastric Balloon Placement in Dialyzed Patients Awaiting Kidney Transplantation. Obes Surg 2019; 29:713-720. [PMID: 30474792 DOI: 10.1007/s11695-018-3574-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The number of obese patients who are candidates for renal transplantation has considerably increased, but obesity can be a barrier to kidney transplantation. Weight loss is often difficult through diet alone. We studied the efficacy and tolerance of the intra-gastric balloon (IGB) procedure in obese patients who were undergoing dialysis and were candidates for a renal transplantation. PATIENTS AND METHODS Obese patients (BMI > 30 kg/m2) who were candidates for renal transplantation were prospectively included in the study between 2010 and 2012. The balloon was inserted and removed during a gastric endoscopy under general anesthesia. The treatment lasted 6 months. The end point was a decrease in BMI after 6 months. Body impedance spectrometry (BIS) and nutritional statute were evaluated initially and then after IGB removal. RESULTS Seventeen patients (nine females and eight males) with a mean age of 53.4 years [19.4-69.4] were included. The decrease in body mass index (BMI) during the 6-month placement was 3 kg/m2 (from 37.7 to 34.4 kg/m2). The mean weight loss was 7 kg. The mean percentage of excess weight loss after 6 months was 20.2 (± 11.4). The tolerance was good without any complications. Eleven patients underwent kidney transplantation. CONCLUSION IGB in obese dialyzed patients who are candidates for renal transplantation is safe and effective. However, the amount of weight loss can vary.
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Affiliation(s)
- Séverine Beaudreuil
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France. .,INSERM UMRS1197, Villejuif, France.
| | - Franck Iglicki
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Séverine Ledoux
- Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michelle Elias
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Erika NNang Obada
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Hadia Hebibi
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Emmanuel Durand
- IR4M (UMR8081), 91405 Univ Paris Sud, Univ Paris Saclay, Department of Nuclear Medicine, Hôpitaux Universitaires Paris Sud, Paris, France
| | - Bernard Charpentier
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
| | - Benoit Coffin
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Antoine Durrbach
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
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Sevmez H, Bankoğlu Güngör M, Yeter H, Erten Y, Elbeg Ş, Yılmaz H. Relationship Among Denture Status, Remaining Teeth Number, and Malnutrition in Patients With Chronic Kidney Disease. Ther Apher Dial 2019; 24:290-299. [PMID: 31381241 DOI: 10.1111/1744-9987.13426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/01/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022]
Abstract
The purpose of the present study was to evaluate the relationship among the denture status, number of remaining teeth, and malnutrition in patients with chronic kidney disease (CKD). Seventy-three patients (43 men/30 women) who required hemodialysis were included in the study. Weight and height, Kt/V, urea reduction ratio, midweek interdialytic weight gain, ultrafiltration volume, and erythropoietin dosage were determined for all patients. Laboratory measurements and predialysis blood samples for biomarkers were collected within the monthly routine tests. Dental examination focused on the denture status and total number of remaining teeth. Denture status were classified into two groups as prosthesis group (patients have prosthesis) and no prosthesis group (patients do not have any kind of prosthesis). And also, patients were assigned to one of four categories based on the number of remaining natural teeth: (i) edentulous, (ii) 1-7 teeth, (iii) 8-19 teeth, and (iv) >20 teeth. The data were statistically analyzed (a = 0.05). Body mass index values were increased in the prosthesis patients. Serum albumin levels of the CKD patients were under the reference value (3.8 g/dL) both in prosthesis and no prosthesis groups. Patients who have eight and more teeth showed higher serum albumin levels, and patients who had 1-7 teeth showed lower serum albumin levels in prosthesis group. CKD patients' nutritional habits were affected by denture status (having prosthesis or not). The number of the remaining teeth in prosthesis group affected the serum albumin levels of CKD patients.
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Affiliation(s)
- Hatice Sevmez
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
| | | | - Hasan Yeter
- Division of Nephrology, Department of Internal Medicine, Medical Faculty, Gazi University, Ankara, Turkey
| | - Yasemin Erten
- Division of Nephrology, Department of Internal Medicine, Medical Faculty, Gazi University, Ankara, Turkey
| | - Şehri Elbeg
- Department of Biochemistry, Medical Faculty, Gazi University, Ankara, Turkey
| | - Handan Yılmaz
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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31
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Imam TH, Coleman KJ. Obesity and Mortality in End-Stage Renal Disease. Is It Time to Reverse the “Reverse Epidemiology”—at Least in Peritoneal Dialysis? J Ren Nutr 2019; 29:269-275. [DOI: 10.1053/j.jrn.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/21/2018] [Accepted: 09/20/2018] [Indexed: 11/11/2022] Open
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Impact of Percent Body Fat on All-Cause Mortality among Adequate Dialysis Patients with and without Insulin Resistance: A Multi-Center Prospective Cohort Study. Nutrients 2019; 11:nu11061304. [PMID: 31181824 PMCID: PMC6627844 DOI: 10.3390/nu11061304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 12/24/2022] Open
Abstract
The association between body fat and mortality in hemodialysis patients remains controversial. We examined the effect of percent body fat (PBF) on all-cause mortality among adequate hemodialysis patients with and without insulin resistance (IR). A prospective cohort study was conducted on 365 adequate hemodialysis patients (equilibrated Kt/V ≥ 1.2) from seven hospitals. Patients’ characteristics and clinical and biochemical parameters were assessed at baseline between September 2013 and April 2017. Patients were followed up for all-cause mortality until April 2018. The median value of homeostatic model assessment (HOMA-IR) was used to classify IR. Cox proportional hazard models were utilized to examine predictors of all-cause mortality. During 1.4 (1.0–3.2) years of follow-up, 46 patients died. In patients with IR (HOMA-IR ≥ 5.18), PBF was significantly higher in the survival group than in the death group (31.3 ± 9.0 vs. 25.4 ± 8.2, p = 0.005). After controlling for confounding factors, PBF was significantly associated with lower risk for all-cause mortality in patients with IR (hazard ratio, 0.94; 95% confidence interval, 0.89–1.00; p = 0.033). The association was not observed in patients without IR. In conclusion, percent body fat shows a protective effect on survival in hemodialysis patients with IR.
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Koppe L, Fouque D, Kalantar‐Zadeh K. Kidney cachexia or protein-energy wasting in chronic kidney disease: facts and numbers. J Cachexia Sarcopenia Muscle 2019; 10:479-484. [PMID: 30977979 PMCID: PMC6596400 DOI: 10.1002/jcsm.12421] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Weight loss and homeostatic disturbances of both energy and protein balances are characteristics of several illnesses including cancer, heart failure, and chronic kidney disease (CKD). Different definitions have been used to describe this deleterious process. The term protein-energy wasting (PEW) has been proposed for CKD patients by the International Society of Renal Nutrition and Metabolism. METHODS We searched the publication in Medline from February 2008 to September 2018 using PEW or cachexia in their title. RESULTS Since its inception, the term PEW has been exceptionally successful, highlighted by 327 original publications referenced in PubMed over 10 years. Using this classification, several studies have confirmed that PEW is among the strongest predictors of mortality in CKD patients [hazard ratio of 3.03; confidence interval of 1.69-5.26 in 1068 haemodialysis patients and 1.40 (1.04-1.89) in 1487 non-dialysed patients across PEW stages 0 to 4]. Based on this classification, prevalence of PEW is 28% to 54% among 16 434 adults undergoing maintenance dialysis. PEW prevalence increases when renal function declines, that is, from <2% in CKD stages 1-2 to 11-54% in CKD stages 3-5. A more general definition of cachexia for all chronic diseases proposed by the Society on Sarcopenia, Cachexia and Wasting Disorders was also published concurrently. In the CKD area, we found 180 publications using 'cachexia' underlining that some confusion or overlap may exist. The definitions of PEW and cachexia are somewhat similar, and the main difference is that a loss of body weight >5% is a mandatory criterion for cachexia but supportive for PEW. CONCLUSIONS The recent understanding of cachexia physiopathology during CKD progression suggests that PEW and cachexia are closely related and that PEW corresponds the initial state of a continuous process that leads to cachexia, implicating the same metabolic pathways as in other chronic diseases. Despite the success of the definition of PEW, using a more uniform term such as 'kidney disease cachexia' could be more helpful to design future research through collaborative groups of researchers with focus on cachexia.
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Affiliation(s)
- Laetitia Koppe
- Centre Hospitalier Lyon‐SudUniv Lyon, CarMeN, Dept NephrologyPierre‐BéniteFrance
| | - Denis Fouque
- Centre Hospitalier Lyon‐SudUniv Lyon, CarMeN, Dept NephrologyPierre‐BéniteFrance
| | - Kamyar Kalantar‐Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and HypertensionUniversity of California, Irvine, School of Medicine, OrangeIrvineCAUSA
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Kuipers J, Oosterhuis JK, Paans W, Krijnen WP, Gaillard CAJM, Westerhuis R, Franssen CFM. Association between quality of life and various aspects of intradialytic hypotension including patient-reported intradialytic symptom score. BMC Nephrol 2019; 20:164. [PMID: 31088398 PMCID: PMC6518736 DOI: 10.1186/s12882-019-1366-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/30/2019] [Indexed: 12/15/2022] Open
Abstract
Background There is increasing awareness that, besides patient survival, Quality of Life (QOL) is a relevant outcome factor for patients who have a chronic disease. In haemodialysis (HD) patients, intradialytic hypotension (IDH) is considered one of the most frequent complications, and this is often accompanied by symptoms. Several studies have investigated QOL in dialysis patients, however, research on the association between intradialytic symptoms and QOL is minimal. The goal of this study was to determine whether the occurrence of IDH has an influence on the perception of QOL. Methods During 3 months, haemodynamic data, clinical events, and interventions of 2623 HD-sessions from 82 patients were prospectively collected. The patients filled out a patient-reported intradialytic symptom score (PRISS) after each HD session. IDH was defined according to the EBPG as a decrease in SBP ≥20 mmHg or in MAP ≥10 mmHg associated with a clinical event and need for nursing interventions. Patient’s self-assessment of QOL was evaluated by the 36-Item Short-Form Health Survey. Results There were no significant associations between the mental summary score or the physical summary score and the proportion of dialysis sessions that fulfilled the full EBPG definition. A lower PRISS was significantly associated with the proportion of dialysis sessions that fulfilled the full EBPG definition (R = − 0.35, P = 0.0011), the proportion of dialysis sessions with a clinical event (R = − 0.64, P = 0.001), and the proportion of dialysis sessions with nursing interventions (R = − 0.41, P = 0.0001). The physical component summary and mental component summary were significantly negatively associated with the variable diabetes and positively with PRISS (P = 0.003 and P = 0.005, respectively). UF volume was significantly negatively associated with mental health (P = 0.02) and general health (P = 0.01). Conclusions Our findings suggest that the EBPG definition of IDH does not capture aspects of intradialytic symptomatology that are relevant for the patient’s QOL. In contrast, we found a significant association between QOL and a simple patient-reported intra-dialytic symptom score, implying that how patients experience HD treatment influences their QOL. Electronic supplementary material The online version of this article (10.1186/s12882-019-1366-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johanna Kuipers
- Dialysis Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Jurjen K Oosterhuis
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wolter Paans
- Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
| | - Wim P Krijnen
- Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands
| | - Carlo A J M Gaillard
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,University of Utrecht Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Ralf Westerhuis
- Dialysis Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Casper F M Franssen
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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35
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La Russa D, Giordano F, Marrone A, Parafati M, Janda E, Pellegrino D. Oxidative Imbalance and Kidney Damage in Cafeteria Diet-Induced Rat Model of Metabolic Syndrome: Effect of Bergamot Polyphenolic Fraction. Antioxidants (Basel) 2019; 8:antiox8030066. [PMID: 30884780 PMCID: PMC6466566 DOI: 10.3390/antiox8030066] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is a potent risk factor for kidney disease as it increases the possibility of developing diabetes and hypertension, and it has a direct impact on the development of chronic kidney disease and end-stage renal disease. In this study, we tested the effect of bergamot polyphenolic fraction in a cafeteria with diet-fed rats, an excellent experimental model for studying human metabolic syndrome, as it is able to induce severe obesity with insulin resistance and high plasma triglyceride levels more efficiently than a traditional lard-based high-fat diet used in rodent models. We analyzed the plasmatic oxidative balance by photometric tests, and the expression of cytoplasmic antioxidant enzymes (superoxide dismutase 1 and glutatione S-tranferasi P1) and apoptotic markers (Caspase 8 and 9) in kidney tissues by Western blot analysis. Our results clearly showed that the cafeteria diet induces a marked pro-oxidant effect: significant reduction of plasmatic antioxidant capacity; downregulation of cytoplasmic antioxidant enzymes expression; and activation of apoptotic pathways. All these hallmarks of redox disequilibrium were mitigated by treatment with polyphenolic fraction of bergamot, highlighting its antioxidant effect in the metabolic syndrome. Our data show that the link between obesity and renal damage could be represented by oxidative stress.
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Affiliation(s)
- Daniele La Russa
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
- LARSO (Analysis and Research on Oxidative Stress Laboratory), University of Calabria, 87036 Rende, Italy.
| | - Francesca Giordano
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
| | - Alessandro Marrone
- LARSO (Analysis and Research on Oxidative Stress Laboratory), University of Calabria, 87036 Rende, Italy.
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036 Rende, Italy.
| | - Maddalena Parafati
- Department of Health Sciences, Univ. "Magna Graecia" (Campus Germaneto), 88100 Catanzaro, Italy.
| | - Elzbieta Janda
- Department of Health Sciences, Univ. "Magna Graecia" (Campus Germaneto), 88100 Catanzaro, Italy.
| | - Daniela Pellegrino
- LARSO (Analysis and Research on Oxidative Stress Laboratory), University of Calabria, 87036 Rende, Italy.
- Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036 Rende, Italy.
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Duong TV, Wu PY, Wong TC, Chen HH, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Feng YW, Yang SH. Mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, dialysis adequacy influence all-cause mortality in hemodialysis patients: A prospective cohort study. Medicine (Baltimore) 2019; 98:e14930. [PMID: 30896655 PMCID: PMC6708842 DOI: 10.1097/md.0000000000014930] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Hemodialysis patients are at the high risk for morbidity and mortality. Evaluation and management of body composition and biochemical values are important to improve dialysis outcomes. We aimed to examine the effects of the mid-arm circumference, body fat, nutritional and inflammatory biomarkers, blood glucose, and dialysis adequacy on the mortality.A prospective cohort study was conducted on 375 patients from 7 hospital-based dialysis centers. At baseline between September 2013 and April 2017, we assessed patients' characteristics using chart review, body composition using the bioelectrical impedance analysis, and biochemical parameters using available laboratory tests. Patients were followed-up for all-cause mortality until April 2018. Kaplan-Meier Curves with Log-rank test, and Cox proportional hazards models were used to analyze the effects of assessed factors on the mortality.During the median of follow-up time of 1.4 (1.0-3.2) years, 47 (12.5%) patients died. In the multivariate analysis, mid-arm circumference (hazard ratio, HR, 0.90; 95% confidence interval, 95%CI, 0.82-0.99; P = .036), body fat mass (HR, 0.95; 95%CI, 0.91-1.00; P = .031), percent body fat (HR, 0.96; 95%CI, 0.92-0.99; P = .024), serum creatinine (HR, 0.81; 95%CI, 0.68-0.96; P = .015), and eKt/V (HR, 0.07; 95%CI, 0.01-0.33; P = .001) reduced the mortality risk. Inflammation (HR, 2.90; 95%CI, 1.59-5.27; P < .001), hyperglycemia (HR, 2.16; 95%CI, 1.06-4.40; P = .033), and low serum uric acid (HR, 2.22; 95%CI, 1.15-4.31; P = .018) increased the death risk.In hemodialysis patients, the higher values of the mid-arm circumference, body fat, serum creatinine, uric acid, and dialysis adequacy were associated with lower mortality, whereas, inflammation and hyperglycemia associated with higher mortality.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Pei-Yu Wu
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University
| | - Hsi-Hsien Chen
- School of Medicine, Taipei Medical University
- Department of Nephrology, Taipei Medical University Hospital
| | - Tso-Hsiao Chen
- School of Medicine, Taipei Medical University
- Department of Nephrology, Taipei Medical University-Wan Fang Hospital
| | - Yung-Ho Hsu
- School of Medicine, Taipei Medical University
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital
| | | | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, New Taipei 231
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli 351
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan 265
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University
- Research Center of Geriatric Nutrition, Taipei Medical University
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
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37
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The associations of fat tissue and muscle mass indices with all-cause mortality in patients undergoing hemodialysis. PLoS One 2019; 14:e0211988. [PMID: 30759133 PMCID: PMC6373951 DOI: 10.1371/journal.pone.0211988] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/23/2019] [Indexed: 12/27/2022] Open
Abstract
Protein-energy wasting, which involves loss of fat and muscle mass, is prevalent and is associated with mortality in hemodialysis (HD) patients. We investigated the associations of fat tissue and muscle mass indices with all-cause mortality in HD patients. The study included 162 patients undergoing HD. The fat tissue index (FTI) and skeletal muscle mass index (SMI), which represent respective tissue masses normalized to height squared, were measured by bioimpedance analysis after dialysis. Patients were divided into the following four groups according to the medians of FTI and SMI values: group 1 (G1), lower FTI and lower SMI; G2, higher FTI and lower SMI; G3, lower FTI and higher SMI; and G4, higher FTI and higher SMI. The associations of the FTI, SMI, and body mass index (BMI) with all-cause mortality were evaluated. During a median follow-up of 2.5 years, 29 patients died. The 5-year survival rates were 48.6%, 76.1%, 95.7%, and 87.4% in the G1, G2, G3, and G4 groups, respectively (P = 0.0002). The adjusted hazard ratio values were 0.34 (95% confidence interval [CI] 0.10–0.95, P = 0.040) for G2 vs. G1, 0.13 (95%CI 0.01–0.69, P = 0.013) for G3 vs. G1, and 0.25 (95%CI 0.07–0.72, P = 0.0092) for G4 vs. G1, respectively. With regard to model discrimination, on adding both FTI and SMI to a model with established risk factors, the C-index increased significantly when compared with the value for a model with BMI (0.763 vs. 0.740, P = 0.016). Higher FTI and/or higher SMI values were independently associated with reduced risks of all-cause mortality in HD patients. Moreover, the combination of the FTI and SMI may more accurately predict all-cause mortality when compared with BMI. Therefore, these body composition indicators should be evaluated simultaneously in this population.
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Abstract
Cardiovascular disease (CVD) is highly prevalent in the peritoneal dialysis (PD) population, affecting up to 60% of cohorts. CVD is the primary cause of death in up to 40% of PD patients in Australia, New Zealand, and the United States. Cardiovascular mortality rates are reported to be approximately 14 per 100 patient-years, which are 10- to 20-fold greater than those of age- and sex-matched controls. The excess risk of CVD is related to a combination of traditional risk factors (such as hypertension, dyslipidemia, obesity, smoking, sedentary lifestyle, and insulin resistance), nontraditional (kidney disease-related) risk factors (such as anemia, chronic volume overload, inflammation, malnutrition, hyperuricemia, and mineral and bone disorder), and PD-specific risk factors (such as dialysis solutions, glycation end products, hypokalemia, residual kidney function, and ultrafiltration failure). Interventions targeting these factors may mitigate cardiovascular risk, although high-level clinical evidence is lacking. This review summarizes the evidence relating to cardiovascular interventions targeting modifiable CVD risk factors in PD patients, as well as highlighting the key recommendations of the International Society for Peritoneal Dialysis Cardiovascular and Metabolic Guidelines.
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39
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Abstract
Diabetic kidney disease commonly is associated with an increased risk of cardiovascular disease. There are traditional common risk factors for both conditions including hypertension and poor glycemic control. However, it is likely that there are other pathophysiological mechanisms that explain the clinical phenomenon of increased cardiovascular disease in diabetic patients with chronic kidney and vice versa. Current management of both conditions includes aggressive glucose and blood pressure control. The protective role of treating dyslipidemia has been shown for cardiovascular disease, but the results for renal disease are not as clear. The advent of new classes of glucose-lowering agents such as sodium glucose co-transporter2 inhibitors and glucagon-like peptide-1 agonists has resulted in impressive effects on both cardiovascular and renal disease in diabetes. However, how these drugs act independently of glucose lowering to confer both kidney and cardiovascular protection has not been fully elucidated. Nevertheless, these new treatments provide optimism for reducing both microvascular and macrovascular complications in diabetes, which represent the major causes of morbidity and premature mortality in this condition.
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Affiliation(s)
- Muhammad Maqbool
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
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40
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Gencer F, Yıldıran H, Erten Y. Association of Malnutrition Inflammation Score With Anthropometric Parameters, Depression, and Quality of Life in Hemodialysis Patients. J Am Coll Nutr 2018; 38:457-462. [PMID: 30589395 DOI: 10.1080/07315724.2018.1550371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Hemodialysis patients may be at risk for malnutrition due to catabolic effects caused by dialysis, loss of amino acids, inadequate nutrient intake, acidosis, and inflammation. Malnutrition may have negative effects on quality of life, mortality, and disease prognosis. This study was conducted to determine the relationship between anthropometric parameters, depression, and quality of life with Malnutrition Inflammation Score (MIS) on 55 patients aged between 18 and 65 years (36 males and 19 females) who have dialysis treatment for 3 days per week for at least 3 months due to end-stage renal disease. Methods: Patients were evaluated with MIS, Subjective Global Assessment (SGA), Beck Depression Inventory (BDI), and Satisfaction with Life Scale (SWLS). In addition, anthropometric (body weight, height, mid-upper arm circumference [MUAC]) and body composition measurements of patients were taken, body mass index (BMI) values were calculated, and biochemical parameters (albumin, C-reactive protein [CRP], and total iron binding capacity [TIBC]) were analyzed. Results: At the end of the study, 14.5% of the patients according to SGA, were classified as malnourished. There was a statistically significant positive correlation of BDI, duration of dialysis, and CRP with MIS. However, MIS had a statistically significant negative correlation with SWLS, body weight, and MUAC (p < 0.05). Conclusion: MIS is an effective screening tool for assessing malnutrition and quality of life in hemodialysis patients. However, there is a need for studies to identify cutoff points of MIS.
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Affiliation(s)
- Feray Gencer
- a Department of Nutrition and Dietetics, Faculty of Health Science , Gazi University , Ankara , Turkey
| | - Hilal Yıldıran
- a Department of Nutrition and Dietetics, Faculty of Health Science , Gazi University , Ankara , Turkey
| | - Yasemin Erten
- b Department of Nephrology, Faculty of Medicine , Gazi University , Ankara , Turkey
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Bansal S, Wei G, Boucher RE, Beddhu S. Self-reported Intentional Weight Loss and Risk of Death in Moderate Chronic Kidney Disease in the United States. J Ren Nutr 2018; 28:422-427. [PMID: 30077396 PMCID: PMC6763338 DOI: 10.1053/j.jrn.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We hypothesized that intentional weight loss is associated with lower mortality risk, whereas unintentional weight loss is associated with higher mortality risk in chronic kidney disease (CKD). DESIGN AND METHODS We examined this hypothesis in 872 participants with age >20 years, body mass index ≥ 25 kg/m2 and CKD from 1999-2004 National Health and Nutrition Examination Survey who reported their 1 year prior and current weights and the intent to lose weight. We examined the association of self-reported intentional versus unintentional weight loss with all-cause mortality. Participants with no intent to lose weight and no change in weight were the reference group. A multivariable Cox regression model was used to relate mortality with intentional and unintentional weight losses after adjustment for demographics and comorbidity. RESULTS There were 446 deaths over 6271 years of follow-up. Compared to the reference group, intentional weight loss of 5% to <10% (hazard ratio (HR) 1.22, 95% confidence interval (CI): 0.74-1.99), intentional weight loss of ≥10% (HR 1.53, 95% CI: 0.75-3.12), and unintentional weight loss of 5% to <10% (HR 1.11, 95% CI: 0.71-1.75) were not associated with mortality; however, unintentional weight loss of ≥10% (HR 1.66, 95% CI: 1.06-2.58) was significantly associated with higher risk of mortality. Retrospective design and self-reported weight loss were the limitations. CONCLUSIONS Intentional weight loss in CKD participants was not associated with lower mortality risk. This might reflect residual confounding. Mechanistic and interventional studies are warranted to determine the effects of intentional weight loss in CKD.
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Affiliation(s)
- Shweta Bansal
- Renal section, South Texas Veterans Health Care System, San Antonio, Texas; Department of Medicine, University of Texas Health at San Antonio, San Antonio, Texas
| | - Guo Wei
- Renal section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Robert E Boucher
- Renal section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah
| | - Srinivasan Beddhu
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah; Renal section, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah.
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Park CH, Do JG, Lee YT, Yoon KJ. Sarcopenic obesity associated with high-sensitivity C-reactive protein in age and sex comparison: a two-center study in South Korea. BMJ Open 2018; 8:e021232. [PMID: 30232104 PMCID: PMC6150137 DOI: 10.1136/bmjopen-2017-021232] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the association between high-sensitivity C-reactive protein (hs-CRP) and sarcopenic obesity, and to determine age or sex differences underlying the relationship between hs-CRP and sarcopenic obesity. DESIGN Observational study. PARTICIPANTS The study included 237 838 participants whose body composition and hs-CRP were analysed at the two health promotion centres in South Korea. Participants were divided into four groups based on body composition: normal, obesity only, sarcopenia only and sarcopenic obesity. PRIMARY MEASURES The levels of hs-CRP and proportion of participants with high (≥1.0 mg/L) hs-CRP. Sarcopenic obesity was defined as subjects fulfilling the criteria for sarcopenia (below 2 SD of mean of Skeletal Muscle Mass Index for young adults) and obesity (waist circumference ≥90 cm for men and ≥85 cm for women). RESULTS The level of hs-CRP was highest in the sarcopenic obesity group. Following adjustment for various confounders including age, sex, comorbidities, metabolic, health-related behaviour and demographic factors, the adjusted ORs (95% CI) for subjects with high hs-CRP associated with obesity, sarcopenia and sarcopenic obesity compared with normal group (reference) were 1.17 (1.05 to 1.31), 2.23 (1.21 to 4.07) and 3.23 (2.71 to 3.83), respectively. In age subgroup analyses, multivariate logistic regression analysis revealed that the association of high hs-CRP with sarcopenic obesity was stronger in younger (<60 years) participants than in older (≥60 years) participants (p for interaction <0.001). In subgroup analyses for sex, the association of high hs-CRP with sarcopenic obesity was higher in female participants than in males (p for interaction <0.001). CONCLUSIONS This study demonstrated that high level of hs-CRP was independently associated with sarcopenic obesity in Korean population. We found for the first time that there was a strong association between increased hs-CRP and sarcopenic obesity in female and younger (<60 years) subjects.
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Affiliation(s)
- Chul-Hyun Park
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Rehabilitation Medicine, Graduate School of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Geol Do
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Yong-Taek Lee
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Kyung Jae Yoon
- Department of Physical & Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
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Evaluation of Body Composition in Hemodialysis Thai Patients: Comparison between Two Models of Bioelectrical Impedance Analyzer and Dual-Energy X-Ray Absorptiometry. J Nutr Metab 2018; 2018:4537623. [PMID: 30174950 PMCID: PMC6098916 DOI: 10.1155/2018/4537623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/04/2018] [Accepted: 06/24/2018] [Indexed: 11/18/2022] Open
Abstract
Background Body composition measurement is very important for early nutritional care in hemodialysis patients. Dual-energy X-ray absorptiometry (DXA) is a gold standard test, but clinically limited. Bioelectrical impedance analysis (BIA) with multifrequency technique is a practical and reliable tool. Objective This cross-sectional study was aimed to compare the agreement of BIA with DXA in measurement of body composition in hemodialysis patients and to evaluate their associated factors. Methods Body composition was measured by 2 BIA methods (InBody S10 and InBody 720) and DXA after a hemodialysis session. A total of 69 measurements were included. Pearson's correlation and Bland and Altman analysis were used to determine the correlation of body composition between methods and to compare the methods agreement, respectively. Results The correlation coefficients of body compositions were strong between DXA and InBody S10 (fat mass index (FMI): r=0.95, fat-free mass index (FFMI): r=0.78) and also between DXA and InBody 720 (FMI: r=0.96, FFMI: r=0.81). Comparing to DXA, the means of each body composition measured by InBody S10 method were not significantly different in each gender, but differences were found in FM, %FM, and FMI measured by InBody 720. Conclusions In maintenance hemodialysis patients, the measurement of body composition with DXA and both BIA methods had highly significant correlations; practically, BIA method could be used as an instrument to follow FM and FFM and to measure the edematous stage. Further studies with large populations are warranted.
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Yajima T, Yajima K, Takahashi H, Yasuda K. The effect of dulaglutide on body composition in type 2 diabetes mellitus patients on hemodialysis. J Diabetes Complications 2018; 32:759-763. [PMID: 29937137 DOI: 10.1016/j.jdiacomp.2018.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/06/2018] [Accepted: 05/02/2018] [Indexed: 12/28/2022]
Abstract
AIMS To evaluate the effect of dulaglutide on body composition in type 2 diabetes mellitus (T2DM) patients undergoing hemodialysis (HD). METHODS Twenty-one T2DM patients on HD, who had been treated with insulin and newly added teneligliptin (N = 10) or dulaglutide (N = 11), were enrolled. Body composition changes, such as fat mass (FM) and skeletal muscle mass (SMM), glycated albumin (GA), and insulin doses were compared before and after six months of treatment with teneligliptin or dulaglutide. RESULTS The percentage changes of GA and insulin doses were comparable between the teneliglipin and dulaglutide groups. Conversely, although FM and SMM did not change in the teneligliptin group (from 15.7 kg to 14.1 kg, P = 0.63 and 18.6 kg to 18.9 kg, P = 0.16, respectively), those in the dulaglutide group significantly decreased (from 21.9 kg to 18.9 kg, P = 0.037 and 21.0 kg to 20.2 kg, P = 0.011, respectively). CONCLUSIONS Six months of dulaglutide treatment significantly reduced not only FM but also SMM, although changes in GA and insulin doses were comparable with those in the teneligliptin group. Dulaglutide may have the effect of promoting sarcopenia; therefore, it may be carefully used in T2DM patients on HD.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan.
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University School of Medicine, Aichi 470-1192, Japan
| | - Keigo Yasuda
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
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Zaman SB, Hossain N, Rahman M. Associations between Body Mass Index and Chronic Kidney Disease in Type 2 Diabetes Mellitus Patients: Findings from the Northeast of Thailand. Diabetes Metab J 2018; 42:330-337. [PMID: 30136452 PMCID: PMC6107363 DOI: 10.4093/dmj.2017.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/19/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has emerged as a public health burden globally. Obesity and long-term hyperglycaemia can initiate the renal vascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the association of body mass index (BMI) with the CKD in patients with T2DM. METHODS This study has used retrospective medical records, biochemical reports, and anthropometric measurements of 3,580 T2DM patients which were collected between January to December 2015 from a district hospital in Thailand. CKD was defined according to the measurement of estimated glomerular filtration rate (<60 mL/min/1.73 m²). Multiple logistic regression analysis was used to explore the association between BMI and CKD in patients with T2DM. RESULTS The mean age of the participants was 60.86±9.67 years, 53.68% had poor glycaemic control, and 45.21% were overweight. About one-in-four (23.26%) T2DM patients had CKD. The mean BMI of non-CKD group was slightly higher (25.30 kg/m² vs. 24.30 kg/m²) when compared with CKD patients. Multivariable analysis showed that older age, female sex, hypertension, and microalbuminuria were associated with the presence of CKD. No association was observed between CKD and poorly controlled glycosylated hemoglobin or hypercholesterolemia. Adjusted analysis further showed overweight and obesity were negatively associated with CKD (adjusted odds ratio [AOR], 0.73; 95% confidence interval [CI], 0.58 to 0.93) and (AOR, 0.53; 95% CI, 0.35 to 0.81), respectively. CONCLUSION The negative association of BMI with CKD could reflect the reverse causality. Lower BMI might not lead a diabetic patient to develop CKD, but there are possibilities that CKD leads the patient to experience reduced BMI.
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Affiliation(s)
- Sojib Bin Zaman
- Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Institute of Tropical Medicine and International Health Berlin, Charite-University Medicine, Berlin, Germany.
| | - Naznin Hossain
- Department of Pharmacology, Dhaka Medical College, Dhaka, Bangladesh
| | - Muntasirur Rahman
- School of Public Health, University of Queensland, Brisbane, Australia
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Vareldzis R, Naljayan M, Reisin E. The Incidence and Pathophysiology of the Obesity Paradox: Should Peritoneal Dialysis and Kidney Transplant Be Offered to Patients with Obesity and End-Stage Renal Disease? Curr Hypertens Rep 2018; 20:84. [PMID: 30051236 PMCID: PMC9058972 DOI: 10.1007/s11906-018-0882-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW To educate nephrologists and primary-care physicians about the incidence, pathophysiology, and survival benefits of the obesity paradox in end-stage renal disease (ESRD). This review also discusses the future of kidney transplant and peritoneal dialysis in obese dialysis patients. RECENT FINDINGS Obesity paradox in ESRD was first reported three decades ago, and since then, there have been several epidemiological studies that confirmed the phenomenon. Regardless of the anthropometric indices used to define obesity in ESRD patients, these markers serve to predict the dialysis patient's survival. The pathophysiology of obesity paradox tends to be multifactorial. Recent cohort studies demonstrated a survival benefit in all race and ethnic groups, but Hispanics and blacks experienced increased survival rates when compared to non-Hispanic whites. Obese dialysis patients should be offered peritoneal dialysis, especially if they are new to dialysis and have an adequate renal residual function. Several studies have shown that the benefit of receiving kidney transplant in obese patients exceeds the risks. The robotic-assisted kidney transplant (RAKT) procedure is the latest innovation that could offer hope for obese dialysis patients who have been denied or are waiting for kidney transplant. The obesity paradox phenomenon in ESRD is a unique illustration of survival benefit in a population that has a high overall annual mortality. Peritoneal dialysis should be encouraged for obese patients who have preserved residual renal function. Kidney transplant centers should encourage RAKT utilization in obese dialysis patients instead of denying them a kidney transplant.
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Affiliation(s)
- Ramzi Vareldzis
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Mihran Naljayan
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
| | - Efrain Reisin
- School of Medicine, Department of Medicine, Section of Nephrology and Hypertension, Louisiana State University Health Sciences Center-New Orleans, LSUHSC: 1542 Tulane Ave, New Orleans, LA, 70112, USA.
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Matsuura S, Shirai Y, Kubo M, Nayama C, Okitsu M, Oiwa Y, Yasui S, Suzuki Y, Murata T, Ishikawa E, Miki C, Hamada Y. Body fat mass is correlated with serum transthyretin levels in maintenance hemodialysis patients. THE JOURNAL OF MEDICAL INVESTIGATION 2018; 64:222-227. [PMID: 28954986 DOI: 10.2152/jmi.64.222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Serum transthyretin (TTR), also known as prealbumin, is a reliable nutritional indicator and an independent prognostic factor for maintenance hemodialysis patients. However, we recently reported that serum TTR levels did not affect protein-energy wasting (PEW). In this study, we investigated factors affecting serum TTR levels in 60 maintenance hemodialysis patients. The patients were divided into High-TTR and Low-TTR groups according to the median serum TTR level. Albumin levels were significantly higher and C-reactive protein (CRP) levels were significantly lower in the High-TTR group than in the Low-TTR group. Although body fat mass was significantly higher in the High-TTR group than in the Low-TTR group, no significant difference in body fat ratio were observed. These findings suggest that body fat mass is related to serum TTR levels, apart from factors such as albumin and CRP levels, which showed correlations with serum TTR levels. Because body fat mass is related to better survival in maintenance hemodialysis patients, it may contribute to the prognostic value of serum TTR levels. In addition, in such patients, it may be important to evaluate body fat mass rather than body fat ratio and to maintain the minimum necessary body fat mass. J. Med. Invest. 64: 222-227, August, 2017.
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Affiliation(s)
- Sayaka Matsuura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School
| | | | - Miyu Kubo
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Chisako Nayama
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Masami Okitsu
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Yuu Oiwa
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Sonoko Yasui
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Yoshiko Suzuki
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.,Dialysis Center, Iga City General Hospital
| | - Eiji Ishikawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.,Dialysis Center, Iga City General Hospital
| | - Chikao Miki
- Dialysis Center, Iga City General Hospital.,Department of Surgery, Iga City General Hospital
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital.,Dialysis Center, Iga City General Hospital
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Carrero JJ, Cabezas-Rodríguez I, Qureshi AR, Floege J, Ketteler M, London G, Locatelli F, Memmos D, Goldsmith D, Ferreira A, Nagy J, Teplan V, Martínez-Salgado C, Fernández-Martín JL, Zoccali C, Cannata-Andia JB. Risk of hospitalization associated with body mass index and weight changes among prevalent haemodialysis patients. Nefrologia 2018; 38:520-527. [PMID: 29776692 DOI: 10.1016/j.nefro.2018.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/17/2018] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
The impact of body mass index (BMI) and body weight on hospitalization rates in haemodialysis patients is unknown. This study hypothesizes that being either underweight or obese is associated with a higher hospitalization rate. Observational study of 6296 European haemodialysis patients with prospective data collection and follow-up every six months for three years (COSMOS study). The risk of being hospitalized was estimated by a time-dependent Cox regression model and the annual risk (incidence rate ratios, IRR) by Poisson regression. We considered weight loss, weight gain and stable weight. Weight change analyses were also performed after patient stratification according to their baseline BMI. A total of 3096 patients were hospitalized at least once with 9731 hospitalizations in total. The hospitalization incidence (fully adjusted IRR 1.28, 95% CI [1.18-1.39]) was higher among underweight patients (BMI <20kg/m2) than patients of normal weight (BMI 20-25kg/m2), while the incidence of overweight (0.88 [0.83-0.93]) and obese patients (≥30kg/m2, 0.85 [0.79-0.92]) was lower. Weight gain was associated with a reduced risk of hospitalization. Conversely, weight loss was associated with a higher hospitalization rate, particularly in underweight patients (IRR 2.85 [2.33-3.47]). Underweight haemodialysis patients were at increased risk of hospitalization, while overweight and obese patients were less likely to be hospitalized. Short-term weight loss in underweight individuals was associated with a strikingly high hospitalization rate.
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Affiliation(s)
- Juan J Carrero
- Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden
| | - Ivan Cabezas-Rodríguez
- UGC Metabolismo Óseo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Abdul R Qureshi
- Divisions of Renal Medicine and Baxter Novum (CLINTEC), Karolinska Institutet, Sweden
| | - Jürgen Floege
- RWTH Aachen University Department of Nephrology and Clinical Immunology, Aachen, Germany
| | | | | | - Francesco Locatelli
- Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Lecco, Italy
| | - Dimitrios Memmos
- University Department of Nephrology, Hippokration General Hospital, Thessaloniki, Greece
| | - David Goldsmith
- Department of Nephrology, Guy's and St Thomas' NHS Foundation Hospital King's Health Partners (AHSC), UK King's Health Partners (AHSC), London, UK
| | - Aníbal Ferreira
- Nephrology Department, Hospital Curry Cabral and Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
| | - Judit Nagy
- Second Department of Medicine and Nephrological Center, University Medical School of Pécs, Pécs, Hungary
| | | | - Carlos Martínez-Salgado
- Hospital Universitario de Salamanca, IECSCYL Instituto Biosanitario de Salamanca (IBSAL), Salamanca, Spain
| | - José L Fernández-Martín
- UGC Metabolismo Óseo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Carmine Zoccali
- CNR National Research Council (Italy), Clinical Epidemiology and Physiopathology of Renal Disease and Hypertension and Renal and Transplantation Unit, Ospedali Riuniti, Italy
| | - Jorge B Cannata-Andia
- UGC Metabolismo Óseo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), REDinREN del ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
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Kovesdy CP, Furth SL, Zoccali C. Obesity and kidney disease: Hidden consequences of the epidemic. J Ren Care 2018; 43:3-10. [PMID: 28205394 DOI: 10.1111/jorc.12194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Obesity has become a worldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risks of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a series of complex pathophysiologic changes occur that lead to the development of Chronic Kidney Disease. These include on the one hand effects mediated by the downstream consequences of obesity (such as diabetes mellitus and hypertension), but also direct effects of adipose tissue, via humoral factors such as leptin, adiponectin, resistin and visfatin). In obese individuals a compensatory hyperfiltration occurs to meet the heightened metabolic demands of the increased body weight, leading to glomerulomegaly and accompanied by deposition of adipose tissue in the glomerulus and the gradual development of focal segmental glomerulosclerosis. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. In addition to the development of Chronic Kidney Disease, obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. Interventions to stem the tide of obesity are thus extremely important for preventing the development and progression of Chronic Kidney Disease and other disorders of the kidneys. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that makes preventive behaviors an affordable option.
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Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Nephrology Section, Memphis VA Medical Center, Memphis, Tennessee, USA
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carmine Zoccali
- CNR-IFC Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio, Calabria, Italy
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- Members of the World Kidney Day Steering Committee are: Philip Kam Tao Li, Guillermo Garcia-Garcia, Mohammed Benghanem-Gharbi, Rik Bollaert, Sophie Dupuis, Timur Erk, Kamyar Kalantar-Zadeh, Csaba Kovesdy, Charlotte Osafo, Miguel C. Riella, Elena Zakharova
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50
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Wong Vega M, Srivaths PR. Air Displacement Plethysmography Versus Bioelectrical Impedance to Determine Body Composition in Pediatric Hemodialysis Patients. J Ren Nutr 2017; 27:439-444. [DOI: 10.1053/j.jrn.2017.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 12/28/2022] Open
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