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Dietzmann M, Radke D, Markus MR, Wiese M, Völzke H, Felix SB, Dörr M, Bahls M, Ittermann T. Associations between 47 anthropometric markers derived from a body scanner and relative fat-free mass in a population-based study. BMC Public Health 2024; 24:1079. [PMID: 38637778 PMCID: PMC11025281 DOI: 10.1186/s12889-024-18611-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Low relative fat free mass (FFM) is associated with a greater risk of chronic diseases and mortality. Unfortunately, FFM is currently not being measured regularly to allow for individuals therapy. OBJECTIVE One reason why FFM is not being used may be related to additional equipment and resources, thus we aimed to identify easily accessible anthropometric markers related with FFM. MATERIALS AND METHODS We analyzed data of 1,593 individuals (784 women; 49.2%, age range 28-88 years) enrolled in the population-based Study of Health in Pomerania (SHIP-TREND 1). Forty-seven anthropometric markers were derived from a 3D optical body-scanner. FFM was assessed by bioelectrical impedance analysis (FFMBIA) or air displacement plethysmography (FFMADP). In sex-stratified linear regression models, FFM was regressed on anthropometric measurements adjusted for body height and age. Anthropometric markers were ranked according to the coefficient of determination (R2) derived from these regression models. RESULTS Circumferences of high hip, belly, middle hip, waist and high waist showed the strongest inverse associations with FFM. These relations were stronger in females than in males. Associations of anthropometric markers with FFMAPD were greater compared to FFMBIA. CONCLUSION Anthropometric measures were more strongly associated with FFMADP compared to FFMBIA. Anthropometric markers like circumferences of the high or middle hip, belly or waist may be appropriate surrogates for FFM to aid in individualized therapy. Given that the identified markers are representative of visceral adipose tissue, the connection between whole body strength as surrogate for FFM and fat mass should be explored in more detail.
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Affiliation(s)
- Maximilian Dietzmann
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany
| | - Dörte Radke
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany
| | - Marcello Rp Markus
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Mats Wiese
- Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Martin Bahls
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Walther Rathenau Str. 48, D-17475, Greifswald, Germany.
- German Centre for Cardiovascular Research (DZHK) partner site Greifswald, Greifswald, Germany.
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Nekooeian M, Roozbeh J, Ezzatzadegan Jahromi S, Moaref A, Masjedi F. The superiority of bioimpedance vs. echocardiography and pitting edema in predicting automated office blood pressure in continuous ambulatory peritoneal dialysis patients. Ther Apher Dial 2024; 28:272-283. [PMID: 37850431 DOI: 10.1111/1744-9987.14074] [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: 07/07/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION To achieve optimal blood pressure control in continuous ambulatory peritoneal dialysis (CAPD) patients, identifying methods of volume assessment with the strongest correlation with blood pressure is essential. METHODS In this cross-sectional study, 52 CAPD patients were assigned to automated office blood pressure (AOBP) measurement, assessment of pedal pitting edema, bioimpedance analysis (BIA), and inferior vena cava collapsibility index (IVCCI%) measurement. Data were analyzed using STATA ver.17, and the significance level was p < 0.05. RESULTS Fifty-two patients were divided based on their AOBP readings. 29 (55.8%) of patients had uncontrolled AOBP. Overhydration (OH) and the grade of pitting edema were significantly higher in the uncontrolled AOBP group. OH was identified as the best variable for predicting blood pressure (p ≤ 0.001) and detecting uncontrolled blood pressure (AUC = 0.832) using multivariate linear regression and ROC analysis, respectively. CONCLUSION BIA-derived OH was the best variable for predicting systolic and diastolic AOBP, outperforming IVCCI% and pitting edema.
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Affiliation(s)
- Mohammad Nekooeian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan Jahromi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Internal Medicine, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Alireza Moaref
- Department of Cardiology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
- Cardiovascular Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Masjedi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Nakayama M. Why should we use a low sodium dialysis solution for peritoneal dialysis? Perit Dial Int 2024; 44:89-97. [PMID: 38265014 DOI: 10.1177/08968608231222141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Overhydration is highly prevalent in patients on peritoneal dialysis (PD), with inappropriately high sodium load supposedly playing a central role in the pathophysiology of the conditions. Recent studies have revealed the novel role of the interstitium as a buffer system for sodium ions, and it has been reported that patients on dialysis, including PD, present increased levels of sodium in the interstitium, such as in subcutaneous tissue and muscle. Hence, therapy for correction of overhydration should target the excess extracellular volume and the excess sodium storage in the interstitium. The ultrafiltrate obtained using the currently available PD solutions is hypo- to isonatric as compared to serum, which is disadvantageous for prompt and efficient sodium removal from the body in patients with overhydration. In contrast, use of low sodium PD solutions is characterised by iso- to hypernatric ultrafiltrate, which may beneficial for reducing sodium storage in the interstitium. Trials of low sodium PD solutions have reported possible clinical merits, for example, decreased blood pressure, reduced dryness of mouth and decreased body water content as assessed using bioimpedance methods. Given these observations and the high prevalence of overhydration in current PD populations, it makes medical sense that low sodium solutions be positioned as the new standard solution in the future. However, for medical safety, that is, to avoid hyponatremia and excessive decreases in blood pressure, further studies are needed to establish the appropriate compositions and applications of low sodium solutions.
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Zhang W, Cui X, Li R, Ji W, Shi H, Cui J. Association between ICW/TBW ratio and cancer prognosis: Subanalysis of a population-based retrospective multicenter study. Clin Nutr 2024; 43:322-331. [PMID: 38142477 DOI: 10.1016/j.clnu.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS Disease burden is known to alter cellular integrity and water balance. Therefore, the intracellular water/total body water (ICW/TBW) ratio is used as an adjunctive indicator to predict disease severity and prognosis. The ICW/TBW ratio of patients with cancer, who typically present with low muscle mass, poor nutritional status, and high inflammatory response, reportedly differs from that of the healthy population. Herein, we aimed to evaluate the effect of the ICW/TBW ratio on the prognosis of different subgroups of patients with cancer. METHODS This multicenter cohort study included 2787 patients with malignancies between June 2014 and December 2018. The association between covariates and overall survival (OS) was assessed using restricted cubic spline models. The multivariate Cox regression model included variables demonstrating a statistical significance in the univariate Cox regression analysis (P < 0.05) without multicollinearity. The generated nomogram used the C-index and calibration curves to validate the predictive accuracy of the scoring system. RESULTS The optimal cut-off value for the ICW/TBW ratio was 0.61. The ICW/TBW ratio was an independent prognostic factor (hazard ratio [HR]: 0.621; 95 % confidence interval [CI]: 0.537-0.719, P < 0.001). Moreover, the ICW/TBW ratio had a greater impact on the prognosis of patients receiving chemoradiotherapy than on those receiving chemotherapy alone (chemoradiotherapy: HR = 0.495, P = 0.005 vs. chemotherapy: HR = 0.646, P < 0.001). Multivariate Cox regression analysis showed that sex, age, tumor stage, body mass index, neutrophil-to-lymphocyte ratio (NLR), and ICW/TBW ratio were associated with OS. Subsequently, a nomogram was developed incorporating these variables and yielded a C-index of 0.743. CONCLUSIONS The ICW/TBW ratio was associated with muscle mass, nutritional status, and inflammation. A low ICW/TBW ratio is an independent risk factor for poor prognosis in patients with cancer, especially when they are female, have advanced cancer stage, have sarcopenia, and are receiving radiotherapy.
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Affiliation(s)
- Wenxin Zhang
- Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Xiao Cui
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Rumeng Li
- Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Ji
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hanping Shi
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
| | - Jiuwei Cui
- Cancer Center, The First Hospital of Jilin University, Changchun, China.
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Guo Y, Zhang M, Ye T, Wang Z, Yao Y. Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease. Nutrients 2023; 15:3941. [PMID: 37764725 PMCID: PMC10537787 DOI: 10.3390/nu15183941] [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: 08/18/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Body composition measurement plays an important role in the nutritional diagnosis and treatment of diseases. In the past 30 years, the detection of body composition based on bioelectrical impedance analysis (BIA) has been widely used and explored in a variety of diseases. With the development of technology, bioelectrical impedance analysis has gradually developed from single-frequency BIA (SF-BIA) to multi-frequency BIA (multi-frequency BIA, MF-BIA) and over a range of frequencies (bioimpedance spectroscopy, BIS). As the clinical significance of nutrition management in chronic kidney disease has gradually become prominent, body composition measurement by BIA has been favored by nephrologists and nutritionists. In the past 20 years, there have been many studies on the application of BIA in patients with CKD. This review describes and summarizes the latest research results of BIA in nutritional management of patients with CKD including pre-dialysis, hemodialysis, peritoneal dialysis and kidney transplantation, in order to provide reference for the application and research of BIA in nutritional management of chronic kidney disease in the future.
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Affiliation(s)
- Yanchao Guo
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Meng Zhang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ting Ye
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
| | - Zhixiang Wang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
| | - Ying Yao
- Department of Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.G.); (T.Y.)
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (M.Z.); (Z.W.)
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Chan GCK, Fung WWS, Szeto CC, Ng JKC. From MIA to FIFA: The vicious matrix of frailty, inflammation, fluid overload and atherosclerosis in peritoneal dialysis. Nephrology (Carlton) 2023; 28:215-226. [PMID: 36807408 DOI: 10.1111/nep.14150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/25/2023] [Accepted: 02/14/2023] [Indexed: 02/20/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of mortality and morbidity in peritoneal dialysis (PD) patients. Two decades ago, the common co-existence of malnutrition and systemic inflammation PD patients with atherosclerosis and CVD led to the proposed terminology of 'malnutrition-inflammation-atherosclerosis (MIA) syndrome'. Although the importance of malnutrition is well accepted, frailty represents a more comprehensive assessment of the physical and functional capability of the patient and encompasses the contributions of sarcopenia (a key component of malnutrition), obesity, cardiopulmonary as well as neuropsychiatric impairment. In recent years, it is also increasingly recognized that fluid overload is not only the consequence but also play an important role in the pathogenesis of CVD. Moreover, fluid overload is closely linked with the systemic inflammatory status, presumably by gut oedema, gastrointestinal epithelial barrier dysfunction and leakage of bacterial fragments to the systemic circulation. There are now a wealth of published evidence to show intricate relations between frailty, inflammation, fluid overload and atherosclerotic disease in patients with chronic kidney disease (CKD) and those on PD, a phenomenon that we propose the term 'FIFA complex'. In this system, frailty and atherosclerotic disease may be regarded as two patient-oriented outcomes, while inflammation and fluid overload are two inter-connected pathogenic processes. However, there remain limited data on how the treatment of one component affect the others. It is also important to define how treatment of fluid overload affect the systemic inflammatory status and to develop effective anti-inflammatory strategies that could alleviate atherosclerotic disease and frailty.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Winston Wing-Shing Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jack Kit-Chung Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Inoue H, Hayashi Y, Watanabe H, Sawamura H, Shiraishi Y, Sugawara R, Kimura A, Masubuchi M, Takeshita K. Handgrip strength is correlated with activities of daily living, balance, and body composition in patients with thoracolumbar compression fracture. Medicine (Baltimore) 2023; 102:e33141. [PMID: 36862919 PMCID: PMC9981377 DOI: 10.1097/md.0000000000033141] [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] [Indexed: 03/04/2023] Open
Abstract
This study assessed the relationship between handgrip strength (HGS) and activities of daily living, balance, walking speed, calf circumference, body muscle, and body composition in elderly patients with thoracolumbar vertebral compression fracture (VCF). A cross-sectional study in a single hospital was performed with elderly patients diagnosed with VCF. After admission, we evaluated HGS, 10-meter walk test (speed), Barthel Index, Berg Balance Scale (BBS), numerical rating scale of body pain, and calf circumference. We examined skeletal muscle mass, skeletal muscle mass index, total body water (TBW), intracellular water, extracellular water (ECW), and phase angle (PhA) in patients with VCF using multi-frequency direct segmental bioelectrical impedance analysis after admission. A total of 112 patients admitted for VCF were enrolled (26 males, 86 females; mean age 83.3 years). The prevalence of sarcopenia according to the 2019 Asian Working Group for Sarcopenia guideline was 61.6%. HGS was significantly correlated with walking speed (P < .001, R = 0.485), Barthel Index (P < .001, R = 0.430), BBS (P < .001, R = 0.511), calf circumference (P < .001, R = 0.491), skeletal muscle mass index (P < .001, R = 0.629), ECW/TBW (P < .001, r = -0.498), and PhA (P < .001, R = 0.550). HGS was more strongly correlated with walking speed, Barthel Index, BBS, ECW/TBW ratio, and PhA in men than women. In patients with thoracolumbar VCF, HGS is associated with walking speed, muscle mass, activities of daily living measured using the Barthel Index, and balance measured using BBS. The findings suggest that HGS is an important indicator of activities of daily living, balance, and whole-body muscle strength. Furthermore, HGS is related to PhA and ECW/TBW.
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Affiliation(s)
- Hirokazu Inoue
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
- * Correspondence: Hirokazu Inoue, Department of Orthopaedics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan (e-mail: )
| | - Yukinori Hayashi
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
- Department of Orthopaedic Surgery, Shiobara Spring Hospital, Nasushiobara, Japan
| | - Hideaki Watanabe
- Department of Pediatric Orthopaedic Surgery, Jichi Children’s Medical Center, Shimotsuke, Japan
| | - Hideaki Sawamura
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
| | | | - Ryo Sugawara
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Kimura
- Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan
| | - Masaaki Masubuchi
- Department of Orthopaedic Surgery, Shiobara Spring Hospital, Nasushiobara, Japan
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Serum globulin is a novel predictor of mortality in patients undergoing peritoneal dialysis. Sci Rep 2023; 13:1139. [PMID: 36670150 PMCID: PMC9859810 DOI: 10.1038/s41598-023-27688-z] [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: 06/26/2021] [Accepted: 12/10/2021] [Indexed: 01/22/2023] Open
Abstract
Serum globulin, which is composed mainly of immunoglobulins and acute phase proteins, can be considered as reflecting the inflammatory state. We conducted the present study to investigate the role of globulin in mortality risk in patients undergoing peritoneal dialysis (PD). The study participants were categorized by the median globulin value (2.8 g/dL) as the high globulin group (≥ 2.8 g/dL), and low globulin group (< 2.8 g/dL). Serum globulin is calculated by the equation: (serum total protein-serum albumin). The area under the curve (AUC) by the receiver operating characteristics curve analysis was calculated to compare the mortality prediction capacity of globulin with that of ferritin, and WBC counts. Among the 554 patients, 265 (47.83%) were men, the mean age was 52.91 ± 15.54 years and the body mass index was 23.44 ± 3.88 kg/m2. Multivariate Cox models showed the high globulin group had higher mortality risks of all-cause and cardiovascular disease (CVD), compared with the low globulin group with adjusted HRs of 2.06 (95% CI 1.39-3.05) and 1.94 (95% CI 1.18-3.16), respectively. The AUC of univariate and multivariate models for all-cause mortality resulted in higher AUC values for globulin than for ferritin and white blood cell (WBC) counts. In patients undergoing PD, the serum globulin can serve as a novel and independent determinant of predicting overall and CVD- associated mortality.
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Barrea L, Muscogiuri G, Savastano S. Phase angle as biomarker of inflammatory changes during very low-calorie ketogenic diet. Int J Obes (Lond) 2023; 47:1-2. [PMID: 36002514 PMCID: PMC10169161 DOI: 10.1038/s41366-022-01201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy. .,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131, Naples, Italy
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Kang SH, Kim JC, Cha RH, Han M, An WS, Kim SH, Do JY. Impact of volume status on sarcopenia in non-dialysis chronic kidney disease patients. Sci Rep 2022; 12:22289. [PMID: 36566275 PMCID: PMC9789973 DOI: 10.1038/s41598-022-25135-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/25/2022] [Indexed: 12/25/2022] Open
Abstract
There were few data regarding the association of volume status with sarcopenia using muscle mass, strength, and physical performance in non-dialysis chronic kidney disease (ND-CKD) patients. We aimed to evaluate the association between volume status and sarcopenia in ND-CKD patients. Our retrospective study analyzed data from a previous study which included ND-CKD patients who had stable renal function. Our study used its baseline data alone. The edema index and muscle mass were measured using a multi-frequency bioimpedance analysis machine. The edema index was calculated using extracellular water/total body water ratio. The skeletal muscle index (SMI, kg/m2) was calculated using appendicular muscle mass per height squared. Handgrip strength (HGS, kg) was measured during the standing position in all patients. Dynamic gait speed (GS, m/s) was evaluated using 6-m walking speed. Patients with both low muscle mass (SMI < 7.0 kg/m2 for men and < 5.7 kg/m2 for women using bioimpedance analysis) and low HGS (< 28 kg for men and < 18 kg for women) or low GS (< 1.0 m/s) were classified as having sarcopenia. The patients (n = 147) were divided into tertiles based on the edema index level. The mean edema index in the low, middle, and high tertiles was 0.377 ± 0.006, 0.390 ± 0.003, and 0.402 ± 0.006, respectively. The edema index was significantly correlated with SMI, HGS, and GS (r = - 0.343 for SMI, - 0.492 for HGS, and - 0.331 for GS; P < 0.001 for three indicators). The SMI, HGS, and GS values were 8.1 ± 1.0 kg/m2, 33.0 ± 9.4 kg, and 1.2 ± 0.2 m/s in the low tertile,7.8 ± 1.2 kg/m2, 30.0 ± 7.5 kg, and 1.0 ± 0.3 m/s in the middle tertile, and 7.2 ± 1.4 kg/m2, 23.7 ± 7.4 kg, and 1.0 ± 0.3 m/s in the high tertile, respectively. Univariate analyses revealed that SMI was lower in patients in the high tertile than in those in the low tertile. HGS was lowest in high tertile, and GS was greatest in the low tertile. The high tertile for predicting sarcopenia had an odds ratio of 6.03 (95% CI, 1.78-20.37; P = 0.004) compared to low or middle tertiles. The results of multivariate analyses were similar to those of the univariate analyses. The subgroup analyses showed that statistical significance was greater in < 65 years and men than ≥ 65 years and women. The present study showed that the edema index is inversely associated with sarcopenia, muscle mass index, strength, and physical performance in ND-CKD patients. However, considering the limitations of our study such as its small sample size, this association was not strong. Further studies that include volume-independent measurements, data on physical activity and diet, and a larger number of patients are warranted to overcome these limitations.
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Affiliation(s)
- Seok Hui Kang
- grid.413028.c0000 0001 0674 4447Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jun Chul Kim
- grid.410886.30000 0004 0647 3511Department of Internal Medicine, CHA Gumi Medical Center, CHA University, 12, Sinsi-ro 10-gil, Gumi, 39295 Republic of Korea
| | - Ran-hui Cha
- grid.415619.e0000 0004 1773 6903Department of Internal Medicine, National Medical Center, 245, Eulji-ro, Jung-gu, Seoul, 04564 Republic of Korea
| | - Miyeun Han
- grid.413641.50000 0004 0647 5322Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 12, Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul, 07247 Republic of Korea
| | - Won Suk An
- grid.255166.30000 0001 2218 7142Department of Internal Medicine, Dong-A University College of Medicine, 26, Daesingongwon-ro, Dongdaesin-dong 3-ga, Seo-gu, Busan, 49201 Republic of Korea
| | - Su Hyun Kim
- grid.411651.60000 0004 0647 4960Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973 Republic of Korea
| | - Jun Young Do
- grid.413028.c0000 0001 0674 4447Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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da Silva BR, Orsso CE, Gonzalez MC, Sicchieri JMF, Mialich MS, Jordao AA, Prado CM. Phase angle and cellular health: inflammation and oxidative damage. Rev Endocr Metab Disord 2022; 24:543-562. [PMID: 36474107 PMCID: PMC9735064 DOI: 10.1007/s11154-022-09775-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Phase angle is a composite measure that combines two raw bioelectrical impedance analysis measures: resistance and reactance. Phase angle has been considered an indicator of cellular health, integrity, and hydration. As inflammation and oxidative stress can damage cellular structures, phase angle has potential utility in early detecting inflammatory and oxidative status. Herein, we aimed to critically review the current understanding on the determinants of phase angle and its relationship with markers of inflammation and oxidative stress. We also discussed the potential role of phase angle in detecting chronic inflammation and related adverse outcomes. Several factors have been identified as predictors of phase angle, including age, sex, extracellular to intracellular water ratio, and fat-free mass. In addition to these factors, body mass index (BMI) also seems to influence phase angle. Available data also show that lower phase angle values are correlated (negligible to high correlation coefficients) with higher c-reactive protein, tumour necrosis factor-α, interleukin-6, and interleukin-10 in studies involving the general and aging populations, as well as patients with chronic conditions. Although fewer studies have evaluated the relationship between phase angle and markers of oxidative stress, available data also suggest that phase angle has potential to be used as an indicator (for screening) of oxidative damage. Future studies including diverse populations and bioelectrical impedance devices are required to confirm the validity and accuracy of phase angle as a marker of inflammation and oxidative stress for clinical use.
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Affiliation(s)
- Bruna Ramos da Silva
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Camila E Orsso
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Juliana Maria Faccioli Sicchieri
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mirele Savegnago Mialich
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Alceu A Jordao
- Department of Health Sciences, Division of Nutrition and Metabolism, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada.
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Cheng L, Chang L, Tian R, Zhou J, Luo F, Zhang H. The predictive value of bioimpedance-derived fluid parameters for cardiovascular events in patients undergoing hemodialysis. Ren Fail 2022; 44:1192-1200. [PMID: 35856161 PMCID: PMC9318232 DOI: 10.1080/0886022x.2022.2095287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is becoming increasingly evident that the accurate assessment of fluid
status is critical to ensure optimal care in patients undergoing
hemodialysis (HD). Various fluid parameters, including
overhydration (OH) and overhydration/extracellular water
(OH/ECW%), which can be obtained using a
bioimpedance spectroscopy device have been used to indicate the hydration
status in such patients. This study aimed to explore the effect of these
fluid parameters on cardiovascular events and determine which parameter was
a better predictor of cardiovascular events (CVEs). Methods A total of 227 patients who underwent HD at the Hangzhou Hospital of
Traditional Chinese Medicine were enrolled in this prospective study between
December 2017 and August 2018. Clinical data were collected, and the fluid
status of patients was assessed using a body composition monitor. The
patients were followed up until December 2020. The primary outcomes were
CVEs. The association between fluid parameters and CVEs was analyzed using
Cox proportional hazards models. The areas under the curve
(AUCs) of receiver operating characteristic analysis and
improvement in the global chi-squared value were used to compare the
predictive values of fluid parameters for CVEs. Results During a median follow-up of 31 months, 66 CVEs were recorded. The
patients with a higher absolute hydration index (OH) and a
relative hydration index (OH/ECW%) exhibited an
increased risk of developing CVEs. After adjusting for confounding factors,
both OH [hazard ratio (HR) 1.279 per L, 95%
confidence interval (CI) 1.047–1.562;
p = 0.016] and OH/ECW%
(HR 1.061 per %, 95% CI 1.017–1.108;
p = 0.006) were
independently associated with CVEs. The predictive ability of the absolute
hydration index was superior to the relative hydration index based on AUC
calculations for CVEs. Furthermore, a greater change in
χ2 in predicting CVEs was noted
for the absolute hydration index. Conclusions Both absolute hydration index and relative hydration index were found to be
independent predictors of CVEs in univariate and multivariate analyses.
Furthermore, the absolute hydration index had a better additive predictive
value than the relative hydration index in predicting CVEs.
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Affiliation(s)
- Linghong Cheng
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Liyang Chang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Rongrong Tian
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianfang Zhou
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fenxia Luo
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongmei Zhang
- Department of Nephrology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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13
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Maggiani-Aguilera P, Chávez-Iñiguez JS, Navarro-Blackaller G, Hernández-Morales K, Geraldo-Ozuna AL, Alcantar-Villín L, Montoya-Montoya O, Luquín-Arellano VH, García-García G. Portable sauna stimulated-diaphoresis for the treatment of fluid-overload in peritoneal dialysis patients: A pilot study. Front Med (Lausanne) 2022; 9:887609. [PMID: 36203760 PMCID: PMC9530624 DOI: 10.3389/fmed.2022.887609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022] Open
Abstract
Background Fluid overload (FO) is a common problem in patients with peritoneal dialysis (PD), it is associated with adverse outcomes and may persist despite adjustements in PD therapy. Objective To evaluate the feasibility and safety of stimulated diaphoresis to reduce FO with the use of a portable sauna bath. Methods Open-label pilot study in patients on continuous ambulatory peritoneal dialysis (CAPD) and FO. The primary outcome was the treatment-related adverse events; secondary outcomes were changes in over-hydration (OH), body weight and blood pressure, FO symptoms, and sleep quality. Dialysis prescription and daily data were recorded. The intervention period consisted in a 30-min, 45°C sauna bath, daily for 10 days, using a portable sauna bath. Results Fifty-one out of 54 total sauna bath sessions were well tolerated. In three (5.5%) sessions adverse effects were reported: transient dizziness in two cases, and a second-degree skin burn in a patient with advanced diabetic neuropathy. OH (6.3 ± 1.2 L vs. 5.5 ± 1.3 L, p = 0.05), body weight (67.7 ± 11.4 vs. 66.8 ± 3.8 kg, p = 0.003), diastolic blood pressure (92 ± 13.5 vs. 83 ± 13.3 mmHg, P = 0.003) and PSQI score (7.3 ± 3.7 vs. 5.1 ± 3.2, p = 0.02) improved significantly between the control and intervention period, respectively. Conclusions Stimulated diaphoresis with a portable sauna bath could be a novel, safe, and effective alternative way to reduce FO in CAPD patients. Larger studies are needed to confirm our results. Clinical trial registration ClinicalTrials.gov, identifier: NCT03563898.
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Affiliation(s)
- Pablo Maggiani-Aguilera
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Jonathan S. Chávez-Iñiguez
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Guillermo Navarro-Blackaller
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Karla Hernández-Morales
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Ariadna Lizbeth Geraldo-Ozuna
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Luz Alcantar-Villín
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | | | - Víctor Hugo Luquín-Arellano
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
| | - Guillermo García-García
- Nephrology Department, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- University of Guadalajara Health Sciences Center, Guadalajara, Mexico
- *Correspondence: Guillermo García-García
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14
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Kim JC, Do JY, Kang SH. Clinical Significance of Volume Status in Body Composition and Physical Performance Measurements in Hemodialysis Patients. Front Nutr 2022; 9:754329. [PMID: 35299757 PMCID: PMC8922218 DOI: 10.3389/fnut.2022.754329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction This study aimed to evaluate the association between volume status and body composition or physical performance measurements in hemodialysis patients. Methods A total of 84 patients were enrolled in this study. The participants were divided into tertiles based on the edema index (extracellular water/total body water): low, middle, and high tertiles. Serum albumin and serum high-sensitivity C-reactive protein levels were measured. The appendicular lean mass index (ALM/Ht2, kg/m2) was measured using dual-energy X-ray absorptiometry. The thigh muscle area index (TMA/Ht2, cm2/m2) was measured using CT. Extracellular and total body water and phase angles were obtained using bioimpedance analysis. The results of the subjective global assessment (SGA), hand-grip strength (HGS), gait speed (GS), short physical performance battery (SPPB), sit-to-stand for 30-second (STS30) test, timed up and go (TUG), sit-to-stand test performed five times (STS5), and 6-minute walk (6-MW) tests were also evaluated. Results On the univariate analysis, the SGA score and phase angle in the high tertile group were the lowest among the three groups. On multivariate analysis, TMA/Ht2 and phase angle in the high tertile were the lowest among the three groups. Inverse correlations were observed between edema index and TMA/Ht2, SGA score, phase angle, HGS, GS, SPPB, STS30, or 6-MW. Positive correlations were observed between the edema index and the STS5 or TUG test. The sensitivity and specificity for predicting low GS were 34.5 and 89.7%, respectively. The values for predicting low SPPB were 68.0 and 79.7%, respectively. Conclusion This study demonstrates that high volume status may be associated with decreased muscle mass and physical performance regardless of inflammatory or nutritional status.
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Affiliation(s)
- Jun Chul Kim
- Division of Nephrology, Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi, South Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
- *Correspondence: Seok Hui Kang
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15
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Verger C, Ronco C, Van Biesen W, Heaf J, Vrtovsnik F, Vera Rivera M, Puide I, Azar R, Gauly A, Atiye S, De Los Ríos T. Association of Prescription With Body Composition and Patient Outcomes in Incident Peritoneal Dialysis Patients. Front Med (Lausanne) 2022; 8:737165. [PMID: 35004718 PMCID: PMC8738083 DOI: 10.3389/fmed.2021.737165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 02/03/2023] Open
Abstract
Objective: The nutritional status of patients on peritoneal dialysis (PD) is influenced by patient- and disease-related factors and lifestyle. This analysis evaluated the association of PD prescription with body composition and patient outcomes in the prospective incident Initiative for Patient Outcomes in Dialysis–Peritoneal Dialysis (IPOD-PD) patient cohort. Design and Methods: In this observational, international cohort study with longitudinal follow-up of 1,054 incident PD patients, the association of PD prescription with body composition was analyzed by using the linear mixed models, and the association of body composition with death and change to hemodialysis (HD) by means of a competing risk analysis combined with a spline analysis. Body composition was regularly assessed with the body composition monitor, a device applying bioimpedance spectroscopy. Results: Age, time on PD, and the use of hypertonic and polyglucose solutions were significantly associated with a decrease in lean tissue index (LTI) and an increase in fat tissue index (FTI) over time. Competing risk analysis revealed a U-shaped association of body mass index (BMI) with the subdistributional hazard ratio (HR) for risk of death. High LTI was associated with a lower subdistributional HR, whereas low LTI was associated with an increased subdistributional HR when compared with the median LTI as a reference. High FTI was associated with a higher subdistributional HR when compared with the median as a reference. Subdistributional HR for risk of change to HD was not associated with any of the body composition parameters. The use of polyglucose or hypertonic PD solutions was predictive of an increased probability of change to HD, and the use of biocompatible solutions was predictive of a decreased probability of change to HD. Conclusion: Body composition is associated with non-modifiable patient-specific and modifiable treatment-related factors. The association between lean tissue and fat tissue mass and death and change to HD in patients on PD suggests developing interventions and patient counseling to improve nutritional markers and, ultimately, patient outcomes. Study Registration: The study has been registered at Clinicaltrials.gov (NCT01285726).
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Affiliation(s)
- Christian Verger
- Registre de Dialyse Péritonéale de Langue Française, Pontoise, France
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | - James Heaf
- Zealand University Hospital, Roskilde, Denmark
| | | | | | - Ilze Puide
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Adelheid Gauly
- Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Saynab Atiye
- Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Tatiana De Los Ríos
- Global Medical Office, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
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16
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Nutritional status and volume control in adolescents on chronic hemodialysis. Pediatr Nephrol 2021; 36:3733-3740. [PMID: 33988730 DOI: 10.1007/s00467-021-05089-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pediatric patients on maintenance hemodialysis (HD) are at risk of both malnutrition and fluid overload. This pilot study aimed to assess correlates of normalized protein catabolic rate (nPCR) in adolescents on chronic HD, in particular fluid status markers. METHODS All patients aged 10-18 years on chronic HD in our center between 2017 and 2019 were enrolled. For each patient, mean nPCR was calculated and correlations with the following parameters investigated: dry body weight change in subsequent 3 months in kg (∆BW) and percentage of BW (∆BW%), change in body mass index (∆BMI), preHD systolic and diastolic blood pressure (SBP, DBP), residual urine output, biochemistry, and blood volume monitoring-derived first hour refill index (RI), calculated as ratio between ultrafiltration rate and reduction in relative blood volume in first hour of dialysis. RESULTS Seventy-nine nPCR determinations were collected in 23 patients, median age 14.8 years. nPCR significantly correlated with ∆BW, ∆BW%, ∆BMI, spKT/V, and preHD serum creatinine, and negatively correlated with age, DBP SDS (r=-0.466, p=0.025) and RI (r=-0.435, p=0.043). RI was significantly higher in patients with nPCR <1 than those with nPCR above this threshold: 3.2 (1.9-4.7) vs. 1.4 (0.7-1.8) ml/kg/h/% (p=0.021). At multivariable analysis, nPCR remained positively correlated with creatinine and spKt/V, and inversely correlated with RI. CONCLUSIONS nPCR is a significant predictor of weight change in adolescents on maintenance HD, and seems associated with creatinine and dialysis adequacy. Inverse correlation with RI suggests possible associations between malnutrition and fluid overload, but larger prospective studies are needed to confirm this. A higher resolution version of the Graphical abstract is available as Supplementary information.
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17
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Li SY, Chuang CL, Lin CC, Tsai SH, Chen JY. Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial. MEMBRANES 2021; 11:membranes11100768. [PMID: 34677534 PMCID: PMC8541348 DOI: 10.3390/membranes11100768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/25/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Abstract
Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.
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Affiliation(s)
- Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan;
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
| | - Shin-Hung Tsai
- Division of Nephrology, Department of Medicine, Cheng Hsin General Hospital, Taipei 112201, Taiwan;
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 112201, Taiwan; (S.-Y.L.); (C.-C.L.)
- Correspondence:
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18
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Exploring the potential role of phase angle as a marker of oxidative stress: A narrative review. Nutrition 2021; 93:111493. [PMID: 34655952 DOI: 10.1016/j.nut.2021.111493] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022]
Abstract
Chronic conditions including non-communicable diseases have become increasingly prevalent in the past decade. Proinflammatory cytokines are associated with the development of several pathologies, their prognoses, and their associated mortality. Chronic inflammation is also associated with oxidative stress whereby reactive oxygen species (ROS) induce cellular injury and, thus, by doing so, initiate inflammatory signaling. Phase angle (PhA) is a measurable body composition parameter obtained using bioelectrical impedance analysis (BIA). PhA is considered an indicator of cellular health and integrity and is also related to inflammatory markers and inflammation. Given the association among oxidative stress, cell damage, and inflammation that may in turn be associated with low PhA values, it is expected that PhA could mirror oxidative stress. In this hypothesis-generating, narrative review we summarize the current knowledge regarding the potential relationship between PhA and oxidative stress and their interrelationship in chronic conditions.
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Fluid overload is associated with increased 90-day mortality in AML patients undergoing induction chemotherapy. Ann Hematol 2021; 100:2603-2611. [PMID: 34304288 PMCID: PMC8440269 DOI: 10.1007/s00277-021-04593-x] [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: 04/19/2021] [Accepted: 06/29/2021] [Indexed: 11/06/2022]
Abstract
Treatment‐related complications contribute substantially to morbidity and mortality in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Although AML patients are susceptible to fluid overload (FO) (e.g., in the context of chemotherapy protocols, during sepsis treatment or to prevent tumor lysis syndrome), little attention has been paid to its role in AML patients undergoing induction chemotherapy. AML patients receiving induction chemotherapy between 2014 and 2019 were included in this study. FO was defined as ≥5% weight gain on day 7 of induction chemotherapy compared to baseline weight determined on the day of admission. We found FO in 23 (12%) of 187 AML patients undergoing induction chemotherapy. Application of >100 ml crystalloid fluids/kg body weight until day 7 of induction chemotherapy was identified as an independent risk factor for FO. AML patients with FO suffered from a significantly increased 90-day mortality rate and FO was demonstrated as an independent risk factor for 90-day mortality. Our data suggests an individualized, weight-adjusted calculation of crystalloid fluids in order to prevent FO-related morbidity and mortality in AML patients during induction chemotherapy. Prospective trials are required to determine the adequate fluid management in this patient population.
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20
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Kim C, Kim JK, Lee HS, Kim SG, Song YR. Longitudinal changes in body composition are associated with all-cause mortality in patients on peritoneal dialysis. Clin Nutr 2021; 40:120-126. [DOI: 10.1016/j.clnu.2020.04.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/30/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
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21
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Barrea L, Pugliese G, de Alteriis G, Colao A, Savastano S, Muscogiuri G. Phase Angle: Could Be an Easy Tool to Detect Low-Grade Systemic Inflammation in Adults Affected by Prader-Willi Syndrome? Nutrients 2020; 12:E2065. [PMID: 32664600 PMCID: PMC7400955 DOI: 10.3390/nu12072065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/01/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Prader-Willi syndrome (PWS) is the most common genetic inherited obesity syndrome. Obesity-related complications, mostly related to chronic low-grade systemic inflammation (LGI), are the commonest cause of mortality and morbidity in PWS adults. Phase angle (PhA) is an easy tool to screen a state of LGI in healthy subjects and in subjects with obesity and is obtained from bioelectrical impedance analysis (BIA). The aim of this study was to validate the PhA in PWS adults as a potential biomarker of LGI. In this single-center, cross-sectional study, fifteen PWS adults (six males, aged 19-41 years, and body mass index (BMI) 31.0-68.0 Kg/m2) and fifteen control subjects matched by gender, age, and BMI were evaluated. PhA values were significantly lower (p < 0.001), while high-sensitivity C-reactive protein (hs-CRP) levels were significantly higher (p < 0.001) in PWS adults compared with controls (p < 0.001), without a gender difference in the latter. After adjustment for gender, BMI, and waist circumference, significant correlation was found between PhA and hs-CRP levels (r = -0.69, p = 0.01). At the ROC analysis, the threshold value of PhA predicting the highest hs-CRP levels above the median value was found at PhA ≤ 4.8° (p = 0.01; AUC, 0.82; standard error, 0.12; 95% CI, 0.58 to 1.00). These results suggest that PWS adults had a significant higher degree of LGI compared with their counterparts. Moreover, our finding suggest that PhA is a valid biomarker of LGI also in PWS adults.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gabriella Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giulia de Alteriis
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco “Educazione alla Salute e allo Sviluppo Sostenibile”, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.P.); (G.d.A.); (A.C.); (S.S.); (G.M.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
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Orlando A, Tutino V, Notarnicola M, Riezzo G, Linsalata M, Clemente C, Prospero L, Martulli M, D’Attoma B, De Nunzio V, Russo F. Improved Symptom Profiles and Minimal Inflammation in IBS-D Patients Undergoing a Long-Term Low-FODMAP Diet: A Lipidomic Perspective. Nutrients 2020; 12:nu12061652. [PMID: 32498383 PMCID: PMC7353020 DOI: 10.3390/nu12061652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Given the link between the minimal inflammation underlying irritable bowel syndrome (IBS) and dietary treatments, considerable attention has focused on diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). In this context, inflammatory patterns and lipidomic investigations may shed light on the pathophysiological mechanisms whereby a low-FODMAP diet (LFD) improves the IBS diarrhoea (IBS-D) variant. Thus, we investigated whether a long-term LFD induced changes in symptom profiles, anthropometric characteristics, inflammatory markers (C-reactive protein, cyclooxygenase-2, and prostaglandin E2) and erythrocyte-membrane fatty acid (FA) composition in IBS-D patients. Twenty IBS-D patients underwent a 90 day personalised LFD programme, and were regularly evaluated at scheduled visits. At the diet’s end, both IBS symptoms and anthropometric parameters were significantly improved. A significant decrease in prostaglandin E2 also accompanied these reductions. As for FAs, the putative inflammatory indicators, arachidonic acid (AA) levels and the AA/eicosapentaenoic acid ratio were significantly decreased. In conclusion, IBS-D patients following a controlled long-term LFD experienced improved symptom profiles and decreased inflammatory markers linked to FAs. Lipidomic data may be insightful for unravelling the molecular mechanisms associated with IBS-D pathophysiology.
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Affiliation(s)
- Antonella Orlando
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Valeria Tutino
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (V.T.); (M.N.); (V.D.N.)
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (V.T.); (M.N.); (V.D.N.)
| | - Giuseppe Riezzo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Michele Linsalata
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Caterina Clemente
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Laura Prospero
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Manuela Martulli
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Benedetta D’Attoma
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
| | - Valentina De Nunzio
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (V.T.); (M.N.); (V.D.N.)
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte (Ba), Italy; (A.O.); (G.R.); (M.L.); (C.C.); (L.P.); (M.M.); (B.D.)
- Correspondence:
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Jaques DA, Davenport A. Determinants of volume status in peritoneal dialysis: A longitudinal study. Nephrology (Carlton) 2020; 25:785-791. [PMID: 32304154 DOI: 10.1111/nep.13716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/12/2023]
Abstract
AIM In peritoneal dialysis (PD), fluid overload is frequent and associated with cardiac dysfunction and mortality. As it is considered a modifiable risk factor, we wished to describe clinical determinants of fluid overload in a longitudinal cohort of PD outpatients. METHODS We consecutively included PD outpatients treated with continuous ambulatory PD (CAPD) or automated PD (APD) attending for their routine clinical visit at a single tertiary hospital. Extracellular water (ECW) to total body water (TBW) ratio was measured by multifrequency bioelectrical impedance. Peritoneal transport characteristics were measured with a standard peritoneal equilibration test. Patients had a second follow-up visit with the same measurements. Univariable and multivariable mixed linear regression models were conducted with ECW/TBW as the dependent variable. RESULTS A total of 155 patients were enrolled with a median follow-up time of 12 months. Median dialysis vintage was 13.5 ± 3.4 months. Overall mean value of ECW/TBW was 39.3% ± 1.1. In multivariable analysis, factors positively associated with ECW/TBW were: Age (P < .001), diabetes (P = .002), and SBP (P = .028). Factors negatively associated with ECW/TBW were: nPNA (P = .001), serum albumin (P < .001) and PTH (P = .014). None of the considered variable showed a significant interaction with time. CONCLUSION We confirm a high prevalence of fluid overload in PD patients and show that it is strongly associated with older age, diabetes, hypoalbuminemia and protein energy wasting. In contrast, when PD prescription is tailored to patient's individual characteristics, residual renal function, PD modality and peritoneal characteristics are not decisive in controlling volume status.
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Affiliation(s)
- David A Jaques
- Department of Nephrology, Geneva University Hospitals, Geneva, Switzerland.,UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free London NHS Foundation Trust, London, UK
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Sarmento-Dias M, Santos-Araújo C, Poínhos R, Oliveira B, Sousa M, Simões-Silva L, Soares-Silva I, Correia F, Pestana M. Phase Angle Predicts Arterial Stiffness and Vascular Calcification in Peritoneal Dialysis Patients. Perit Dial Int 2020; 37:451-457. [DOI: 10.3747/pdi.2015.00276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/13/2016] [Indexed: 11/15/2022] Open
Abstract
ObjectivesFluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with markers of malnutrition, inflammation, and atherosclerosis/calcification (MIAC) syndrome. We examined the relationships in stable PD patients between phase angle (PhA) and the spectrum of uremic vasculopathy including vascular calcification and arterial stiffness and between PhA and changes in serum fetuin-A levels.MethodsSixty-one stable adult PD patients were evaluated in a cross-sectional study (ST1). Phase angle was measured by multifrequency bioimpedance analysis (InbodyS10, Biospace, Korea) at 50 kHz. Augmentation index (AI), a surrogate marker of arterial stiffness, was assessed by digital pulse amplitude tonometry (Endo PAT, Itamar Medical, Caesarea, Israel). Vascular calcification was assessed by simplified calcification score (SCS). Serum fetuin-A levels were measured by ELISA (Thermo scientific; Waltham, MA, USA). Serum albumin was used as a nutritional marker, and serum C-reactive protein (CRP) was used as an inflammatory marker. The same assessments were carried out longitudinally (ST2) in the first 33 patients who completed 1 year of evaluation in ST1.ResultsIn ST1, patients with PhA < 6° had higher CRP levels, AI, and SCS and lower serum albumin and fetuin-A levels, in comparison with patients with PhA ≥ 6°. In addition, PhA was a predictor of both AI ((3 = -0.351, p = 0.023) and SCS > 3 (EXP (B) = 0.243, p = 0.005). In ST2, the increase of PhA over time was associated with decreases in both AI ( r = -0.378, p = 0.042) and CRP levels ( r = -0.426, p = 0.021), as well as with the increase in serum fetuin-A levels ( r = 0.411, p = 0.030).ConclusionsPhase angle predicts both arterial stiffness and vascular calcification in stable PD patients.
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Affiliation(s)
- Margarida Sarmento-Dias
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Carla Santos-Araújo
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Centro Hospitalar de São João, EPE, Porto, Portugal; Unidade de Investigação e Desenvolvimento Cardiovascular, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Poínhos
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Bruno Oliveira
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Sousa
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Liliana Simões-Silva
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto; Departamento de Doenças Renais Urológicas e Infecciosas, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Isabel Soares-Silva
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Flora Correia
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Porto, Portugal; Faculdade de Ciências da Nutrição e Alimentação, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Manuel Pestana
- i3S – Instituto de Investigação e Inovação em Saúde, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; INEB – Instituto de Engenharia Biomédica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Universidade do Porto, Portugal; Serviço de Nefrologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto; Departamento de Doenças Renais Urológicas e Infecciosas, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Effects of volume status on body composition in incident peritoneal dialysis patients. Eur J Clin Nutr 2020; 74:633-641. [PMID: 32029910 DOI: 10.1038/s41430-020-0574-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Inadequate fluid removal or high water intake leads to overhydration, which results in malnutrition. The aim of the present study was to evaluate the effects of volume status on body composition in incident peritoneal dialysis (PD) patients. METHODS All incident PD patients who survived ≥1 year after PD initiation were considered eligible. A total of 366 incident PD patients were finally included and divided into three tertiles according to the time-averaged-edema index (TA-EI). The body composition parameters measured using bioimpedance analysis included the EI, fat mass index (FMI, kg/m2), and appendicular muscle mass index (AMMI, kg/m2). dFMI and dAMMI were defined as delta values for each variable. The cutoff value for sarcopenia (SP) was defined as previously reported. Patients with AMMI below the cutoff values were defined as having SP. RESULTS The number of participants in the low, middle, and high tertiles was 126, 100, and 140, respectively. A high volume status was associated with high solute clearance, albumin loss, and glucose absorption through the peritoneal membrane, which led to high dialysate glucose. In addition, volume status was inversely associated with increases in AMMI, but was not associated with changes in FMI. SP as a categorical variable was positively associated with a high volume status. On subgroup analyses, TA-EI had the greatest negative correlation coefficients for dAMMI. CONCLUSION Overhydration in PD patients was associated with decrease in muscle mass indices and the development of SP.
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Caron-Lienert RS, Poli-de-Figueiredo CE, Figueiredo AEPL, da Costa BEP, Crepaldi C, Pizzato AC, Ferrari F, Giuliani A, Ronco C. The Influence of Glucose Exposure Load and Peritoneal Membrane Transport on Body Composition and Nutritional Status Changes after 1 Year on Peritoneal Dialysis. Perit Dial Int 2020; 37:458-463. [DOI: 10.3747/pdi.2016.00265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/14/2017] [Indexed: 12/20/2022] Open
Abstract
BackgroundThe characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD.MethodsWe examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM).ResultsIn total, 50.6% of the patients presented DW gain, 41.2% showed LTM loss, and 65.9% presented FM gain. Over the time (T0 – T12), we found significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI). Patients with lower dialysate-to-plasma creatinine ratio showed DW and FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with DW no gain. As for glucose exposure load, no body composition changes were seen.ConclusionsMost patients presented DW gain, FM gain, and LTM loss. The characteristics of peritoneal membrane transport affected DW during the first year, changes being greater in nonfast than in fast transporters.
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Affiliation(s)
- Rafaela Siviero Caron-Lienert
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Brazil
- International Renal Research Institute of Vicenza, Italy
| | | | | | | | - Carlo Crepaldi
- International Renal Research Institute of Vicenza, Italy
| | | | | | - Anna Giuliani
- International Renal Research Institute of Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Italy
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Increased arterial velocity pulse index is an independent factor related to skeletal muscle mass reduction and tissue damage in patients with cardiovascular disease. Hypertens Res 2020; 43:534-542. [DOI: 10.1038/s41440-020-0404-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/09/2019] [Accepted: 12/23/2019] [Indexed: 11/08/2022]
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Sukackiene D, Laucyte-Cibulskiene A, Vickiene A, Rimsevicius L, Miglinas M. Risk stratification for patients awaiting kidney transplantation: Role of bioimpedance derived edema index and nutrition status. Clin Nutr 2019; 39:2759-2763. [PMID: 31866127 DOI: 10.1016/j.clnu.2019.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/10/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recent studies demonstrate that the edema index (ECW/TBW) may be a significant predictor of poor outcomes as a composite of overhydration and protein-energy wasting. There is no consensus regarding ECW/TBW cut-off values. We aimed to determine the performance of ECW/TBW in all-cause mortality prediction and to establish certain cut-off values in patients on chronic hemodialysis. METHODS Body composition of 158 hemodialysis patient was performed by using InBody S10 (Biospace, Seoul, Korea) analyzer. Demographic profile and laboratory data were collected. Subjective Global Assessment Scale (SGA) was used to assess nutrition status. In the mean follow up of 3.5 ± 1.15 years, two independent clinicians evaluated death cases and factors for all-cause mortality were established. Statistical analysis was performed with R software. RESULTS 73 of 158 hemodialysis patients were on kidney transplant waiting list. Mean age of study subjects was 53.6 ± 15.1 years, 51.9% were females, and 13.9% had diabetes. During the follow-up period, 17.72% of patients died. They had significantly higher ECW/TBW values 0.393 vs 0.408, p < 0.001. Subjects with lower edema index had better nutrition according to SGA (SGA A 0.391; SGA B 0.400; SGA C 0.413; p < 0.001). The calculated ECW/TBW cut-off point for all-cause mortality was 0.4055, with sensitivity of 84.6%, specificity of 69.8%. On the other hand, the cut-off point for SGA scores B and C was 0.396 with sensitivity of 72.7% and specificity of 68.7%. CONCLUSION The manufacturer provided ECW/TBW cut-off point of 0.400 should be addressed carefully, because it varies depending on the selected outcome and population studied. InBody ECW/TBW reference values from 0.390 to 0.410 are the most promising in hemodialysis population to assess all-cause mortality, nutrition status and body composition.
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Affiliation(s)
- D Sukackiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania.
| | | | - A Vickiene
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - L Rimsevicius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
| | - M Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania
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Lee JY, Ryu HS, Yoon SS, Kim EH, Yoon SW. Extracellular-to-Intracellular Fluid Volume Ratio as a Prognostic Factor for Survival in Patients With Metastatic Cancer. Integr Cancer Ther 2019; 18:1534735419847285. [PMID: 31043080 PMCID: PMC6498769 DOI: 10.1177/1534735419847285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose: This study aimed to investigate whether the
extracellular-to-intracellular fluid volume (E/I) ratio can predict survival in
patients with metastatic cancer. Methods: Clinical data were
collected from April 2016 to March 2018. Patients aged ≥19 years with metastatic
solid tumor were eligible. Bioimpedance analysis was used to assess body fluid
distribution and the E/I ratio. Clinical characteristics, including laboratory
test results and nutrition status according to the E/I ratio, were analyzed. Cox
proportional hazards models and Kaplan-Meier analysis were used to identify risk
factors for mortality. Results: In total, 87 patients were included
in the study. The 87 patients were divided into 2 groups according to the median
E/I ratio: a high E/I group (E/I ratio ≥1.0, n = 43) and a low E/I group (E/I
ratio <1.0, n = 44). Poor performance status, fluid retention, malnutrition,
elevation of C-reactive protein levels, and decreases in hemoglobin, albumin,
and protein levels were significantly associated with the high E/I group. The
median overall survival time was 1.6 and 12.5 months in the high E/I and low E/I
groups, respectively (P < .001). In the multivariate
analysis, poor performance status, leukocytosis, fluid retention, and E/I ratio
were independent prognostic factors, and the E/I ratio was the strongest
prognostic factor predicting overall survival (hazard ratio = 3.49, 95%
confidence interval = 1.75-6.96, P < .001).
Conclusions: The E/I ratio can predict survival time in
patients with metastatic cancer. More rigorous research is required to confirm
this result.
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Affiliation(s)
- Jee Young Lee
- Kyung Hee University Hospital at
Gangdong, Gangdonggu, Seoul, Republic of Korea
| | - Han Sung Ryu
- Kyung Hee University Hospital at
Gangdong, Gangdonggu, Seoul, Republic of Korea
| | - Sung Soo Yoon
- Kyung Hee University Hospital at
Gangdong, Gangdonggu, Seoul, Republic of Korea
| | - Eun Hye Kim
- Kyung Hee University Hospital at
Gangdong, Gangdonggu, Seoul, Republic of Korea
| | - Seong Woo Yoon
- Kyung Hee University Hospital at
Gangdong, Gangdonggu, Seoul, Republic of Korea
- Seong Woo Yoon, Department of Internal
Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at
Gangdong, Dongnamro 892, Gangdonggu, Seoul 134-727, Republic of Korea.
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Deng Y, Liu H, Lin N, Ma L, Fu W. Influence of dry weight reduction on anemia in patients undergoing hemodialysis. J Int Med Res 2019; 47:5536-5547. [PMID: 31530055 PMCID: PMC6862877 DOI: 10.1177/0300060519872048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Volume load in patients undergoing hemodialysis correlates with renal anemia, with reductions in volume load significantly improving hemoglobin levels. We performed a prospective controlled study to assess the effect of post-dialysis dry weight reduction, resulting from the gradual enhancement of ultrafiltration, on renal anemia in this patient population. Methods Sixty-four patients with renal anemia on maintenance hemodialysis were randomized to an ultrafiltration group, in which dry weight was gradually reduced by slightly increasing the ultrafiltration volume while maintaining routine hemodialysis, and a control group, in which patients underwent conventional dialysis while routine ultrafiltration was maintained. After 28 weeks, post-dialysis weight and levels of hematocrit, hemoglobin, C-reactive protein, serum albumin, serum ferritin, and transferrin saturation were compared. Results All parameters were similar at baseline between the two groups and remained unchanged at week 28 in the control group compared with baseline. In contrast, the ultrafiltration group showed a significant reduction in post-dialysis weight and C-reactive protein concentration and a significant increase in hematocrit, hemoglobin, albumin, serum ferritin, and transferrin saturation. Conclusions Dry weight reduction resulting from enhanced ultrafiltration may improve renal anemia in patients undergoing hemodialysis.
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Affiliation(s)
- Yinghui Deng
- Department of Nephrology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Hua Liu
- Department of Nephrology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Na Lin
- Department of Nephrology, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Lina Ma
- Department of Geriatrics, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Wenjing Fu
- Department of Nephrology, Xuan Wu Hospital, Capital Medical University, Beijing, China
- Wenjing Fu, Department of Nephrology, Xuan Wu Hospital, Capital Medical University, #45 Changchun Street, Xicheng District, Beijing 100053, China.
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Factors associated with systolic hypertension in peritoneal dialysis patients. J Nephrol 2019; 33:365-370. [PMID: 31401794 PMCID: PMC7118037 DOI: 10.1007/s40620-019-00633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/30/2019] [Indexed: 01/20/2023]
Abstract
Background Hypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients. Methods We retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements. Results We studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47–72) years, and 51% treated by APD with a day-time icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (β = 29.5 (95% confidence limits 11.4–47.5, p = 0.001), N-terminal brain natriuretic peptide [β = 11.9 (7.2–16.7), p < 0.001], and daily urine sodium excretion [β = 1.7 (1.0–2.3), p < 0.001]. Conclusion In the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.
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Low Bioelectrical Impedance Phase Angle Is a Significant Risk Factor for Frailty. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6283153. [PMID: 31281842 PMCID: PMC6590642 DOI: 10.1155/2019/6283153] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/18/2022]
Abstract
The phase angle, which is measured via bioelectrical impedance analysis (BIA), is a clinically important bioimpedance parameter used for nutritional assessment and evaluating the risk of various diseases, such as locomotive syndrome (LS). It remains unclear if the phase angle is associated with frailty (fragile state of physical and mental health). We therefore examined this association in a large prospective sample. Of 1081 individuals receiving health checkups, 550 (male; 235, female; 365) were enrolled in this study. We applied the Japanese version of the Cardiovascular Health Study criteria to evaluate frailty and administered the 25-Item Geriatric Locomotive Function Scale to diagnose LS. The phase angle was measured via BIA. Multiple logistic regression analysis was used to evaluate the relationship between the phase angle and frailty. For all participants and for each sex, the phase angle was significantly lower among individuals with frailty. After controlling for age, sex, and body mass index, we found that a low phase angle was a significant risk factor of frailty. As a result of multiple regression analysis including other confounding factors, among male participants, a low phase angle was significantly related with both frailty (P = 0.015) and LS (P < 0.001), whereas among female participants, the low phase angle had a stronger association with frailty (P = 0.001) than with LS (P = 0.52). Our findings suggest that a low angle is a risk factor of frailty. Furthermore, among female participants, frailty has a stronger relation with the phase angle than does LS. Therefore, the phase angle may be considered a useful indicator of frailty that does not require lengthy or costly assessment.
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Yoowannakul S, Kotecha T, Fontana M, Davenport A. Do Pre‐Hemodialysis Estimates of Extracellular Volume Excess Using Bioimpedance and N‐Terminal Brain Natriuretic Peptide Correlate With Cardiac Chamber Size Measured by Magnetic Resonance Imaging? Ther Apher Dial 2018; 23:362-368. [DOI: 10.1111/1744-9987.12779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023]
Affiliation(s)
| | - Tushar Kotecha
- National Amyloid Centre, Royal Free Hospital, Department of MedicineUniversity College London London UK
- Department of CardiologyRoyal Free Hospital London UK
| | - Marianna Fontana
- National Amyloid Centre, Royal Free Hospital, Department of MedicineUniversity College London London UK
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Kooman JP, van der Sande FM. Body Fluids in End-Stage Renal Disease: Statics and Dynamics. Blood Purif 2018; 47:223-229. [PMID: 30517920 DOI: 10.1159/000494583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Abnormalities in fluid status in hemodialysis (HD) patients are highly prevalent and are related to adverse outcomes. SUMMARY The inherent discontinuity of the HD procedure in combination with an often compromised cardiovascular response is a major contributor to this phenomenon. In addition, systemic inflammation and endothelial dysfunction are related to extracellular fluid overload (FO). Underlying this relation may be factors such as hypoalbuminemia and an increased capillary permeability, leading to an altered fluid distribution between the blood volume (BV) and the interstitial fluid compartments, compromising fluid removal during dialysis. Indeed, whereas estimates of extracellular volume by bioimpedance spectroscopy are highly predictive of mortality, absolute BV assessed by the saline dilution technique was predictive of intra-dialytic morbidity. Changes in relative BV during HD are positively related to ultrafiltration rate (UFR) and, at least in some studies, negatively to FO. High UFR is also related to changes in central venous oxygen saturation (ScvO2), a marker for tissue perfusion. On the one hand, high UFR and more pronounced declines in ScvO2, but on the other hand, flat relative BV curves are also predictive of mortality; the relation between outcome which statics and dynamics of fluid status appears to be complex. Key Message: While technological developments enable the clinician to monitor statics and dynamics of fluid status and hemodynamics during HD in an accessible way, the role of technology-based interventions needs further study.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands,
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Brzozowska A, Mlak R, Gołębiowski P, Małecka-Massalska T. Status of hydration assessed by bioelectrical impedance analysis: a valuable predictive factor for radiation-induced oral mucositis in head and neck cancer patients. Clin Transl Oncol 2018; 21:615-620. [PMID: 30327938 DOI: 10.1007/s12094-018-1963-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Apart from surgery, the methods of treatment of HNC are radiotherapy (RTH) and/or chemotherapy (CRTH/CHT). One of the most frequent and serious complications of RTH is oral mucositis (OM). There is a strict correlation between the inflammation and the status of hydration. The aim of the study was to evaluate the changes in hydration, occurring in the course of RTH, measured by means of bioelectrical impedance analysis (BIA) and to analyze them in correlation with the intensification of OM in HNC patients. PATIENTS AND METHODS Data from 49 HNC patients (stages I-IV) were analyzed. All of them were irradiated using IMRT technique with the doses of 50-70 Gy. Oral mucositis (OM) was evaluated according to RTOG/EORTC guidelines. BIA was performed using ImpediMed bioimpedance analysis SFB7 BioImp v1.55. RESULTS In the fourth week of RTH, 4-5 days before the occurrence of severe OM, it was found that patients with OM grade 3 or higher compared to OM grade 2 or lower had significantly: lower ICW% values (respectively, 53.02% vs 50.72%; p = 0.0047), higher: ECW%: (47.95% vs 46.92%; p = 0.0020), TBW% (respectively, 56.34% vs 51.06%; p = 0.0455), ECW/ICW (respectively, 0.96 vs 0.86; p = 0.0007) and ECW/TBW (respectively, 0.49 vs 0.46, p = 0.0033). CONCLUSION Our study indicates that HNC patients undergo changes in hydration in the course of RTH. We have also confirmed that the intensification of OM leads to ICW decrease and the increase of ECW, TBW as well as ECW/ICW and ECW/TBW values.
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Affiliation(s)
- A Brzozowska
- Department of Oncology, Medical University of Lublin, Jaczewskiego Street 7, 20-090, Lublin, Poland.
| | - R Mlak
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
| | - P Gołębiowski
- Department of Oncology, Medical University of Lublin, Jaczewskiego Street 7, 20-090, Lublin, Poland
| | - T Małecka-Massalska
- Department of Human Physiology, Medical University of Lublin, Radziwiłłowska 11, 20-080, Lublin, Poland
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Dekker MJE, Konings C, Canaud B, van der Sande FM, Stuard S, Raimann JG, Öztürk E, Usvyat L, Kotanko P, Kooman JP. Interactions Between Malnutrition, Inflammation, and Fluid Overload and Their Associations With Survival in Prevalent Hemodialysis Patients. J Ren Nutr 2018; 28:435-444. [PMID: 30146272 DOI: 10.1053/j.jrn.2018.06.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/22/2018] [Accepted: 06/18/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Predialysis fluid overload (FO) in hemodialysis (HD) patients is associated with an increased risk of death, further increased by the presence of inflammation. Malnutrition is also associated with outcome. Study objectives were, firstly, to investigate if the presence of FO is associated with malnutrition and whether this association is influenced by the presence of inflammation. Second, we assessed the associations of FO, malnutrition, and inflammation with outcome individually and in combination. DESIGN International cohort study. SETTING European patients of the Monitoring Dialysis Outcome Initiative cohort where bioimpedance and C-reactive protein measurements are performed as standard of care. SUBJECTS 8883 prevalent HD patients. MAIN OUTCOME MEASURE Body composition, nutritional and inflammation status were assessed during a 3-month baseline period, and all-cause mortality was noted during 1 year follow-up. Malnutrition was defined as a lean tissue index <10th percentile (of age and gender matched healthy controls), FO as a predialysis overhydration >+1.1 L and inflammation as a C-reactive protein > 6.0 mg/L. We used Cox models to investigate the association with outcome. RESULTS The presence of malnutrition was associated with higher levels of FO, this amount further increased when inflammation was present. Only 11.6% of the patients did not have any of the 3 risk factors and only 6.5% of the patients were only malnourished, which was not associated with an increased risk of death (Hazard Ratio [HR] 1.22 [95% Confidence Interval [CI]: 0.75-1.97]), whereas the combination of severe malnutrition, FO, and inflammation comprised the highest risk of death (HR 5.89 [95% CI: 2.28-8.01]). CONCLUSION In HD patients, predialysis FO associates with both malnutrition and the presence of inflammation, with the highest levels of FO observed when both are present. Malnutrition as singular risk factor was not associated with increased mortality risk. The highest mortality risk was observed in patients where all 3 risk factors were present.
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Affiliation(s)
- Marijke J E Dekker
- Maastricht University Medical Center, Maastricht, The Netherlands; Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| | | | | | | | | | | | - Elife Öztürk
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Len Usvyat
- Renal Research Institute, New York, New York; Fresenius Medical Care North America, Waltham, Massachusetts
| | - Peter Kotanko
- Renal Research Institute, New York, New York; Mount Sinai Hospital, New York, New York
| | - Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands
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Ng JKC, Kwan BCH, Chow KM, Pang WF, Cheng PMS, Leung CB, Li PKT, Szeto CC. Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients. PLoS One 2018; 13:e0202203. [PMID: 30102739 PMCID: PMC6089451 DOI: 10.1371/journal.pone.0202203] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background Fluid overload is common among asymptomatic peritoneal dialysis (PD) patients. We aim to determine the prevalence and prognostic significance of fluid overload, as measured by bioimpedance spectroscopy, in asymptomatic incident PD patients. Methods We performed a single-center study on 311 incident PD patients. Volume status was represented by the volume of overhydration (OH), OH/extracellular water (ECW) ratio, ECW/total body water (TBW) ratio, and ECW to intracellular water (ICW) ratio (E:I ratio). Patient survival, technique survival and cardiovascular event-free survival were determined. Results The median period of follow up was 27.3 months. Fluid overload was present in 272 patients (87.5%) when defined as OH volume over 1.1L. All hydration parameters significantly correlated with Charlson Comorbidity Index, and inversely with total Kt/V, and serum albumin. Multivariate cause-specific Cox analysis showed that volume status independently predicted patient survival; every 0.1 unit increase in E:I ratio was associated with 24.5% increase in all-cause mortality (adjusted cause-specific hazard ratio [ACSHR] 1.245, p = 0.002). Hydration status was also an independent predictor of cardiovascular event-free survival after excluding hospital admission for congestive heart failure; each 0.1 unit increase in E:I ratio was associated with 18.7% decrease in cardiovascular event-free survival (ACSHR 1.187, p = 0.011). In contrast, hydration parameters were not associated with technique survival. Conclusions Fluid overload is common in asymptomatic incident PD patients and is a strong predictor of patient survival and cardiovascular event. The impact of bioimpedance spectroscopy-guided fluid management on the outcome of PD patients deserves further study.
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Affiliation(s)
- Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bonnie Ching-Ha Kwan
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Kai-Ming Chow
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Fai Pang
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Phyllis Mei-Shan Cheng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi-Bon Leung
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-To Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk-Chun Szeto
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- * E-mail:
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Mahmoud MM, Shamseldeen AM, Rashed LA, Fares AE, Shamaa A, Gharib DM. Contribution of volume overload to progression of cardiovascular disease in a rat model of chronic kidney disease. Can J Physiol Pharmacol 2018; 96:1197-1208. [PMID: 30079760 DOI: 10.1139/cjpp-2018-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Volume overload is a common phenomenon in patients with chronic kidney disease that is associated with cardiovascular risk factors. However, its contribution to the development of adverse cardiovascular outcomes in those patients is not fully understood. Thus, the present work investigated the effect of salt-induced volume overload on cardiac functions and geometry in a rat model of chronic kidney disease. Thirty adult male Sprague-Dawley rats were randomly divided. One set of animals received a sham operation, while another set of animals underwent uninephrectomy. Rats were then fed either a normal-salt (0.4%) or high-salt (8.0%) diet for 6 weeks. The salt-loaded, uninephrectomized rats were treated with indapamide (3 mg·kg-1·day-1, orally) for 6 weeks. We found that uninephrectomized rats subjected to a high-salt diet (8.0%) for 6 weeks presented with hypertension, proteinuria, decreased renal Klotho expression, and deterioration in cardiac hemodynamics and histology. Echocardiography to assess cardiac function showed that ejection fraction and fractional shortening were positively correlated with relative renal Klotho expression. In conclusion, salt-induced volume overload in a rat model of chronic kidney disease has an adverse cardiovascular outcome and is associated with inflammatory activation and decrease in renal Klotho expression.
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Affiliation(s)
| | | | - Laila Ahmed Rashed
- b Department of Biochemistry, Faculty of Medicine, Cairo University, Egypt
| | - Amal Elham Fares
- c Department of Medical Histology, Faculty of Medicine, Cairo University, Egypt
| | - Ashraf Shamaa
- d Faculty of Veterinary Medicine, Cairo University, Egypt
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Tanaka S, Ando K, Kobayashi K, Hida T, Ito K, Tsushima M, Morozumi M, Machino M, Ota K, Seki T, Ishiguro N, Hasegawa Y, Imagama S. A low phase angle measured with bioelectrical impedance analysis is associated with osteoporosis and is a risk factor for osteoporosis in community-dwelling people: the Yakumo study. Arch Osteoporos 2018; 13:39. [PMID: 29623499 DOI: 10.1007/s11657-018-0450-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 03/27/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Although the phase angle has been reported to be related to predictive factors and therapeutic effects in various diseases, its relation with osteoporosis is unclear. In our large prospective survey of community-dwelling people, a low phase angle was related with osteoporosis, and it could be a predictor of osteoporosis. PURPOSE The phase angle measured with bioelectrical impedance analysis (BIA) is one of the clinically important impedance parameters, and it is a predictor of prognosis and mortality for several diseases. The present cross-sectional study aimed to elucidate the association between osteoporosis and variables measured with BIA, including the phase angle. METHODS The study included 307 participants from an annual health checkup. All participants underwent measurement of bone status by quantitative ultrasound and body composition by BIA. Osteoporosis was diagnosed according to the WHO classification, and statistical comparisons were conducted between normal individuals and osteoporosis patients. RESULTS Age, proteins, minerals, and the phase angle were significantly different between normal individuals and osteoporosis patients (p < 0.001). Furthermore, after controlling for age and sex, proteins, minerals, and the phase angle were significantly lower in osteoporosis patients than those in normal individuals (p < 0.001). In multivariate logistic regression analysis, older age and a low phase angle were risk factors for osteoporosis. Additionally, multiple regression analysis showed that age, sex, proteins, minerals, and the appendicular skeletal muscle index were significantly related to the phase angle. CONCLUSIONS The phase angle is a predictor of osteoporosis, which is unaffected by age and sex, and a lower phase angle is associated with greater probability of osteoporosis. The phase angle can be easily measured, and osteoporosis can be confirmed even at home. This may facilitate early diagnosis and treatment, which may be useful for preventing diseases related to osteoporosis.
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Affiliation(s)
- Satoshi Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Tetsuro Hida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kenyu Ito
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Mikito Tsushima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Masayoshi Morozumi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Masaaki Machino
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Kyotaro Ota
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Science, Osaka, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai Showa-ward, Nagoya, Aichi, 466-8550, Japan.
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Oh KH, Baek SH, Joo KW, Kim DK, Kim YS, Kim S, Oh YK, Han BG, Chang JH, Chung W, Na KY. Does Routine Bioimpedance-Guided Fluid Management Provide Additional Benefit to Non-Anuric Peritoneal Dialysis Patients? Results from COMPASS Clinical Trial. Perit Dial Int 2018; 38:131-138. [PMID: 29386302 DOI: 10.3747/pdi.2016.00241] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/22/2017] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION In peritoneal dialysis (PD) patients, volume overload is related to cardiac dysfunction and mortality, while intravascular volume depletion is associated with a rapid decline in the residual renal function (RRF). This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients. SUBJECTS AND METHODS This is a multicenter, prospective, open-label study that was conducted over a 1-year period (NCT01887262). Non-anuric (urine volume > 500 mL/day) subjects on PD were enrolled. Subjects in the control group received fluid management based on the clinical information alone. Those in the BIS group received BIS-guided fluid management along with clinical information. RESULTS The subjects (N = 137, mean age 51.3 ± 12.8 years, 54% male) were randomly assigned to the BIS group (n = 67) or to the control group (n = 70). There were no significant differences between the 2 groups with regard to age, sex ratio, cause of kidney failure, duration of PD, baseline comorbidity, RRF, PD method, or peritoneal transport type. At baseline, the 2 groups were not different in terms of RRF (glomerular filtration rate [GFR], 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2). After follow-up, changes in the GFR between the 2 groups were not different (-1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2, p = 0.593). Over the 1-year study period, both groups maintained stability of various fluid status parameters. Between the 2 groups, there were no differences in the net change of various fluid status parameters such as overhydration (OH) and extracellular water/total body water (ECW/TBW). A net change in ECW over 1 year was slightly but significantly higher in the control group (net increase, 0.57 ± 1.27 vs 0.05 ± 1.63 L, p = 0.047). However, this difference was not translated into an improvement in RRF in the BIS group. There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up. CONCLUSION Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control, RRF preservation, or cardiovascular (CV) parameters. However, our study cannot be generalized to the whole PD population. Further research is warranted in order to investigate the subpopulation of PD patients who may benefit from routine BIS-guided fluid management.
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Affiliation(s)
- Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
| | - Kwon-Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byoung Geun Han
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Jae Hyun Chang
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Do, Korea
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Dekker MJE, van der Sande FM, van den Berghe F, Leunissen KML, Kooman JP. Fluid Overload and Inflammation Axis. Blood Purif 2018; 45:159-165. [PMID: 29478061 DOI: 10.1159/000485153] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Extracellular fluid overload (FO), which is assessed using bioimpedance technologies, is an important predictor of outcome in dialysis patients and in patients with early stages of chronic kidney disease. While traditional cardiovascular abnormalities are assumed to mediate this risk, recently also, the importance of noncardiovascular factors, such as systemic inflammation and malnutrition has been shown. While both FO and inflammation are independent risk factors for mortality, recent studies have shown that their combined presence can lead to a cumulative risk profile. From a pathophysiologic viewpoint, FO and inflammation can also be mutually reinforcing. Inflammation could contribute to FO by hypoalbuminemia, capillary leakage, and a (unnoticed) decline in lean and/or fat tissue mass resulting in incorrect estimation of dry weight. Reciprocally, FO could lead to inflammation by the translocation of endotoxins through a congested bowel wall or by a proinflammatory effect of tissue sodium. The relative importance of these putative factors is, however, not clear yet and epidemiological studies have shown no clear temporal direction regarding the relationship between FO and inflammation. FO and inflammation appear to be part of (dynamic) clusters of risk factors, including malnutrition and hyponatremia. Technology-guided fluid management of the often vulnerable dialysis patient with FO and inflammation cannot yet be based on evidence from randomized controlled trials, in which these specific patients were in general not included. In the absence of those trials, treatment should be based on identifying actionable causes of inflammation and on the judicious removal of excess volume based on frequent clinical reassessment.
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Abstract
Inflammation is one of the well-recognized nontraditional risk factors that contributes to the excessive cardiovascular mortality in peritoneal dialysis (PD) patients. Serum C-reactive protein and interleukin-6 levels are common surrogate markers used to measure inflammatory burden and predict adverse clinical outcomes in PD patients. Causes of inflammation are complex and can be categorized into factors related to a decrease in renal function and factors related to dialysis. They interact with each other and finally result in systemic and intraperitoneal inflammation. This review discusses the various causes and clinical implications of inflammation in PD patients. More importantly, potential therapeutic options that target the underlying pathogenic mechanisms are explored.
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Affiliation(s)
- Philip Kam-Tao Li
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Jack Kit-Chung Ng
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Christopher William Mcintyre
- Division of Nephrology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Querido S, Quadros Branco P, Silva Sousa H, Adragão T, Araújo Gonçalves P, Gaspar MA, Barata JD. Hypervolemia, hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Querido S, Quadros Branco P, Silva Sousa H, Adragão T, Araújo Gonçalves P, Gaspar MA, Barata JD. Hypervolemia, hypoalbuminemia and mitral calcification as markers of cardiovascular risk in peritoneal dialysis patients. Rev Port Cardiol 2017; 36:599-604. [PMID: 28843932 DOI: 10.1016/j.repc.2016.12.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mortality in patients with end-stage renal disease is higher than in the general population. This is linked to traditional and non-traditional cardiovascular (CV) risk factors, as well as with risk factors associated with end-stage renal disease itself. The aim of this study is to identify CV risk markers in patients beginning peritoneal dialysis (PD) and their association with CV events and CV mortality. METHODS This was a retrospective cohort study of 112 incident PD patients, in which demographic, clinical and laboratory parameters, valvular calcifications, types of PD solutions, hospitalizations, CV events and death were analyzed. Occurrence of CV events or death due to a CV event after PD initiation was defined as the primary endpoint. The use of icodextrin solution was taken as a marker of hypervolemia. RESULTS Mean age was 53.7±16.1 years. Patients were treated with PD for 29.3±17.4 months. Eighteen patients (16.1%) had valvular calcifications at baseline, 15 patients (13.4%) had major CV events and 11 patients (9.8%) died from CV-related causes. Cox proportional hazards analysis of CV events or CV-related mortality revealed that mitral calcification, use of icodextrin solution and low albumin were independent predictors of CV events or mortality. CONCLUSIONS Traditional CV risk factors appear to have little impact on CV complications in PD patients. Nevertheless, hypervolemia, hypoalbuminemia and mitral calcifications were independent predictors of CV events or mortality in this group of patients.
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Affiliation(s)
- Sara Querido
- Department of Nephrology, Centro Hospitalar do Médio Tejo, Torres Novas, Portugal
| | | | - Henrique Silva Sousa
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - Teresa Adragão
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | | | - Maria Augusta Gaspar
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
| | - José Diogo Barata
- Department of Nephrology, Centro Hospitalar de Lisboa Ocidental, Carnaxide, Portugal
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High C-reactive protein instead of metabolic syndrome is associated with lower bioimpedance phase angle in individuals clinically screened for a lifestyle modification program. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41110-017-0043-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kooman JP, Dekker MJ, Usvyat LA, Kotanko P, van der Sande FM, Schalkwijk CG, Shiels PG, Stenvinkel P. Inflammation and premature aging in advanced chronic kidney disease. Am J Physiol Renal Physiol 2017; 313:F938-F950. [PMID: 28701312 DOI: 10.1152/ajprenal.00256.2017] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 12/22/2022] Open
Abstract
Systemic inflammation in end-stage renal disease is an established risk factor for mortality and a catalyst for other complications, which are related to a premature aging phenotype, including muscle wasting, vascular calcification, and other forms of premature vascular disease, depression, osteoporosis, and frailty. Uremic inflammation is also mechanistically related to mechanisms involved in the aging process, such as telomere shortening, mitochondrial dysfunction, and altered nutrient sensing, which can have a direct effect on cellular and tissue function. In addition to uremia-specific causes, such as abnormalities in the phosphate-Klotho axis, there are remarkable similarities between the pathophysiology of uremic inflammation and so-called "inflammaging" in the general population. Potentially relevant, but still somewhat unexplored in this respect, are abnormal or misplaced protein structures, as well as abnormalities in tissue homeostasis, which evoke danger signals through damage-associated molecular patterns, as well as the senescence-associated secretory phenotype. Systemic inflammation, in combination with the loss of kidney function, can impair the resilience of the body to external and internal stressors by reduced functional and structural tissue reserves, and by impairing normal organ crosstalk, thus providing an explanation for the greatly increased risk of homeostatic breakdown in this population. In this review, the relationship between uremic inflammation and a premature aging phenotype, as well as potential causes and consequences, are discussed.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, Netherlands;
| | | | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - Peter Kotanko
- Renal Research Institute, New York, New York.,Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Paul G Shiels
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom; and
| | - Peter Stenvinkel
- Divsion of Renal Medicine, Department of Clinical Science Technology and Intervention, Karolinska Institutet, Stockholm, Sweden
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Yeşiltepe A, Dizdar OS, Gorkem H, Dondurmacı E, Ozkan E, Koç A, Oguz Baktır A, Gunal AI. Maintenance of negative fluid balance can improve endothelial and cardiac functions in primary hypertensive patients. Clin Exp Hypertens 2017; 39:579-586. [PMID: 28613081 DOI: 10.1080/10641963.2017.1291663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE The issue of unidentified volume expansion is well recognized as a cause for resistance to antihypertensive therapy. The aim of study is to identify contribution of negative fluid balance to hypertension control and impact on endothelial and cardiac functions among primary hypertensive patients who do not have kidney failure. MATERIALS AND METHODS This is a prospective interventional study with one-year follow-up. Preceded by volume status measurements were performed by a body composition monitor (BCM), the patients were put on ambulatory blood pressure monitoring for 24 hours. Then, echocardiographic assessments and flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT) measurements were completed. Patients in one of the two groups were kept negative hydrated during trial with diuretic treatment. RESULTS At the end of one-year follow-up, patients in negative hydrated group were found to have significantly lower CIMT, left ventricle mass index, left ventricular end-diastolic diameter, mean systolic and diastolic BP, non-dipper patient ratio, and higher FMD. In negatively hydrated group, target organ damage significantly reduced during trial. CONCLUSIONS The significance of negative hydration status with respect to blood pressure control, endothelial and cardiac functions within primary hypertensive patients who do not suffer from kidney failure has been demonstrated.
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Affiliation(s)
- Ali Yeşiltepe
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Oguzhan Sıtkı Dizdar
- b Department of Internal Medicine and Clinical Nutrition , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Hasan Gorkem
- a Department of Internal Medicine , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Engin Dondurmacı
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Eyup Ozkan
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Koç
- d Department of Radiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ahmet Oguz Baktır
- c Department of Cardiology , Kayseri Training and Research Hospital , Kayseri , Turkey
| | - Ali Ihsan Gunal
- e Department of Internal Medicine Division of Nephrology , Kayseri Training and Research Hospital , Kayseri , Turkey
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Garrido Pérez L, Sanz Turrado M, Caro Domínguez C. Variables de la desnutrición en pacientes en diálisis. ENFERMERÍA NEFROLÓGICA 2016. [DOI: 10.4321/s2254-28842016000400002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: El paciente en diálisis va a sufrir una desnutrición proteico-calórica, con diferentes factores implicados en su aparición, lo cual se asocia con una elevadísima morbilidad cardiovascular y mortalidad. Se ha estimado una prevalencia de desnutrición en la población en hemodiálisis del 18-75%, siendo por tanto, un problema de especial relevancia en este tipo de pacientes.
Objetivo: Realizar una revisión bibliográfica de los artículos científicos existentes sobre las variables que intervienen en la desnutrición del paciente en diálisis.
Metodología: Se ha realizado una revisión bibliográfica mediante las bases de datos PubMed, Scielo, Pro- Quest. La búsqueda se ha realizado con términos Mesh, con una antigüedad no mayor de 5 años y con distintas palabras clave.
Resultados: Se han revisado 19 artículos. La mayoría de los artículos fueron estudios observacionales y de revisión. Los factores que se asocian con desnutrición son la edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Otro factor muy importante, es la inflamación. En cuanto a los métodos diagnósticos, son variados y diferentes, debido a la gran cantidad de variables que influyen en la desnutrición.
Conclusiones: La desnutrición en pacientes en diálisis depende de distintas variables y no solamente de la dieta. Los factores que se asocian con desnutrición son mayor edad, pérdida de masa muscular, baja actividad física y dieta pobre en micronutrientes. Además, habría que añadir el doble papel que juega la inflamación en este proceso, pues puede ser tanto consecuencia como factor predisponente a la desnutrición.
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Greenhall GHB, Davenport A. Screening for muscle loss in patients established on peritoneal dialysis using bioimpedance. Eur J Clin Nutr 2016; 71:70-75. [DOI: 10.1038/ejcn.2016.202] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 07/13/2016] [Accepted: 08/12/2016] [Indexed: 12/27/2022]
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