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Khatri P, Davenport A. Comparison of hemodialysis urea clearance using spent dialysate and Kt/Vurea equations. Artif Organs 2024. [PMID: 39177022 DOI: 10.1111/aor.14848] [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: 05/13/2024] [Revised: 07/15/2024] [Accepted: 08/07/2024] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Dialysis adequacy is traditionally calculated from pre- and post-hemodialysis session serum urea concentrations and expressed as the urea reduction ratio, or Kt/Vurea. However, with increasing hemodiafiltration usage, we wished to determine whether there were any differences between standard Kt/Vurea equations and directly measured spent dialysate urea clearance. METHODS Urea clearance was measured from collected effluent dialysate and compared with various other methods of Kt/Vurea calculation, including change in total body urea from measuring pre- and post-total body water with bioimpedance and the Watson equation, by standard Kt/V equations, and online clearance measurements using effective ionic dialysance (OLC). RESULTS We compared urea clearance in 41 patients, 56.1% male, mean age 69.3 ± 12.6 years with 87.8% treated by hemodiafiltration. Reduction in total body urea was greater when estimating changes in total body urea, compared to measured dialysate losses of 58.4% (48.5-67.6) vs 71.6% (62.1-78), p < 0.01. Sessional urea clearance (Kt/Vurea) was greater using the online Solute-Solver program compared to OLC, median 1.45(1.13-1.75) vs 1.2 (0.93-1.4), and 2nd generation Kt/V equations 1.3 (1.02-1.66), p < 0.01, but not different from estimated total body urea clearance 1.36 (1.15-1.73) and dialysate clearance 1.36 (1.07-1.76). The mean bias compared to the Solute-Solver program was greatest with OLC (-0.25), compared to second-generation equations (-0.02), estimated total body clearance (-0.02) and measured dialysate clearance (-0.01). CONCLUSION This study demonstrated that the result from equations estimating urea clearance indirectly from pre- and postblood samples from hemo- and hemodiafiltration treatments was highly correlated with direct measurements of dialysate urea clearance.
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Affiliation(s)
- Priyanka Khatri
- Fast and Chronic Programmes, Alexandra Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Andrew Davenport
- UCL Department of Renal Medicine, Royal Free Hospital, London, UK
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de Luca Corrêa H, Gadelha AB, Vainshelboim B, Dutra MT, Ferreira-Júnior JB, Deus LA, Neves RVP, Reis AL, de Araújo TB, Tzanno-Martins C, Tavares FS, Andrade RV, Dos Santos Rosa T. Could sarcopenia-related mortality in end-stage renal disease be underpinned by the number of hospitalizations and cardiovascular diseases? Int Urol Nephrol 2023; 55:157-163. [PMID: 35819667 DOI: 10.1007/s11255-022-03291-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/26/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To investigate the association between sarcopenia with the number of all-cause mortality, hospitalizations, and cardiovascular diseases in patients with end-stage renal disease (ESRD). METHODS 247 patients with ESRD (women, n = 97) (66.6 ± 3.53 years) participated in this study. At baseline, all participants were measured with dual-energy X-ray absorptiometry and handgrip dynamometer and were prospectively followed up for 5 years. The European Working Group on Sarcopenia in Older People guidelines were utilized for Sarcopenia determination. Cox proportional hazard analysis adjusted for established risk factors was used to quantify the risk between Sarcopenia and all-cause mortality. RESULTS Sixty-five participants (26%) were determined to have Sarcopenia at baseline and 38 (15%) have died during the follow-up. At baseline, Participants with Sarcopenia had lower body mass index and fat-free mass index. Moreover, through the 5-year follow-up, sarcopenic patients had higher number of cardiovascular disease (56.9% vs. 12.6%) and hospitalizations (93.8% vs. 49.5%) (all P < 0.0001). Sarcopenia was associated with significantly higher risk of mortality, [Hazard ratio = 3.3, (95% CI: 1.6-6.9), P = 0.001]. CONCLUSION Sarcopenia may be a risk factor for hospitalizations, cardiovascular diseases, and all-cause mortality in patients with ESRD. These results provide support of the relevance in assessing sarcopenia in the clinical practice of chronic kidney disease and how muscle mass and strength may negatively impact the daily life of ESRD patients undergoing hemodialysis. Greater efforts at preventing muscle wasting and malfunctioning are needed through the worldwide healthcare system.
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Affiliation(s)
- Hugo de Luca Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil.
| | - André Bonadias Gadelha
- Serviço de Preparação Física/COSAU/DIGEP/SA/SG/Presidência da República, Zona Cívico-Administrativa, Brasília, DF, 70150-900, Brazil
- Seção de Educação Física, Colégio Militar de Brasília, Asa Norte, Brasília, DF, Brasil
| | - Baruch Vainshelboim
- Cardiovascular and Metabolic Disease Research Institute, Mountain View, CA, USA
| | - Maurílio Tiradentes Dutra
- Federal Institute of Education, Science and Technology of Brasilia, College of Physical Education, Brasília, Brazil
- College of Physical Education, University of Brasília, Brasília, DF, Brazil
| | | | - Lysleine Alves Deus
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Rodrigo Vanerson Passos Neves
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Andrea Lucena Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | - Thaís Branquinho de Araújo
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
| | | | | | - Rosângela Vieira Andrade
- Graduate Program of Genomic Sciences and Biotechnology, Catholic University of Brasilia, Brasília, DF, Brazil
| | - Thiago Dos Santos Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, UCB, EPTC, QS07, LT1 s/n. Bloco G Sala 119, Águas Claras, Taguatinga, Brasília, DF, 72030-170, Brazil
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Kang SH, Kim AY, Do JY. Association of sarcopenia and its components with clinical outcomes in patients undergoing peritoneal dialysis. Kidney Res Clin Pract 2022; 41:741-752. [DOI: 10.23876/j.krcp.21.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Further studies are needed to identify whether muscle mass, muscle strength, or sarcopenia is the best indicator of survival in patients undergoing peritoneal dialysis (PD). We aimed to compare the association of sarcopenia and its components with survival in patients undergoing PD.Methods: We identified all patients with prevalent PD (n = 199). We routinely recommended handgrip strength (HGS) and lean mass measurements using dual energy X-ray absorptiometry in all patients with PD. Sarcopenia was defined using cutoff values from the Asian Working Group for Sarcopenia. We evaluated the patient and technique survival rates.Results: The number of patients with low HGS was 95 (47.7%). The median follow-up interval was 17 months (interquartile range, 13–21 months). Kaplan-Meier curve analysis showed that patients with low HGS or sarcopenia had poorer patient and technique survival compared with patients with normal HGS or without sarcopenia. Cox regression analysis showed that patients with low HGS had greater hazard ratios for patient death and technique failure compared with those with normal HGS. However, patients with low muscle mass did not show significant hazard ratios for patient death or technique failure compared with those with normal muscle mass. Patients with sarcopenia had significantly greater hazard ratios for patient death or technique failure than those without sarcopenia only in univariate analysis.Conclusion: The present study demonstrated that HGS may be superior to muscle mass or sarcopenia for predicting patient or technique survival in patients undergoing PD.
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Prasad R, Jha RK, Keerti A. Chronic Kidney Disease: Its Relationship With Obesity. Cureus 2022; 14:e30535. [DOI: 10.7759/cureus.30535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
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Lev-Wiesel R, Sasson L, Scharf N, Abu Saleh Y, Glikman A, Hazan D, Shacham Y, Barak-Doenyas K. "Losing Faith in My Body": Body Image in Individuals Diagnosed with End-Stage Renal Disease as Reflected in Drawings and Narratives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10777. [PMID: 36078494 PMCID: PMC9517917 DOI: 10.3390/ijerph191710777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Chronic kidney disease (CKD) and the dependency on dialysis is an abrupt life-changing event that harms a patient's life (e.g., social relationships, work, and well-being). This study aimed to examine how individuals who undergo chronic dialysis due to failure end-stage renal disease perceive their bodies, as reflected in drawings and narratives. Following ethical approval and signing a consent form to participate in the study, 29 adults between the ages of 20 and 85 who have undergone dialysis filled out an anonymous questionnaire that consisted of the following measures: The Center for Epidemiological Studies-Depression (CES-D), The Multidimensional Body-Self Relations Questionnaire (MBSRQ), and The MOS 36-Item Short-Form Health Survey (SF-36). After completion, they were asked to draw their self-figure before and after being diagnosed and narrate it. The data were quantitatively and narratively analyzed. The results revealed high levels of depression and concerns regarding body fitness and weight. Few significant differences were noted between self-figured drawings before and after the diagnosis, such as the body line and gender markers. Additionally, Fitness Evaluation and Overweight Preoccupation were significant among the participants.
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Affiliation(s)
- Rachel Lev-Wiesel
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Liraz Sasson
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Netta Scharf
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Yasmeen Abu Saleh
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Anat Glikman
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Denis Hazan
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Yarden Shacham
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Keren Barak-Doenyas
- The Sagol Center for Hyperbaric Medical Treatment and Research, Shamir Medical Center, Be’er Ya’akov 7035000, Israel
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Curcumin Supplementation (Meriva ®) Modulates Inflammation, Lipid Peroxidation and Gut Microbiota Composition in Chronic Kidney Disease. Nutrients 2022; 14:nu14010231. [PMID: 35011106 PMCID: PMC8747135 DOI: 10.3390/nu14010231] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 12/12/2022] Open
Abstract
Chronic kidney disease (CKD) subjects suffer from high risk of cardiovascular mortality, and any intervention preventing the progression of CKD may have an enormous impact on public health. In the last decade, there has been growing awareness that the gut microbiota (GM) can play a pivotal role in controlling the pathogenesis of systemic inflammatory state and CKD progression. To ameliorate the quality of life in CKD subjects, the use of dietary supplements has increased over time. Among those, curcumin has demonstrated significant in vitro anti-inflammatory properties. In this pilot study, 24 CKD patients and 20 healthy volunteers were recruited. CKD patients followed nutritional counselling and were supplemented with curcumin (Meriva®) for six months. Different parameters were evaluated at baseline and after 3-6 months: uremic toxins, metagenomic of GM, and nutritional, inflammatory, and oxidative status. Curcumin significantly reduced plasma pro-inflammatory mediators (CCL-2, IFN-γ, and IL-4) and lipid peroxidation. Regarding GM, after 6 months of curcumin supplementation, Escherichia-Shigella was significantly lower, while Lachnoclostridium was significant higher. Notably, at family level, Lactobacillaceae spp. were found significantly higher in the last 3 months of supplementation. No adverse events were observed in the supplemented group, confirming the good safety profile of curcumin phytosome after long-term administration.
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Kim B, Kim G, Kim E, Park J, Isobe T, Sakae T, Oh S. The A Body Shape Index Might Be a Stronger Predictor of Chronic Kidney Disease Than BMI in a Senior Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412874. [PMID: 34948483 PMCID: PMC8701813 DOI: 10.3390/ijerph182412874] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/23/2021] [Accepted: 12/05/2021] [Indexed: 12/20/2022]
Abstract
The A Body Shape Index (ABSI) was recently introduced to quantify abdominal adiposity relative to the body mass index (BMI) and height. This cross-sectional study was performed to explore whether the ABSI is linked to chronic kidney disease (CKD) in older adults and compare the predictive capacity of the ABSI versus BMI for CKD. In total, 7053 people aged ≥ 60 years were divided into normal, mild, and moderate-to-severe CKD groups based on their estimated glomerular filtration rate (eGFR). The correlation of the ABSI with the eGFR and the differences and trends in the ABSI and BMI among the groups were analyzed, and the cutoff points for moderate-to-severe CKD were calculated. The association between the ABSI and CKD was stronger than that between the BMI and CKD. The ABSI had a better capacity to discriminate the CKD stage than did the BMI. The capacity of the ABSI to predict moderate-to-severe CKD was higher than that of the BMI and was more substantial in women than men. The ABSI cutoff points for CKD were ≥0.0822 and 0.0795 in men and women, respectively. In conclusion, the ABSI serves as a better index than the BMI for screening and detecting high-risk individuals with CKD.
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Affiliation(s)
- Bokun Kim
- Department of Kinesiology, Silla University, Busan 46958, Korea;
| | - Gwonmin Kim
- Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.K.); (J.P.)
| | - Eonho Kim
- Department of Physical Education, Dongguk University, Seoul 04620, Korea;
| | - Jonghwan Park
- Medical Research Institute, Pusan National University Hospital, Busan 49241, Korea; (G.K.); (J.P.)
| | - Tomonori Isobe
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
| | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
| | - Sechang Oh
- Faculty of Medicine, University of Tsukuba, Ibaraki 305-8575, Japan; (T.I.); (T.S.)
- Correspondence: ; Tel.: +81-29-853-3291
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Mertowska P, Mertowski S, Wojnicka J, Korona-Głowniak I, Grywalska E, Błażewicz A, Załuska W. A Link between Chronic Kidney Disease and Gut Microbiota in Immunological and Nutritional Aspects. Nutrients 2021; 13:3637. [PMID: 34684638 PMCID: PMC8540836 DOI: 10.3390/nu13103637] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is generally progressive and irreversible, structural or functional renal impairment for 3 or more months affecting multiple metabolic pathways. Recently, the composition, dynamics, and stability of a patient's microbiota has been noted to play a significant role during disease onset or progression. Increasing urea concentration during CKD can lead to an acceleration of the process of kidney injury leading to alterations in the intestinal microbiota that can increase the production of gut-derived toxins and alter the intestinal epithelial barrier. A detailed analysis of the relationship between the role of intestinal microbiota and the development of inflammation within the symbiotic and dysbiotic intestinal microbiota showed significant changes in kidney dysfunction. Several recent studies have determined that dietary factors can significantly influence the activation of immune cells and their mediators. Moreover, dietary changes can profoundly affect the balance of gut microbiota. The aim of this review is to present the importance and factors influencing the differentiation of the human microbiota in the progression of kidney diseases, such as CKD, IgA nephropathy, idiopatic nephropathy, and diabetic kidney disease, with particular emphasis on the role of the immune system. Moreover, the effects of nutrients, bioactive compounds on the immune system in development of chronic kidney disease were reviewed.
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Affiliation(s)
- Paulina Mertowska
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Sebastian Mertowski
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Julia Wojnicka
- Department of Pathobiochemistry and Interdisciplinary Applications of Ion Chromatography, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland; (J.W.); (A.B.)
| | - Izabela Korona-Głowniak
- Department of Pharmaceutical Microbiology, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland
| | - Ewelina Grywalska
- Department of Experimental Immunology, Medical University of Lublin, 4a Chodzki Street, 20-093 Lublin, Poland; (P.M.); (S.M.); (E.G.)
| | - Anna Błażewicz
- Department of Pathobiochemistry and Interdisciplinary Applications of Ion Chromatography, Medical University of Lublin, 1 Chodzki Street, 20-093 Lublin, Poland; (J.W.); (A.B.)
| | - Wojciech Załuska
- Department of Nephrology, Medical University of Lublin, 8 Jaczewskiego Street, 20-954 Lublin, Poland;
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Association analysis of body composition with survival among prevalent peritoneal dialysis patients. Int Urol Nephrol 2021; 54:437-446. [PMID: 34181145 DOI: 10.1007/s11255-021-02923-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Progressive decline in lean mass and gain of fat mass are common in patients treated with peritoneal dialysis (PD). It is unclear whether body composition or its longitudinal changes contribute to increased mortality among prevalent PD patients. METHODS This was a retrospective cohort study. Body composition was assessed using bioelectrical impedance spectroscopy (BIS). Lean and fat tissue indices were derived from lean and fat mass indexed to height-squared, respectively. The patient's baseline BIS results were used to explore its mortality risk prediction for the entire cohort. Among patients with subsequent BIS measurements, changes of lean and fat mass over time were also examined with survival outcomes. RESULTS Among all participants (n = 555, PD vintage 38 months), higher baseline lean tissue index was associated with lower mortality after adjusting for fat tissue index and confounders (HR 0.90; 95% CI 0.84-0.97, p = 0.01). However, this association was no longer significance after the final adjustment with serum albumin level (p = 0.06). A total of 136 patients had repeated BIS data. After the interval of 10.1 months during two consecutive BIS measurements, there was a strong inverse correlation between the percentage changes of lean and fat tissue indices (r = - 0.73, p < 0.001). The longitudinal changes in lean mass, either high or low categories, were not significantly associated with all-cause mortality. In contrast, patients who were classified as having low values of fat tissue index (below median) from baseline to the next BIS measurements had a lower odds of death in the univariable (HR 0.32; 95% CI 0.12-0.84, p = 0.02) but not in the adjusted models. CONCLUSION Among prevalent PD patients, higher baseline lean mass was independently associated with better survival. However, the longitudinal changes in lean mass were not significantly associated with mortality. In contrast, the maintenance of low fat status over time appeared to be associated with a lower likelihood of death among PD population.
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El-Serw HESS, Bassiouni DARH, Al-Wakeil AA, El-Masry RSAI, Bakr AMAEB. Efficacy of intradialytic amino acids on nutritional status in children with stage 5 chronic kidney disease. Pediatr Nephrol 2021; 36:1561-1569. [PMID: 33206228 DOI: 10.1007/s00467-020-04806-x] [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: 06/08/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Protein energy wasting (PEW) is a common cause of morbidity and mortality in patients with stage 5 chronic kidney disease (CKD 5). Intradialytic parenteral nutrition (IDPN) has been used as a therapy for preventing and treating PEW in children with CKD 5 when other conventional modalities fail. However, not enough data is available to define its effectiveness in treating malnutrition in children. This study aims to investigate potential benefits of IDPN in Egyptian children with CKD 5. METHODS In this prospective, placebo-controlled, parallel-group single blinded study, we enrolled 50 CKD 5 patients; 25 patients (intervention group) received intravenous amino acids (KIDIMN), while 25 patients (control group) received normal saline as placebo, each given during regular dialysis 3 times a week for 9 months. Patients were subjected to nutritional assessment at baseline and 3-, 6-, and 9-month follow-up using height Z-score, hand grip strength (HGS) for muscle power assessment, body composition monitor (BCM) for assessing lean tissue mass (LTM) and adipose tissue mass (ATM), and biochemical measures including serum albumin, serum triglyceride, and serum cholesterol. RESULTS When comparing baseline and 9-month follow-up values, significant improvement was recorded in height Z-score, LTM, and serum albumin in the intervention group unlike the control group where no significant changes were recorded. CONCLUSION IDPN is proposed to be an effective method for preventing and treating malnutrition in children with CKD 5. However, further multi-centric studies with larger sample size and longer duration of follow-up are still recommended.
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Affiliation(s)
| | | | - Angy Adel Al-Wakeil
- Faculty of Medicine, Pediatric Department, Mansoura University, Elgomhoria Street, Mansoura, Egypt
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Significance of Adipose Tissue Maintenance in Patients Undergoing Hemodialysis. Nutrients 2021; 13:nu13061895. [PMID: 34072922 PMCID: PMC8226793 DOI: 10.3390/nu13061895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
In the general population, obesity is known to be associated with adverse outcomes, including mortality. In contrast, high body mass index (BMI) may provide a survival advantage for hemodialysis patients, which is known as the obesity paradox. Although BMI is the most commonly used measure for the assessment of obesity, it does not distinguish between fat and lean mass. Fat mass is considered to serve as an energy reserve against a catabolic condition, while the capacity to survive starvation is also thought to be dependent on its amount. Thus, fat mass is used as a nutritional marker. For example, improvement of nutritional status by nutritional intervention or initiation of hemodialysis is associated with an increase in fat mass. Several studies have shown that higher levels of fat mass were associated with better survival in hemodialysis patients. Based on body distribution, fat mass is classified into subcutaneous and visceral fat. Visceral fat is metabolically more active and associated with metabolic abnormalities and inflammation, and it is thus considered to be a risk factor for cardiovascular disease and mortality. On the other hand, subcutaneous fat has not been consistently linked to adverse phenomena and may reflect nutritional status as a type of energy storage. Visceral and subcutaneous adipose tissues have different metabolic and inflammatory characteristics and may have opposing influences on various outcomes, including mortality. Results showing an association between increased subcutaneous fat and better survival, along with other conditions, such as cancer or cirrhosis, in hemodialysis patients have been reported. This evidence suggests that fat mass distribution (i.e., visceral fat and subcutaneous fat) plays a more important role for these beneficial effects in hemodialysis patients.
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Canaud B, Ye X, Usvyat L, Kooman J, van der Sande F, Raimann J, Wang Y, Kotanko P. Clinical and predictive value of simplified creatinine index used as muscle mass surrogate in end-stage kidney disease haemodialysis patients-results from the international MONitoring Dialysis Outcome initiative. Nephrol Dial Transplant 2021; 35:2161-2171. [PMID: 32830264 PMCID: PMC7716813 DOI: 10.1093/ndt/gfaa098] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 04/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background Protein-energy wasting, muscle mass (MM) loss and sarcopenia are highly prevalent and associated with poor outcome in haemodialysis (HD) patients. Monitoring of MM and/or muscle metabolism in HD patients is of paramount importance for timely detection of muscle loss and to intervene adequately. In this study we assessed the reliability and reproducibility of a simplified creatinine index (SCI) as a surrogate marker of MM and explored its predictive value on outcome. Method We included all in-centre HD patients from 16 European countries with at least one SCI. The baseline period was defined as 30 days before and after the first multifrequency bioimpedance spectroscopy measurement; the subsequent 7 years constituted the follow-up. SCI was calculated by the Canaud equation. Multivariate Cox proportional hazards models were applied to assess the association of SCI with all-cause mortality. Using backward analysis, we explored the trends of SCI before death. Bland–Altman analysis was performed to analyse the agreement between estimated and measured MM. Results We included 23 495 HD patients; 3662 were incident. Females and older patients have lower baseline SCI. Higher SCI was associated with a lower risk of mortality [hazard ratio 0.81 (95% confidence interval 0.79–0.82)]. SCI decline accelerated ∼5–7 months before death. Lean tissue index (LTI) estimated by SCI was correlated with measured LTI in both sexes (males: R2 = 0.94; females: R2 = 0.92; both P < 0.001). Bland–Altman analysis showed that measured LTI was 4.71 kg/m2 (±2 SD: −12.54–3.12) lower than estimated LTI. Conclusion SCI is a simple, easily obtainable and clinically relevant surrogate marker of MM in HD patients.
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Affiliation(s)
- Bernard Canaud
- School of Medicine, Montpellier University, Montpellier, France.,Global Medical Office, Europe Middle East and Africa, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Xiaoling Ye
- Research Department, Renal Research Institute, New York, NY, USA
| | - Len Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, MA, USA
| | - Jeroen Kooman
- Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank van der Sande
- Department of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jochen Raimann
- Research Department, Renal Research Institute, New York, NY, USA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Peter Kotanko
- Research Department, Renal Research Institute, New York, NY, USA.,Department of Nephrology, Icahn School of Medicine at the Mount Sinai Hospital, New York, NY, USA
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da Silva V, Corrêa H, Neves R, Deus L, Reis A, Souza M, dos Santos C, de Castro D, Honorato F, Simões H, Moraes M, Schoenfeld B, Prestes J, Rosa T. Impact of Low Hemoglobin on Body Composition, Strength, and Redox Status of Older Hemodialysis Patients Following Resistance Training. Front Physiol 2021; 12:619054. [PMID: 33776788 PMCID: PMC7987944 DOI: 10.3389/fphys.2021.619054] [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: 10/19/2020] [Accepted: 02/09/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION The purpose of this study was to: (i) investigate the effect of six months of resistance training (RT) on body composition, muscle strength, hematological patterns, and redox profile in maintenance hemodialysis (HD) patients, and; (ii) evaluate the effects of baseline concentrations of hemoglobin on the RT response. METHODS One hundred fifty-seven subjects with chronic kidney disease (CKD) were randomly allocated into two groups: Control [CTL, (n = 76)] and RT (n = 81). A first visit was required for anamnesis and anthropometric measurements. Venous blood samples were collected at baseline and after twenty-four weeks of training in all patients for the analysis of clinical and redox balance markers. The RT program spanned six months and consisted of three sets of 8-12 repetitions with a rating of perceived exertion between 5 and 8 for three weekly sessions. Each exercise session was performed in twelve resistance exercises and it least for approximately 40 min. RESULTS The main results demonstrated that RT decreased waist circumference by 3%, and decreased thiobarbituric reactive species (TBARS) by 28%. Moreover, RT increased handgrip strength by 28.4%, fat-free mass by 4.1%, hemoglobin by 5%, iron by 33.4%, glutathione by 121%, and Trolox equivalent antioxidant capacity by 14.2% (p < 0.05). Low hemoglobin concentrations impaired the effect of RT on fat-free mass gain. CONCLUSION Six months of RT in HD patients improved clinical parameters, such as hemoglobin, iron, body composition, and redox balance, while low hemoglobin concentration impaired exercise-benefits on fat-free mass in patients with CKD. These findings can contribute to a better clinical application of RT in the maintenance of hemodialysis patients.
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Affiliation(s)
- Victor da Silva
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Hugo Corrêa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Rodrigo Neves
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Lysleine Deus
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Andrea Reis
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Michel Souza
- Department of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Danilo de Castro
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Fernando Honorato
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Herbert Simões
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Milton Moraes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Brad Schoenfeld
- Department of Health Sciences, University of New York City, New York City, NY, United States
| | - Jonato Prestes
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
| | - Thiago Rosa
- Graduate Program of Physical Education, Catholic University of Brasilia, Brasília, Brazil
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Body composition, adipokines, FGF23-Klotho and bone in kidney transplantation: Is there a link? J Nephrol 2021; 35:293-304. [PMID: 33560479 DOI: 10.1007/s40620-021-00972-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/09/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Kidney transplantation-associated mineral and bone disorder (KT-MBD) still represents a black box on the long-term due to scarce available data. We aimed to investigate the impact of non-classical bone regulating factors (body composition, adipokines, inflammatory markers, fibroblast growth factor 23-FGF23 and α-Klotho) in long-standing kidney transplant (KT) recipients compared to the general population. METHODS Our cross-sectional study, enrolling 59 KT patients and age, sex and body mass index-matched healthy general population volunteers, assessed the predictive role of the body composition, serum adipokines (leptin, adiponectin, resistin), inflammatory markers (erythrocyte sedimentation rate, C-reactive protein) and parathyroid hormone (PTH)-FGF23/α-Klotho axis upon bone mineral density (BMD) and osteocalcin, using correlation and linear multiple regression. RESULTS The 59 KT recipients (mean transplantation span of 57.7 ± 7.2 months) had similar body composition but significantly lower BMD (p < 0.01) compared to the general population group. Total lean mass was independently associated with BMD in both groups. In KT patients, age, time spent on dialysis and PTH were the main negative independent predictors of BMD, after adjusting for possible confounders. Resistin and α-Klotho also negatively predicted lumbar bone density (p < 0.001), while adiponectin and α-Klotho positively predicted osteocalcin levels (p < 0.001) in KT recipients, independently of inflammatory markers. No significant associations were found between FGF23 and bone parameters in any of the groups. CONCLUSIONS Age, PTH, time on dialysis and lean mass are among the main bone density predictors in long-standing KT patients. The bone impact of adipokine dysregulation and of α-Klotho merits further investigations in KT-MBD. Preserving lean mass for improved bone outcomes should be part of KT-MBD management on the long-term.
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15
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Changes in body composition in peritoneal dialysis patients after kidney transplantation. Int Urol Nephrol 2021; 53:383-390. [PMID: 33387221 DOI: 10.1007/s11255-020-02713-6] [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: 08/10/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Serial follow-up data of body composition from peritoneal dialysis (PD) initiation until 1 year after kidney transplantation (KT) would be useful in identifying pathologic or physiologic changes, related to each modality or during the exchange of the modality. METHODS Body composition analysis was performed 1 month after PD initiation, repeated annually, immediately before KT, 1 month and 1 year after KT (n = 43). Body composition analysis was performed using a bioimpedance analysis (BIA) machine. The body composition parameters measured using BIA included the water contents, fat mass index (FMI), appendicular muscle mass index (aMMI), and bone mineral content (BMC). RESULTS The aMMI values 1 month and 1 year after PD initiation, immediately before KT, and 1 month and 1 year after KT were 7.6 ± 1.5, 7.8 ± 1.4, 8.0 ± 1.4, 6.8 ± 0.9, and 7.0 ± 1.0 kg/m2, respectively. The aMMI increased during the first year of PD (P = 0.029) and was maintained during the remaining period of PD (P = 0.413). The value decreased during the first month after KT (P < 0.001) and recovered during the first year after KT (P = 0.010). FMI increased during the first year of PD (P < 0.001) and was maintained during the remaining period of PD (P = 0.214). The value increased during the first year of KT (P < 0.001). BMC was stable during the PD period but decreased after KT. Body waters were maintained during PD and decreased after KT. The presence of low muscle mass (LMM) 1 month after PD initiation or 1 month after KT, was associated with development of LMM 1 year after KT. CONCLUSION Our study showed that body composition was significantly changed during the first year after PD or the first month after KT, as evidenced by a decrease in aMMI and BMC and an increase in FMI. Adequate interventions provided at these two points might help maintain proper body composition.
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Ebrahim Z, Moosa MR, Blaauw R. Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants. Nutrients 2020; 12:E3608. [PMID: 33255334 PMCID: PMC7760142 DOI: 10.3390/nu12123608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.
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Affiliation(s)
- Zarina Ebrahim
- Division of Human Nutrition, Stellenbosch University, Cape Town 8000, South Africa;
| | - M. Rafique Moosa
- Department of Medicine, Stellenbosch University, Cape Town 8000, South Africa;
| | - Renée Blaauw
- Division of Human Nutrition, Stellenbosch University, Cape Town 8000, South Africa;
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Chan GCK, N. G. JKC, Chow KM, Kwong VWK, Pang WF, Cheng PMS, Law MC, Leung CB, L. I. PKT, Szeto CC. Interaction between central obesity and frailty on the clinical outcome of peritoneal dialysis patients. PLoS One 2020; 15:e0241242. [PMID: 33104712 PMCID: PMC7588087 DOI: 10.1371/journal.pone.0241242] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/11/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Frailty and obesity contribute to the adverse clinical outcome of peritoneal dialysis (PD) patients, but the interaction between frailty and obesity remains uncertain. OBJECTIVE To examine the interaction between frailty and obesity on the clinical outcome of PD patients. DESIGN Single centre prospective observational cohort study. PATIENTS 267 prevalent Chinese PD patients were recruited. MEASUREMENTS Frailty was identified by a standard score. General and central obesity were determined by body mass index (BMI) and waist-hip ratio (WHR), respectively. Body composition was assessed by bioimpedance spectroscopy. All patients were followed for two years. Outcome measures included all-cause as well as cardiovascular mortality and hospitalization. RESULTS Of the 267 patients, 120 (44.9%) were frail. Frail individuals were more likely to have central obesity (p < 0.001) but not general obesity. Although WHR did not predict patient survival, there was a significant interaction between WHR and frailty on patient survival and cardiovascular survival (p = 0.002 and p = 0.038, respectively). For patients without frailty, the two-year cardiovascular survival was 91.3% and 74.4% for those with and without central obesity, respectively (p = 0.002). For patients with frailty, however, the two-year cardiovascular survival was 64.6% and 66.7% for those with and without central obesity, respectively (p = 0.6). For patients without frailty, the number of hospital admission for cardiovascular disease over 2 years were 0.12 ± 0.37 and 0.34 ± 0.72 for those with and without central obesity, respectively (p = 0.03). For frail patients, however, the number of hospital admission was similar between those with and without central obesity. CONCLUSION There is a significant interaction between frailty and central obesity on the outcome of PD patients. The protective role of central obesity is only apparent in PD patients without frailty but not the frail ones, and there is a little prognostic value of general (non-central) obesity.
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Affiliation(s)
- Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jack Kit-Chung N. G.
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Vickie Wai-Ki Kwong
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wing-Fai Pang
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Phyllis Mei-Shan Cheng
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Man-Ching Law
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chi-Bon Leung
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Philip Kam-Tao L. I.
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Cheuk Chun Szeto
- Department of Medicine & Therapeutics, Carol & Richard Yu Peritoneal Dialysis Research Centre, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Seo YK, Lee H, Kim H, Kim TY, Ryu H, Ju DL, Jang M, Oh KH, Ahn C, Han SN. Foods contributing to nutrients intake and assessment of nutritional status in pre-dialysis patients: a cross-sectional study. BMC Nephrol 2020; 21:301. [PMID: 32711448 PMCID: PMC7382820 DOI: 10.1186/s12882-020-01958-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 07/15/2020] [Indexed: 01/23/2023] Open
Abstract
Background For chronic kidney disease (CKD) patients, management of nutritional status is critical for delaying progression to end-stage renal disease. The purpose of this study is to provide the basis for personalized nutritional intervention in pre-dialysis patients by comparing the foods contributing to nutrients intake, nutritional status and potential dietary inflammation of CKD patients according to the diabetes mellitus (DM) comorbidity and CKD stage. Methods Two hundred fifty-six outpatients referred to the Department of Nephrology at SNUH from Feb 2016 to Jan 2017 were included. Subjects on dialysis and those who had undergone kidney transplantation were excluded. Bioelectrical impedance analysis (BIA), subjective global assessment (SGA), dietary intake, and biochemical parameters were collected. Subjects were classified into 4 groups according to DM comorbidity (DM or Non-DM) and CKD stage (Early or Late) by kidney function. Two-way analysis of variance and multinomial logistic regression analysis were performed for statistical analysis. Results Total number of malnourished patients was 31 (12.1%), and all of them were moderately malnourished according to SGA. The body mass index (BMI) of the DM-CKD group was significantly higher than the Non-DM-CKD group. The contribution of whole grains and legumes to protein intake in the DM-CKD group was greater than that in the Non-DM-CKD group. The DM- Early-CKD group consumed more whole grains and legumes compared with the Non-DM-Early-CKD group. The subjects in the lowest tertile for protein intake had lower phase angle, SGA score and serum albumin levels than those in the highest tertile. The potential for diet-induced inflammation did not differ among the groups. Conclusions Significant differences in intakes of whole grains and legumes between CKD patients with or without DM were observed. Since contribution of whole grains and legumes to phosphorus and potassium intake were significant, advice regarding whole grains and legumes may be needed in DM-CKD patients if phosphorus and potassium intake levels should be controlled. The nutritional status determined by BIA, SGA and serum albumin was found to be different depending on the protein intake. Understanding the characteristics of food sources can provide a basis for individualized nutritional intervention for CKD patients depending on the presence of diabetes.
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Affiliation(s)
- Yeon Kyung Seo
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Hyesu Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University Medical Center, Chuncheon-si, Gangwon-do, Korea
| | - Tae Yeon Kim
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dal Lae Ju
- Department of Nutrition, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Miyoung Jang
- Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Korea. .,Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Korea.
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Bolasco P. Hemodialysis-Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses be the Sharpest "Sword of Damocles"? Nutrients 2020; 12:nu12061773. [PMID: 32545868 PMCID: PMC7353226 DOI: 10.3390/nu12061773] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023] Open
Abstract
This review aims to highlight the strengths and weaknesses emerging from diagnostic evaluations and prescriptions in an intent to prevent progression over time of malnutrition and/or protein-energy wasting (PEW) in hemodialysis (HD) patients. In particular, indications of the most effective pathway to follow in diagnosing a state of malnutrition are provided based on a range of appropriate chemical-clinical, anthropometric and instrumental analyses and monitoring of the nutritional status of HD patients. Finally, based on the findings of recent studies, therapeutic options to be adopted for the purpose of preventing or slowing down malnutrition have been reviewed, with particular focus on protein-calorie intake, the role of oral and/or intravenous supplements and efficacy of some classes of amino acids. A new determining factor that may lead inexorably to PEW in hemodialysis patients is represented by severe amino acid loss during hemodialysis sessions, for which mandatory compensation should be introduced.
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Affiliation(s)
- Piergiorgio Bolasco
- Nephrology Consultant, Sardinian Regional Public Health Institution, 09047 Selargius, Italy; ; Tel.: +39-333-2914-844; Fax: +39-070-609-3240
- Chronic Kidney Disease Treatment Group of the Italian Society of Nephrology, University Street, 11, 00185 Rome, Italy
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20
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George C, Matsha TE, Davidson FE, Goedecke JH, Erasmus RT, Kengne AP. Chronic Kidney Disease Modifies The Relationship Between Body Fat Distribution and Blood Pressure: A Cross-Sectional Analysis. Int J Nephrol Renovasc Dis 2020; 13:107-118. [PMID: 32494185 PMCID: PMC7231753 DOI: 10.2147/ijnrd.s247907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Measures of adiposity are related to cardiovascular disease risk, but this relationship is inconsistent in disease states, such as chronic kidney disease (CKD). This study investigated the relationship between adiposity and blood pressure (BP) by CKD status. Materials and Methods South Africans of mixed-ancestry (n=1,621) were included. Estimated glomerular filtration rate (eGFR) was based on the modification of diet in renal disease (MDRD) equation, and CKD defined as eGFR <60mL/min/1.73m2. Body fat distribution was assessed using anthropometry [body mass index (BMI) and waist circumference (WC)] and dual-energy x-ray absorptiometry (DXA) (n=152). Pulse pressure (PP) and mean arterial pressure (MAP) were calculated from systolic blood pressure (SBP) and diastolic blood pressure (DBP). Results In participants without CKD, anthropometric and DXA-derived measures positively correlated with SBP, DBP, MAP and PP (p<0.02 for all), except for leg fat mass (LFM), which was not associated with BP indices (p>0.100 for all). Contrary, in prevalent CKD (6%, n=96), only BMI was inversely associated with PP (p=0.0349). In multivariable analysis, only BMI and WC remained independently associated with SBP, DBP and MAP in the overall sample. Notably, the association between BMI, WC and LFM with SBP and PP, differed by CKD status (interaction: p<0.100 for all), such that only BMI and WC were associated with SBP in those without CKD and inversely associated with PP in those with CKD. LFM was inversely associated with SBP and PP in those with CKD. Conclusion In people without CKD, BP generally increases with increasing measures of adiposity. However, excess body fat has a seemingly protective or neutral effect on BP in people with CKD.
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Affiliation(s)
- Cindy George
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tandi E Matsha
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Florence E Davidson
- SAMRC/CPUT/Cardiometabolic Health Research Unit, Department of Biomedical Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa.,Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Science, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Julia H Goedecke
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | - Rajiv T Erasmus
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, National Health Laboratory Service (NHLS) and University of Stellenbosch, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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Grønberg BH, Valan CD, Halvorsen T, Sjøblom B, Jordhøy MS. Associations between severe co-morbidity and muscle measures in advanced non-small cell lung cancer patients. J Cachexia Sarcopenia Muscle 2019; 10:1347-1355. [PMID: 31385663 PMCID: PMC6903441 DOI: 10.1002/jcsm.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/15/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies show that low skeletal muscle index (SMI) and low skeletal muscle density (SMD) are negative prognostic factors and associated with more toxicity from systemic therapy in cancer patients. However, muscle depletion can be caused by a range of diseases, and many cancer patients have significant co-morbidity. The aim of this study was to investigate whether there were associations between co-morbidity and muscle measures in patients with advanced non-small cell lung cancer. METHODS Patients in a Phase III trial comparing two chemotherapy regimens in advanced non-small cell lung cancer were analysed (n = 436). Co-morbidity was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), which rates co-morbidity from 0 to 4 on 14 different organ scales. Severe co-morbidity was defined as having any grades 3 and 4 CIRS-G score. Muscle measures were assessed from baseline computed tomography slides at the L3 level using the SliceOMatic software. RESULTS Complete data were available for 263 patients (60%). Median age was 66, 57.0% were men, 78.7% had performance status 0-1, 25.9% Stage IIIB, 11.4% appetite loss, 92.4% were current/former smokers, 22.8% were underweight, 43.7% had normal weight, 26.6% were overweight, and 6.8% obese. The median total CIRS-G score was 7 (range: 0-16), and 48.2% had severe co-morbidity. Mean SMI was 44.7 cm2 /m2 (range: 27-71), and the mean SMD was 37.3 Hounsfield units (HU) (range: 16-60). When comparing patients with and without severe co-morbidity, there were no significant differences in median SMI (44.5 vs. 44.1 cm2 /m2 ; 0.70), but patients with severe co-morbidity had a significantly lower median SMD (36 HU vs. 39 HU; 0.001), mainly due to a significant difference in SMD between those with severe heart disease and those without (32.5 vs. 37.9 HU; 0.002). Linear regression analyses confirmed the association between severe co-morbidity and SMD both in the simple analysis (0.001) and the multiple analysis (0.037) adjusting for baseline characteristics. Stage of disease, gender, and body mass index (BMI) were significantly associated with SMI in both the simple and multiple analyses. Age and BMI were significantly associated with SMD in the simple analysis; and age, gender, and BMI were significantly associated in the multiple analysis. CONCLUSIONS There were no significant differences in SMI between patients with and patients without severe co-morbidity, but patients with severe co-morbidity had lower SMD than other patients, mainly due to severe heart disease. Co-morbidity might be a confounder in studies of the clinical role of SMD in cancer patients.
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Affiliation(s)
- Bjørn H Grønberg
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Christine Damgaard Valan
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tarje Halvorsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,The Cancer Clinic, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørg Sjøblom
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Marit S Jordhøy
- Department of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway
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Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria: A Cross-Sectional Study among Hemodialysis Patients in UAE. Nutrients 2019; 11:nu11112771. [PMID: 31739568 PMCID: PMC6893836 DOI: 10.3390/nu11112771] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/27/2022] Open
Abstract
(1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria.
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The associations of fat tissue and muscle mass indices with all-cause mortality in patients undergoing hemodialysis. PLoS One 2019; 14:e0211988. [PMID: 30759133 PMCID: PMC6373951 DOI: 10.1371/journal.pone.0211988] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/23/2019] [Indexed: 12/27/2022] Open
Abstract
Protein-energy wasting, which involves loss of fat and muscle mass, is prevalent and is associated with mortality in hemodialysis (HD) patients. We investigated the associations of fat tissue and muscle mass indices with all-cause mortality in HD patients. The study included 162 patients undergoing HD. The fat tissue index (FTI) and skeletal muscle mass index (SMI), which represent respective tissue masses normalized to height squared, were measured by bioimpedance analysis after dialysis. Patients were divided into the following four groups according to the medians of FTI and SMI values: group 1 (G1), lower FTI and lower SMI; G2, higher FTI and lower SMI; G3, lower FTI and higher SMI; and G4, higher FTI and higher SMI. The associations of the FTI, SMI, and body mass index (BMI) with all-cause mortality were evaluated. During a median follow-up of 2.5 years, 29 patients died. The 5-year survival rates were 48.6%, 76.1%, 95.7%, and 87.4% in the G1, G2, G3, and G4 groups, respectively (P = 0.0002). The adjusted hazard ratio values were 0.34 (95% confidence interval [CI] 0.10–0.95, P = 0.040) for G2 vs. G1, 0.13 (95%CI 0.01–0.69, P = 0.013) for G3 vs. G1, and 0.25 (95%CI 0.07–0.72, P = 0.0092) for G4 vs. G1, respectively. With regard to model discrimination, on adding both FTI and SMI to a model with established risk factors, the C-index increased significantly when compared with the value for a model with BMI (0.763 vs. 0.740, P = 0.016). Higher FTI and/or higher SMI values were independently associated with reduced risks of all-cause mortality in HD patients. Moreover, the combination of the FTI and SMI may more accurately predict all-cause mortality when compared with BMI. Therefore, these body composition indicators should be evaluated simultaneously in this population.
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Fitzpatrick J, Sozio SM, Jaar BG, Estrella MM, Segev DL, Parekh RS, McAdams-DeMarco MA. Frailty, body composition and the risk of mortality in incident hemodialysis patients: the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease study. Nephrol Dial Transplant 2019; 34:346-354. [PMID: 29868775 PMCID: PMC6365769 DOI: 10.1093/ndt/gfy124] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/28/2018] [Indexed: 01/05/2023] Open
Abstract
Background Frail obese community-dwelling older adults are at increased mortality risk. Among hemodialysis (HD) patients, frailty is common and associated with increased mortality risk; however, in dialysis, obesity is associated with decreased mortality risk. Whether the frail-obese phenotype is associated with increased mortality risk among HD patients remains unclear. Methods This study included 370 incident HD patients enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease (PACE) study. We measured frailty using the Fried phenotype, general obesity [body mass index (BMI) ≥30 kg/m2] and abdominal obesity [waist:hip ratio (WHR) ≥median WHR] and estimated their associations with mortality. Results The mean age was 55 years, with 42% female, 73% African American, 57% diabetic and 52% frail. Frail HD patients had higher mean BMI (frail = 30.3 kg/m2, non-frail = 28.3 kg/m2; P = 0.02) and similar WHR (P = 0.8). Twenty-two percent were frail with general obesity and 27% were frail with abdominal obesity. Frailty was associated with 1.66-fold increased mortality risk [95% confidence interval (CI) 1.03-2.67]. BMI was associated with a decreased mortality risk [25.0-29.9 kg/m2 hazard ratio (HR) 0.53 (95% CI 0.31-0.93); ≥30 kg/m2 HR 0.34 (95% CI 0.19-0.62)]. Frailty was associated with elevated mortality risk among HD patients with general [HR 3.77 (95% CI 1.10-12.92)] and abdominal obesity [HR 2.38 (95% CI 1.17-4.82)]. Frailty was not associated with mortality among HD patients without general or abdominal obesity. Conclusions In adults initiating HD, frailty was associated with elevated mortality risk, even among the obese. Frail-obese HD patients may be a high-risk, often-overlooked population, as obesity is assumed to be protective. Measurement of frailty and obesity may facilitate risk stratification.
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Affiliation(s)
- Jessica Fitzpatrick
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen M Sozio
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
| | - Bernard G Jaar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Nephrology Center of Maryland, Baltimore, MD, USA
| | - Michelle M Estrella
- Kidney Health Research Collaborative, Department of Medicine, University of California, San Francisco and Department of Medicine, San Francisco VA Medical Center, San Francisco, CA, USA
| | - Dorry L Segev
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Division of Nephrology, Department of Pediatrics and Medicine, Hospital for Sick Children, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mara A McAdams-DeMarco
- Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore, MD, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University, Baltimore, MD, USA
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Olvera-Soto MG, Melquiades-Castillo D, Castillo-Martínez L, Clark P, Medeiros M, Monroy A, Valdez-Ortiz R. 25 hydroxyvitamin D and nutritional parameters correlation in adults with stage 4 chronic kidney disease. Clin Nutr ESPEN 2018; 28:80-87. [DOI: 10.1016/j.clnesp.2018.09.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 08/08/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
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Pommer W. Preventive Nephrology: The Role of Obesity in Different Stages of Chronic Kidney Disease. KIDNEY DISEASES (BASEL, SWITZERLAND) 2018; 4:199-204. [PMID: 30574496 PMCID: PMC6276753 DOI: 10.1159/000490247] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obesity is increasing worldwide and has become a nontraditional risk factor in chronic kidney disease (CKD). SUMMARY Obesity-related nephropathy may aggravate renal complications of the metabolic syndrome and progress to advanced CKD stages, while obesity in early stages of CKD is clearly related to the development of kidney disease. A high body mass index (BMI) in advanced CKD stages and dialysis is an advantage for survival (so called "obesity paradox"). A high lean body to fat mass index indicates a beneficial state of body composition. In contrast, loss of muscle mass with increasing fat mass causes "sarcopenia obesity," which is related to unfavorable outcomes in renal replacement therapy. Obesity (BMI > 30-35) in renal transplant recipients is associated with a higher risk of complications such as delayed graft function, increased rates of rejection, and graft loss. While conservative management of morbid obesity is failing in most cases, bariatric surgery seems to be an option in some cases to improve renal complications in the early stage of CKD or in transplant candidates. KEY MESSAGE In conclusion, obesity is increasingly prevalent among CKD patients. Adequate management with respect to the specific role of obesity in different stages of CKD should be integrated in routine renal care.
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Affiliation(s)
- Wolfgang Pommer
- *Prof. Dr. med. Wolfgang Pommer, KfH-Bildungszentrum, Martin-Behaimstrasse 20, DE–63263 Neu-Isenburg (Germany), E-Mail
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Xiao J, Caan BJ, Weltzien E, Cespedes Feliciano EM, Kroenke CH, Meyerhardt JA, Baracos VE, Kwan ML, Castillo AL, Prado CM. Associations of pre-existing co-morbidities with skeletal muscle mass and radiodensity in patients with non-metastatic colorectal cancer. J Cachexia Sarcopenia Muscle 2018; 9:654-663. [PMID: 29675984 PMCID: PMC6104112 DOI: 10.1002/jcsm.12301] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 02/21/2018] [Accepted: 03/01/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND AIM Co-morbidities and computerized tomography-measured muscle abnormalities are both common in cancer patients and independently adversely influence clinical outcomes. Muscle abnormalities are also evident in other diseases, such as diabetes and obesity. This study examined for the first time the association between co-morbidities and muscle abnormalities in patients diagnosed with colorectal cancer (CRC). METHODS This cross-sectional study included 3051 non-metastatic patients with Stages I-III CRC. Muscle abnormalities, measured at diagnosis, were defined as low skeletal muscle mass index (SMI) or low skeletal muscle radiodensity (SMD) quantified using computerized tomography images using optimal stratification. Co-morbidities included in the Charlson index were ascertained. χ2 tests were used to compare the prevalence of co-morbidities by the presence or absence of each muscle abnormality. Logistic regressions were performed to evaluate which co-morbidities predicted muscle abnormalities adjusting for age, sex, body mass index, weight change, cancer stage, cancer site, race/ethnicity, and smoking. RESULTS Mean age was 63 years; 50% of patients were male. The prevalence of low SMI and low SMD were 43.1% and 30.2%, respectively. Co-morbidities examined were more prevalent in patients with low SMD than in those with normal SMD, and most remained independent predictors of low SMD after adjustment for covariates. Co-morbidities associated with higher odds of low SMD included myocardial infarction [odds ratio (OR) = 1.77, P = 0.023], congestive heart failure (OR = 3.27, P < 0.001), peripheral vascular disease (OR = 2.15, P = 0.002), diabetes with or without complications (OR = 1.61, P = 0.008; OR = 1.46, P = 0.003, respectively), and renal disease (OR = 2.21, P < 0.001). By contrast, only diabetes with complications was associated with lower odds of low SMI (OR = 0.64, P = 0.007). CONCLUSIONS Prevalence of muscle abnormalities was high in patients with non-metastatic CRC. Pre-existing co-morbidities were associated with low SMD, suggestive of a potential shared mechanism between fat infiltration into muscle and each of these co-morbidities.
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Affiliation(s)
- Jingjie Xiao
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | - Erin Weltzien
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | | | | | - Jeffrey A. Meyerhardt
- Department of Medical OncologyDana‐Farber Cancer Institute, Harvard Medical SchoolBostonMAUSA
| | - Vickie E. Baracos
- Division of Palliative Care Medicine, Department of OncologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Marilyn L. Kwan
- Division of ResearchKaiser Permanente Northern CaliforniaOaklandCAUSA
| | | | - Carla M. Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional ScienceUniversity of AlbertaEdmontonAlbertaCanada
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Monzani A, Perrone M, Prodam F, Moia S, Genoni G, Testa S, Paglialonga F, Rapa A, Bona G, Montini G, Edefonti A. Unacylated ghrelin and obestatin: promising biomarkers of protein energy wasting in children with chronic kidney disease. Pediatr Nephrol 2018; 33:661-672. [PMID: 29150712 DOI: 10.1007/s00467-017-3840-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 08/17/2017] [Accepted: 10/23/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Impairment in orexigenic/anorexigenic hormone balance may be key in the pathogenesis of protein energy wasting in children with chronic kidney disease (CKD). Measurement of ghrelin and obestatin concentrations in children with CKD would help assess the potential contribution of these hormones to uremic protein energy wasting. METHODS This was a cross-sectional case-control study. Acylated and unacylated ghrelin and obestatin were measured in 42 children on conservative treatment (CT), 20 children on hemodialysis, 48 pediatric renal transplant (RTx) recipients and 43 controls (CTR) (mean age 11.9, range 5-20 years). Weight, height and bicipital, tricipital, subscapular and suprailiac folds were measured, and the body mass index-standard deviation score (BMI-SDS), percentage of fat mass and fat-free mass were calculated. Urea and creatinine were measured and the glomerular filtration rate (GFR) calculated. RESULTS Unacylated ghrelin level was higher in patients than controls (p = 0.0001), with the highest levels found in hemodialysis patients (p = 0.001 vs. CKD-CT, p = 0.0001 vs. RTx, p < 0.0001 vs. CTR). Obestatin level was significantly higher in patients on hemodialysis than those on conservative treatment, RTx recipients and controls (p < 0.0001 in each case). Unacylated ghrelin negatively correlated with weight-SDS (p < 0.0001), BMI-SDS (p = 0.0005) and percentage fat mass (p = 0.004) and positively correlated with percentage fat-free mass (p = 0.004). Obestatin concentration negatively correlated with weight-SDS (p = 0.007). Unacylated ghrelin and obestatin concentrations positively correlated with creatinine and urea and inversely with eGFR, even after adjustments for gender, age, puberty and BMI-SDS (p < 0.0001 for each model). CONCLUSIONS Unacylated ghrelin and obestatin, negatively related to renal function, seem to be promising inverse indicators of nutritional status in children with CKD. Potential therapeutic implications in terms of optimization of their removal in patients on hemodialysis could be hypothesized.
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Affiliation(s)
- Alice Monzani
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy
| | - Michela Perrone
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
| | - Flavia Prodam
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy
| | - Stefania Moia
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy
| | - Giulia Genoni
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy.
| | - Sara Testa
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Rapa
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, V. Solaroli 17, 28100, Novara, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Cà Granda IRCCS, Ospedale Maggiore Policlinico, Milan, Italy
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Gender-specific associations of skeletal muscle mass and arterial stiffness among peritoneal dialysis patients. Sci Rep 2018; 8:1351. [PMID: 29358587 PMCID: PMC5778131 DOI: 10.1038/s41598-018-19710-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/08/2018] [Indexed: 11/20/2022] Open
Abstract
Decreased skeletal muscle has been identified as a relevant factor for arterial stiffness but has not been thoroughly investigated in peritoneal dialysis (PD) patients. The aim of this study was to investigate the relationship between skeletal muscle and arterial stiffness in PD patients. A cross-sectional study of 658 prevalent PD patients with a mean brachial-ankle pulse wave velocity (baPWV) of 1714 (±501) cm/s and mean skeletal muscle mass of 26.6 (±5.4) kg was performed. Skeletal muscle mass level was significantly higher in males than in females. When examining skeletal muscle mass as a continuous variable, skeletal muscle mass was significantly associated with baPWV in fully adjusted linear regression models in total patients [standardized coefficients (β), −0.181; 95% confidence interval (95% CI), −0.276 to −0.056; P = 0.003] or female patients (β, −0.119; 95% CI, −0.350 to −0.015; P = 0.03) but not in male patients (β, −0.117; 95% CI, −0.300 to 0.011; P = 0.07). Furthermore, in females, a significant association between the middle or highest tertile of skeletal muscle mass and baPWV was found in fully adjusted models (β, −0.123; 95% CI, −0.204 to −0.008; P = 0.03; β, −0.140; 95% CI, −0.228 to −0.016; P = 0.02, respectively). In conclusion, decreased skeletal muscle mass was independently associated with increased baPWV in PD patients, and this association was significant in females but not in males.
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Noori N, Wald R, Sharma Parpia A, Goldstein MB. Volume Estimates in Chronic Hemodialysis Patients by the Watson Equation and Bioimpedance Spectroscopy and the Impact on the Kt/V urea calculation. Can J Kidney Health Dis 2018; 5:2054358117750156. [PMID: 29348925 PMCID: PMC5768265 DOI: 10.1177/2054358117750156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/03/2017] [Indexed: 11/15/2022] Open
Abstract
Background Accurate assessment of total body water (TBW) is essential for the evaluation of dialysis adequacy (Kt/Vurea). The Watson formula, which is recommended for the calculation of TBW, was derived in healthy volunteers thereby leading to potentially inaccurate TBW estimates in maintenance hemodialysis recipients. Bioimpedance spectroscopy (BIS) may be a robust alternative for the measurement of TBW in hemodialysis recipients. Objectives The primary objective of this study was to evaluate the accuracy of Watson formula-derived TBW estimates as compared with TBW measured with BIS. Second, we aimed to identify the anthropometric characteristics that are most likely to generate inaccuracy when using the Watson formula to calculate TBW. Finally, we derived novel anthropometric equations for the more accurate estimation of TBW. Design and Setting This was a cross-sectional study of prevalent in-center HD patients at St Michael's Hospital. Patients One hundred eighty-four hemodialysis patients (109 men and 75 women) were evaluated in this study. Measurements Anthropometric measurements including weight, height, waist circumference, midarm circumference, and 4-site skinfold (biceps, triceps, subscapular, and suprailiac) thickness were measured; fat mass was measured using the formula by Durnin and Womersley. We measured TBW by BIS using the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany). Methods We used the Bland-Altman method to calculate the difference between the TBW derived from the Watson method and the BIS. To derive new equations for TBW estimation, Pearson's correlation coefficients between BIS-TBW (the reference test) and other variables were examined. We used the least squares regression analysis to develop parsimonious equations to predict TBW. Results TBW values based on the Watson method had a high correlation with BIS-TBW (correlation coefficients = 0.87 and P < .001). Despite the high correlation, the Watson formula overestimated TBW by 5.1 (4.5-5.8) liters and 3.8 (3.0-4.5) liters, in men and women, respectively. Higher fat mass and waist circumference (general and abdominal obesity) were correlated with the greater TBW overestimation by the Watson formula. We created separate equations for men and women based on weight and waist circumference. Limitations The main limitation of our study was the lack of an external validation for our novel estimating equation. Furthermore, though BIS has been validated against traditional reference standards, our assumption that it represents the "gold standard" for body compartment assessment may be flawed. Conclusions The Watson formula generally overestimates TBW in chronic dialysis recipients, particularly in patients with the highest waist circumference. Widespread reliance on the Watson formula for derivation of TBW may lead to the underestimation of Kt/Vurea..
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Affiliation(s)
- Nazanin Noori
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arti Sharma Parpia
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Marc B Goldstein
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
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Bellafronte NT, Batistuti MR, dos Santos NZ, Holland H, Romão EA, G. Chiarello P. Estimation of Body Composition and Water Data Depends on the Bioelectrical Impedance Device. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2018; 9:96-105. [PMID: 33584925 PMCID: PMC7852023 DOI: 10.2478/joeb-2018-0014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 06/12/2023]
Abstract
Overweight, obese and chronic kidney disease patients have an altered and negative body composition being its assessment important. Bioelectrical impedance analysis is an easy-to-operate and low-cost method for this purpose. This study aimed to compare and correlate data from single- and multi-frequency bioelectrical impedance spectroscopy applied in subjects with different body sizes, adiposity, and hydration status. It was a cross-sectional study with 386 non-chronic kidney disease volunteers (body mass index from 17 to 40 kg/m2), 30 patients in peritoneal dialysis, and 95 in hemodialysis. Bioelectrical impedance, body composition, and body water data were assessed with single- and multi-frequency bioelectrical impedance spectroscopy. Differences (95% confidence interval) and agreements (Bland-Atman analyze) between devices were evaluated. The intraclass correlation coefficient was used to measure the strength of agreement and Pearson's correlation to measure the association. Regression analyze was performed to test the association between device difference with body mass index and overhydration. The limits of agreement between devices were very large. Fat mass showed the greatest difference and the lowest intraclass and Pearson's correlation coefficients. Pearson's correlation varied from moderate to strong and the intraclass correlation coefficient from weak to substantial. The difference between devices were greater as body mass index increased and was worse in the extremes of water imbalance. In conclusion, data obtained with single- and multi-frequency bioelectrical impedance spectroscopy were highly correlated with poor agreement; the devices cannot be used interchangeably and the agreement between the devices was worse as body mass index and fat mass increased and in the extremes of overhydration.
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Affiliation(s)
- Natália T. Bellafronte
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marina R. Batistuti
- Department of Physics and Chemistry, Faculty of Pharmaceutical Sciences, University of São Paulo, Ribeirão Preto, Brazil
| | - Nathália Z. dos Santos
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Héric Holland
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Elen A. Romão
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Paula G. Chiarello
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Al-Rubeaan K, Siddiqui K, Alghonaim M, Youssef AM, AlNaqeb D. The Saudi Diabetic Kidney Disease study (Saudi-DKD): clinical characteristics and biochemical parameters. Ann Saudi Med 2018; 38:46-56. [PMID: 29295969 PMCID: PMC6074186 DOI: 10.5144/0256-4947.2018.03.01.1010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Saudi Arabia is facing an epidemic of type 2 diabetes that is complicated by a high rate of chronic complications such as kidney disease, which have a major impact on the healthcare system and economy. The Saudi diabetic kidney disease (SAUDI-DKD) study was launched to understand the implications of chronic diabetic kidney disease . OBJECTIVES Examine the hematological, biochemical and metabolic parameters of the selected cohorts to look for biomarkers of diabetic nephropathy. DESIGN Cross-sectional, hospital-based. SETTING Four general hospitals and two dialysis centers in Riyadh. PATIENTS AND METHODS We recruited adult type 2 diabetic patients aged between 35 and 70 years, with a duration of diabetes > 10 years, including subjects with microalbuminuria, macroalbuminuria and end stage renal disease (ESRD). They were compared with subjects with normal albumin excretion classified according to American Diabetes Association (ADA) criteria. MAIN OUTCOME MEASURES The effect of different stages of diabetic nephropathy on hematological and biochemical parameters. RESULTS Of 427 subjects with nephropathy, 184 (43%) had microalbuminuria, 83 (19%) had macroalbu.minuria and 160 (37%) had end stage renal disease (ESRD). The remaining 213 (50%) subjects did not have nephropathy. Patients with nephropathy were older with a mean age (SD) of 55.62 (6.00) years and had a longer duration of diabetes (mean [SD], 19.04 [6.33]) years), and had a lower monthly income and body mass index (BMI) than patients without nephropathy. Insulin resistance, elevated uric acid level, low red blood cells (RBCs) count and low hemoglobin level were associated with significantly increased risk of macroalbuminuria and ESRD. Elevated uric acid and LDH were associated with significantly increased risk of microalbuminuria and ESRD, while elevated red blood cell distribution width was significantly associated with an increased risk of ESRD. CONCLUSION Diabetic nephropathy is associated with insulin resistance, changes in liver enzymes and uric acid in addition to abnormalities in the red blood cell count and red blood cell shape that warrant frequent monitoring among patients with diabetic kidney disease. LIMITATIONS Cross-sectional study design and exclusion of patients with some risk factors.
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Affiliation(s)
- Khalid Al-Rubeaan
- Dr. Khalid Al-Rubeaan, College of Medicine, King Saud University,, PO Box 18397, Riyadh 11415,, Saudi Arabia, T: 966.11-4786100 loc 5123, , ORCID: http://orcid.org/0000-0003-3615-7192
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Zhuang Q, Cheng K, Ming Y. CX3CL1/CX3CR1 Axis, as the Therapeutic Potential in Renal Diseases: Friend or Foe? Curr Gene Ther 2017; 17:442-452. [PMID: 29446734 PMCID: PMC5902862 DOI: 10.2174/1566523218666180214092536] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/06/2017] [Accepted: 01/14/2018] [Indexed: 12/21/2022]
Abstract
The fractalkine receptor chemokine (C-X3-C motif) receptor 1 (CX3CR1) and its highly selective ligand CX3CL1 mediate chemotaxis and adhesion of immune cells, which are involved in the pathogenesis and progression of numerous inflammatory disorders and malignancies. The CX3CL1/CX3CR1 axis has recently drawn attention as a potential therapeutic target because it is involved in the ontogeny, homeostatic migration, or colonization of renal phagocytes. We performed a Medline/PubMed search to detect recently published studies that explored the relationship between the CX3CL1/CX3CR1 axis and renal diseases and disorders, including diabetic nephropathy, renal allograft rejection, infectious renal diseases, IgA nephropathy, fibrotic kidney disease, lupus nephritis and glomerulonephritis, acute kidney injury and renal carcinoma. Most studies demonstrated its role in promoting renal pathopoiesis; however, several recent studies showed that the CX3CL1/CX3CR1 axis could also reduce renal pathopoiesis. Thus, the CX3CL1/CX3CR1 axis is now considered to be a double-edged sword that could provide novel perspectives into the pathogenesis and treatment of renal diseases and disorders.
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Affiliation(s)
- Quan Zhuang
- Transplantation Center of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan410013, China
| | - Ke Cheng
- Transplantation Center of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan410013, China
| | - Yingzi Ming
- Transplantation Center of the 3rd Xiangya Hospital, Central South University, Changsha, Hunan410013, China
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Peng Y, Wang H, Chen F, Huang FY, Xia TL, Liao YB, Chai H, Wang PJ, Zuo ZL, Liu W, Zhang C, Li YJ, Gui YY, Chen M, Huang DJ. The influence of body composition on renal function in patients with coronary artery disease and its prognostic significance: a retrospective cohort study. Cardiovasc Diabetol 2016; 15:106. [PMID: 27484994 PMCID: PMC4971613 DOI: 10.1186/s12933-016-0420-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/05/2016] [Indexed: 02/05/2023] Open
Abstract
Objective We try to analyse the effect of renal functions on death in CAD patients with different body compositions. Methods A retrospective analysis was conducted in 2989 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into two categories: basically preserved renal function (PRF) (eGFR ≥60 ml/min) and obviously reduced renal function (RRF) (eGFR <60 ml/min). The influence of renal insufficiency on mortality of CAD was detected in every tertile of body composition, including body mass index (BMI), body fat (BF) and lean mass index (LMI). The end points were all-cause mortality. Results The mean follow-up time was 29.1 ± 12.5 months and death events occurred in 271 cases. The percentage of patients with RRF was positively correlated with BF and inversely correlated with the LMI, but no relationship to BMI. The survival curves showed that the risk of death was significantly higher in the RRF patients in all subgroups stratified using BMI, BF, or LMI (log rank test, all p < 0.001). The COX multivariate regression analysis showed that the risk of death was significantly higher in the RRF patients with high BF (HR 1.95, CI 1.25–3.05) and low LMI (HR 1.82, CI 1.19–2.79). Meanwhile, risk of death was significantly higher in RRF patients with a high BMI (HR 2.08, CI 1.22–3.55) or low BMI (HR 1.98, CI 1.28–3.08) but this risk was not significant in patients with a medium BMI (HR 1.12, 0.65–1.94). The subgroup analysis of patients with acute coronary syndrome (ACS) showed similar results. Conclusions For patients with CAD, renal insufficiency was positively correlated with BF, inversely correlated with LMI, and unrelated to BMI. The effect of renal insufficiency on the risk of death of CAD was related to body composition.
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Affiliation(s)
- Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Fei Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Fang-Yang Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Tian-Li Xia
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Hua Chai
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Peng-Ju Wang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Zhi-Liang Zuo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Wei Liu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Chen Zhang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Yi-Yue Gui
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China.
| | - De-Jia Huang
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, 610041, Chengdu, People's Republic of China.
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Rückgang der Nierenfunktion im Alter. Z Gerontol Geriatr 2016; 49:469-76. [DOI: 10.1007/s00391-016-1109-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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Hoffmann MR, Senior PA, Jackson ST, Jindal K, Mager DR. Vitamin D status, body composition and glycemic control in an ambulatory population with diabetes and chronic kidney disease. Eur J Clin Nutr 2015; 70:743-9. [PMID: 26530927 DOI: 10.1038/ejcn.2015.185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 09/26/2015] [Accepted: 09/29/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES To determine the interrelationships between body composition, glycemic control and vitamin D status in an ambulatory population with diabetes (DM) and chronic kidney disease (CKD). SUBJECTS/METHODS Adult (18-80 years) patients (n=60) with DM and stage 1-4 CKD were recruited from the Northern Alberta Renal Program. Outcome variables included body composition (absolute/regional fat (FM)/lean soft tissue/total mass, percent fat/lean/fat-free (FFM) mass), glycemic control (glycated hemoglobin (HbA1c)), vitamin D intake (dietary/supplemental) and vitamin D status (25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D)) measured by validated methodologies. Sarcopenia was determined as an appendicular skeletal mass/height(2) less than 7.26 kg/m(2) (males) and 5.45 kg/m(2) (females). RESULTS Suboptimal HbA1c (>7%), 25(OH)D (<50 nmol/l) and 1,25(OH)2D (<43 pmol/l) concentrations were present in 57, 8 and 11% of participants. Ten percent of subjects had sarcopenia. Gender/age/DM type, not CKD, significantly influenced regional/whole body composition. Females, older participants and those with type 2 DM had higher %FM. No significant interrelationships between vitamin D status and glycemic control were observed (P>0.05). Serum 25(OH)D concentrations were inversely associated with arm lean soft tissue/FFM/total mass, weight, appendicular skeletal mass, lean soft tissue/height(2), FFM/height(2), appendicular skeletal mass/height(2) and body mass index (P<0.05). Sarcopenia occurred more frequently in patients with 25(OH)D concentrations ⩾100 nmol/l. Regional/whole body %FM was inversely related to 1,25(OH)2D, not 25(OH)D. CONCLUSIONS Body composition, not glycemic control, is associated with vitamin D status in an ambulatory population of adults with DM and CKD.
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Affiliation(s)
- M R Hoffmann
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - P A Senior
- Department of Endocrinology, University of Alberta, Edmonton, Alberta, Canada.,Diabetic Nephropathy Prevention Clinic, Alberta Health Services, Edmonton, Alberta, Canada
| | - S T Jackson
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - K Jindal
- Diabetic Nephropathy Prevention Clinic, Alberta Health Services, Edmonton, Alberta, Canada.,Northern Alberta Renal Program, Edmonton, Alberta, Canada.,Department of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - D R Mager
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.,Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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