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Kolak E, Radić J, Vučković M, Bučan Nenadić D, Begović M, Radić M. Nutritional and Hydration Status and Adherence to Dietary Recommendations in Dalmatian Dialysis Patients. Nutrients 2022; 14:nu14173553. [PMID: 36079811 PMCID: PMC9460881 DOI: 10.3390/nu14173553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support.
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Affiliation(s)
- Ela Kolak
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Josipa Radić
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence:
| | - Marijana Vučković
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
| | - Dora Bučan Nenadić
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Mirna Begović
- Student of School of Medicine, University of Split, 21000 Split, Croatia
| | - Mislav Radić
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Department of Clinical Immunology and Rheumatology, University Hospital Centre Split, 21000 Split, Croatia
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Markaki A, Kyriazis P, Dermitzaki EK, Maragou S, Psylinakis E, Spyridaki A, Drosataki H, Lygerou D, Grammatikopoulou MG, Petrakis I, Stylianou K. The Association Between Handgrip Strength and Predialysis Serum Sodium Level in Patients With Chronic Kidney Disease Stage 5D. Front Med (Lausanne) 2021; 7:610659. [PMID: 33511145 PMCID: PMC7835135 DOI: 10.3389/fmed.2020.610659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: Handgrip strength (HGS) is a useful tool for the systematic assessment of muscle function related to nutritional status. Reduced HGS has been associated with adverse clinical outcomes in chronic kidney disease (CKD) stage 5D patients. In the same patients, predialysis low serum sodium (sNa) has been associated with malnutrition and mortality. Here, we investigated the role of predialysis sNa on muscle function in CKD-5D patients. Methods: We evaluated 45 patients on hemodialysis (HD) and 28 patients on peritoneal dialysis (PD) with HGS measurement, bioimpedance analysis, anthropometric measures, and malnutrition inflammation score (MIS). According to established diagnostic criteria, reduced HGS was defined as strength below 30 and 20 Kg in men and women, respectively. Predialysis sNa values were defined as the mean of all predialysis measurements during the preceding 6 months. Data analysis was performed separately for each of the HD and PD groups. Results: The proportions of reduced HGS did not differ between the HD (66%) and PD (54%) groups, respectively. Patients in the HD group as compared to those in the PD group had higher serum albumin and potassium and mid-arm muscle circumference and lower residual renal function (RRF) and residual urine volume. Multivariate logistic analysis, after controlling for muscle mass, nutritional biomarkers, MIS, fluid overload and RRF, showed that for every 1 mmol/l increase of sNa the odds of reduced HGS was decreased by 60% (OR = 0.40, 95% CI: 0.16–0.99) and 42% (OR = 0.58, 95% CI: 0.36–0.93) in HD and PD patients, respectively. However, stratified analysis indicated that lower sNa levels predicted reduced HGS in individuals with a background of malnutrition, inflammation, overhydration and less preserved RRF, representing unfavorable conditions strongly related to muscle wasting in the dialysis setting. Conclusions: Predialysis sNa is a strong and independent determinant of HGS, a reliable nutritional marker in CKD-5D stage patients. However, according to our findings, lower sNa levels appear to be a marker of underlying unfavorable conditions that are heavily associated with reduced HGS, rather than a causal determinant of reduced HGS. Whether optimizing sNa levels improves patient muscle performance requires further investigations.
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Affiliation(s)
- Anastasia Markaki
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Periklis Kyriazis
- Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | - Sevasti Maragou
- Department of Nephrology, Heraklion University Hospital, Crete, Greece
| | - Emmanuel Psylinakis
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Aspasia Spyridaki
- Department of Nutrition and Dietetics Sciences, Hellenic Mediterranean University, Crete, Greece
| | - Helen Drosataki
- Department of Nephrology, Heraklion University Hospital, Crete, Greece
| | - Dimitra Lygerou
- Department of Nephrology, Heraklion University Hospital, Crete, Greece
| | - Maria G Grammatikopoulou
- Department of Nutritional Sciences and Dietetics, Faculty of Health Sciences, International Hellenic University, Thessaloniki, Greece
| | - Ioannis Petrakis
- Department of Nephrology, Saarland University Medical Center, Homburg, Germany
| | - Kostas Stylianou
- Department of Nephrology, Heraklion University Hospital, Crete, Greece
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Grammatikopoulou MG, Gkiouras K, Markaki AG, Gkouskou KK, Aivaliotis M, Stylianou K, Bogdanos DP. AMY1 diploid copy number among end-stage renal disease patients. Hormones (Athens) 2020; 19:369-376. [PMID: 32405930 DOI: 10.1007/s42000-020-00199-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE The salivary amylase gene (AMY1) copy number variation (CNV) is increased as a human adaptation to starch-enriched nutritional patterns. The purpose of this study was to evaluate the relationship between AMY1 CNV, dietary starch consumption, and anthropometric indices among a known population with elevated cardiovascular risk, being end-stage renal disease (ESRD) patients. METHODS A total of 43 ESRD patients were recruited based on the following inclusion criteria: being (1) adults, (2) on hemodialysis for more than 3 months, (3) able to communicate effectively, and (4) willing to participate. Anthropometric measurements were performed, dietary intake was recorded via food-frequency questionnaires, and AMY1 CNV was quantified in blood samples DNA via real-time PCR. RESULTS Median AMY1 CNV was 4.0 (2.0-17.0). A total of 21 patients had an even, and 22 had an odd AMY1 copy number (CN). Independent samples t tests revealed that AMY1-odd diploid CN is associated with increased body weight, waist and hip circumferences, and fat mass compared to the respective even diploid CN carrier group. No differences were observed for BMI or nutritional intake. Multiple regression analysis revealed that AMY1-odd diploid CN was positively associated with increased hip circumference (ß = 7.87, 95% CI = 0.34 to 15.39) and absolute fat mass (ß = 6.66, 95% CI = 0.98 to 12.34); however, after applying the Bonferroni correction for multiplicity, all regression analyses lost their significance. CONCLUSIONS AMY1-odd diploid CN appears to be associated with selected adiposity variables among hemodialysis patients. However, more research is needed to verify this finding in this population with known increased cardiovascular risk.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anastasia G Markaki
- Department of Nutrition & Dietetics, Faculty of Health Sciences, Hellenic Mediterranean University, Sitia, Greece
| | - Kalliopi K Gkouskou
- Department of Medical Laboratories, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
- Embiodiagnostics, Biology Research Company, Melissinon and Damvergidon Str, Heraklion, Crete, Greece
| | - Michalis Aivaliotis
- Laboratory of Biological Chemistry, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Institute of Molecular Biology and Biotechnology, Foundation of Research and Technology Hellas (FORTH), Heraklion, Crete, Greece
| | | | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Division of Transplantation, Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London, UK
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Gencer F, Yıldıran H, Erten Y. Association of Malnutrition Inflammation Score With Anthropometric Parameters, Depression, and Quality of Life in Hemodialysis Patients. J Am Coll Nutr 2018; 38:457-462. [PMID: 30589395 DOI: 10.1080/07315724.2018.1550371] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Hemodialysis patients may be at risk for malnutrition due to catabolic effects caused by dialysis, loss of amino acids, inadequate nutrient intake, acidosis, and inflammation. Malnutrition may have negative effects on quality of life, mortality, and disease prognosis. This study was conducted to determine the relationship between anthropometric parameters, depression, and quality of life with Malnutrition Inflammation Score (MIS) on 55 patients aged between 18 and 65 years (36 males and 19 females) who have dialysis treatment for 3 days per week for at least 3 months due to end-stage renal disease. Methods: Patients were evaluated with MIS, Subjective Global Assessment (SGA), Beck Depression Inventory (BDI), and Satisfaction with Life Scale (SWLS). In addition, anthropometric (body weight, height, mid-upper arm circumference [MUAC]) and body composition measurements of patients were taken, body mass index (BMI) values were calculated, and biochemical parameters (albumin, C-reactive protein [CRP], and total iron binding capacity [TIBC]) were analyzed. Results: At the end of the study, 14.5% of the patients according to SGA, were classified as malnourished. There was a statistically significant positive correlation of BDI, duration of dialysis, and CRP with MIS. However, MIS had a statistically significant negative correlation with SWLS, body weight, and MUAC (p < 0.05). Conclusion: MIS is an effective screening tool for assessing malnutrition and quality of life in hemodialysis patients. However, there is a need for studies to identify cutoff points of MIS.
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Affiliation(s)
- Feray Gencer
- a Department of Nutrition and Dietetics, Faculty of Health Science , Gazi University , Ankara , Turkey
| | - Hilal Yıldıran
- a Department of Nutrition and Dietetics, Faculty of Health Science , Gazi University , Ankara , Turkey
| | - Yasemin Erten
- b Department of Nephrology, Faculty of Medicine , Gazi University , Ankara , Turkey
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Markaki A, Grammatikopoulou MG, Venihaki M, Kyriazis J, Perakis K, Stylianou K. Associations of adiponectin and leptin levels with protein-energy wasting, in end stage renal disease patients. ACTA ACUST UNITED AC 2017; 63:449-457. [PMID: 27638461 DOI: 10.1016/j.endonu.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 07/03/2016] [Accepted: 07/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW. DESIGN Prospective (18 months). SETTING University Hospital of Heraklion, Crete, Greece. SUBJECTS Seventy-four end-stage-renal-disease patients, 47 on HD and 27 on PD. MAIN OUTCOME MEASURES At three sequential time points (baseline, 6 and 18 months) anthropometric, nutritional and inflammatory status data were collected. Serum adiponectin and leptin were also assessed at each time point. Patients were allocated to 3 strata according to PEW severity (0, 1-2 and ≥3 criteria for PEW). RESULTS Adiponectin and leptin levels were greater among PD compared to HD patients (p≤0.035). Adiponectin levels were incrementally greater across increasing strata of PEW (p≤0.002). Leptin showed the opposite trend, with lower levels in malnourished patients and higher levels in patients with zero PEW criteria (p≤0.042). Alterations of adiponectin levels during the observation period were dependent on PEW stratum (p≤0.021) and mode of dialysis (p≤0.002), after adjustment for age, dialysis vintage, gender and fat mass index. Particularly, adiponectin levels increased over time in HD patients with ≥3 criteria for PEW, whereas adiponectin levels decreased in PD patients with ≥3 criteria for PEW throughout the study. Leptin alterations over time were not affected by dialysis mode or PEW stratification. CONCLUSIONS Our study provides evidence that increased adiponectin and decreased leptin levels are independently associated with PEW and thus, poor prognosis.
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Affiliation(s)
- Anastasia Markaki
- Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Sitia, Greece.
| | - Maria G Grammatikopoulou
- Department of Nutrition & Dietetics, Alexander Technological Educational Institute, Thessaloniki, Greece
| | - Maria Venihaki
- Department of Clinical Chemistry, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - John Kyriazis
- Department of Nephrology, General Hospital of Chios, Chios, Greece
| | - Kostas Perakis
- Department of Nephrology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Kostas Stylianou
- Department of Nephrology, University Hospital of Heraklion, Heraklion, Crete, Greece
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Oliveira TS, Valente AT, Caetano CG, Garagarza CA. Nutritional parameters as mortality predictors in haemodialysis: Differences between genders. J Ren Care 2017; 43:83-91. [PMID: 28417563 DOI: 10.1111/jorc.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malnutrition is common in patients undergoing haemodialysis (HD). Several studies have described different nutritional parameters as mortality predictors but few have studied whether there are differences between genders. This study aimed to evaluate which nutrition parameters may be associated with mortality in patients undergoing long-term HD depending on their gender. METHODS Longitudinal prospective multicentre study with 12 months of follow-up. Anthropometric and laboratory measures were obtained from 697 patients. RESULTS Men who died were older, had lower dry weight, body mass index, potassium, phosphorus and albumin, compared with male patients who survived. Female patients who died had lower albumin and nPCR compared with survivors. Kaplan-Meier analysis displayed a significantly worse survival in patients with albumin <3.5 g/dl in both genders and with body mass index <23 kg/m2 in men. In the Cox regression analysis patients overall mortality was related to body mass index <23 kg/m2 , potassium ≤5.5 mEq/l and phosphorus <3.0 mg/dl for male patients and albumin <3.5 g/dl and normalised protein catabolic rate (nPCR) <0.8 g/kg/day for both genders. Associations between albumin, body mass index and mortality risk continued to be significant after adjustments for age, length of time on dialysis and diabetes for males. However, in women, only albumin persisted as an independent predictor of death. CONCLUSION Depending on the gender, different parameters such as protein intake, potassium, phosphorus, body mass index and albumin are associated with mortality in patients undergoing HD. Albumin <3.5 g/dl is an independent mortality predictor in both genders, whereas a body mass index <23 kg/m2 is an independent predictor of death, but only in men.
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Colombo G, Reggiani F, Cucchiari D, Portinaro NM, Giustarini D, Rossi R, Garavaglia ML, Saino N, Milzani A, Badalamenti S, Dalle-Donne I. Plasma protein-bound di-tyrosines as biomarkers of oxidative stress in end stage renal disease patients on maintenance haemodialysis. BBA CLINICAL 2017; 7:55-63. [PMID: 28127532 PMCID: PMC5257032 DOI: 10.1016/j.bbacli.2016.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/07/2016] [Accepted: 12/15/2016] [Indexed: 12/26/2022]
Abstract
Background Patients with end-stage renal disease (ESRD) undergoing haemodialysis (HD) experience enhanced oxidative stress and systemic inflammation, which are risk factors for cardiovascular disease, the most common cause of excess morbidity and mortality for these patients. Different pathways producing different types of oxidative stress occur in ESRD. The purpose of our study was to determine the effect of HD on plasma levels of protein-bound dityrosine (di-Tyr), a biomarker of protein oxidation. Methods Protein-bound di-Tyr formation was measured by size exclusion HPLC coupled to fluorescence detector. Clinical laboratory parameters were measured by standardized methods. Results In most ESRD patients, a single HD session decreased significantly the plasma protein-bound di-Tyr level, although the mean post-HD level remained significantly greater than the one in healthy people. Furthermore, pre-HD plasma protein-bound di-Tyr level was positively correlated with pre-HD serum creatinine and albumin concentrations. No significant correlation was found between plasma protein-bound di-Tyr level and serum concentration of C-reactive protein, a biomarker of systemic inflammation. Conclusions This study demonstrates that a single HD session does not increase, rather partially decreases, oxidative pathways producing di-Tyr in the haemodialyzed patient. General significance The choice of the most pertinent biomarkers of oxidative stress is critical for the development of novel treatments for ESRD. However, the relative importance of oxidative stress and inflammation in ESRD remains largely undetermined, and several questions concerning oxidative stress and inflammation remain poorly defined. These results could stimulate further studies on the use of plasma protein-bound di-Tyr as a long-lasting oxidative stress biomarker in ESRD. Haemodialyzed patients experience oxidative stress and systemic inflammation. We assessed haemodialysis (HD) effect on plasma protein-bound dityrosine (di-Tyr). In most patients, a single HD session decreased significantly the di-Tyr level. Pre-HD di-Tyr level was positively correlated with those of creatinine and albumin. No correlation was found between di-Tyr level and C-reactive protein concentration.
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Affiliation(s)
- Graziano Colombo
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | - Francesco Reggiani
- Humanitas Clinical and Research Center - Nephrology Unit, Rozzano, Milan, Italy
| | - David Cucchiari
- Humanitas Clinical and Research Center - Nephrology Unit, Rozzano, Milan, Italy
| | - Nicola M Portinaro
- Humanitas Clinical and Research Center - Clinica ortopedica e traumatologica, Rozzano, Milan, Italy
| | | | - Ranieri Rossi
- Department of Life Sciences, University of Siena, Siena, Italy
| | - Maria Lisa Garavaglia
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | - Nicola Saino
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | - Aldo Milzani
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
| | | | - Isabella Dalle-Donne
- Department of Biosciences, Università degli Studi di Milano, via Celoria 26, I-20133 Milan, Italy
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Hand RK, Steiber AL. Subjective global assessment remains an important nutrition assessment tool: response to Marcelli, DiBenedetto, Ciotola, Grassmann, and Canaud. J Ren Nutr 2014; 25:135. [PMID: 25446838 DOI: 10.1053/j.jrn.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rosa K Hand
- Dietetics Practice Based Research Network, Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Nutrition, Case Western Reserve University, Cleveland, Ohio
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