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Dam M, Weijs PJM, van Ittersum FJ, Hoekstra T, Douma CE, van Jaarsveld BC. Nocturnal Hemodialysis Leads to Improvement in Physical Performance in Comparison with Conventional Hemodialysis. Nutrients 2022; 15:nu15010168. [PMID: 36615825 PMCID: PMC9823778 DOI: 10.3390/nu15010168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/16/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
End-stage kidney disease patients treated with conventional hemodialysis (CHD) are known to have impaired physical performance and protein-energy wasting (PEW). Nocturnal hemodialysis (NHD) was shown to improve clinical outcomes, but the evidence is limited on physical performance and PEW. We investigate whether NHD improves physical performance and PEW. This prospective, multicenter, non-randomized cohort study compared patients who changed from CHD (2−4 times/week 3−5 h) to NHD (2−3 times/week 7−8 h), with patients who continued CHD. The primary outcome was physical performance at 3, 6 and 12 months, assessed with the short physical performance battery (SPPB). Secondary outcomes were a 6-minute walk test (6MWT), physical activity monitor, handgrip muscle strength, KDQOL-SF physical component score (PCS) and LAPAQ physical activity questionnaire. PEW was assessed with a dietary record, dual-energy X-ray absorptiometry, bioelectrical impedance spectroscopy and subjective global assessment (SGA). Linear mixed models were used to analyze the differences between groups. This study included 33 patients on CHD and 32 who converted to NHD (mean age 55 ± 15.3). No significant difference was found in the SPPB after 1-year of NHD compared to CHD (+0.24, [95% confidence interval −0.51 to 0.99], p = 0.53). Scores of 6MWT, PCS and SGA improved (+54.3 [95%CI 7.78 to 100.8], p = 0.02; +5.61 [−0.51 to 10.7], p = 0.03; +0.71 [0.36 to 1.05], p < 0.001; resp.) in NHD patients, no changes were found in other parameters. We conclude that NHD patients did not experience an improved SPPB score compared to CHD patients; they did obtain an improved walking distance and self-reported PCS as well as SGA after 1-year of NHD, which might be related to the younger age of these patients.
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Affiliation(s)
- Manouk Dam
- Amsterdam UMC, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Correspondence:
| | - Peter J. M. Weijs
- Amsterdam UMC, Nutrition and Dietetics, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, 1067 SM Amsterdam, The Netherlands
| | - Frans J. van Ittersum
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Tiny Hoekstra
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Caroline E. Douma
- Spaarne Gasthuis Hoofddorp, Nephrology, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Brigit C. van Jaarsveld
- Amsterdam UMC, Nephrology, Amsterdam Cardiovascular Sciences, VU University, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Dam M, Hartman EA, Kruizenga H, van Jaarsveld BC, Weijs PJM. Are we overfeeding hemodialysis patients with protein? Exploring an alternative method to estimate protein needs. Clin Nutr ESPEN 2021; 44:230-235. [PMID: 34330471 DOI: 10.1016/j.clnesp.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/16/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS Sufficient protein intake is of great importance in hemodialysis (HD) patients, especially for maintaining muscle mass. Daily protein needs are generally estimated using bodyweight (BW), in which individual differences in body composition are not accounted for. As body protein mass is best represented by fat free mass (FFM), there is a rationale to apply FFM instead of BW. The agreement between both estimations is unclear. Therefore, the aim of this study is to compare protein needs based on either FFM or BW in HD patients. METHODS Protein needs were estimated in 115 HD patients by three different equations; FFM, BW and BW adjusted for low or high BMI. FFM was measured by multi-frequency bioelectrical impedance spectroscopy and considered the reference method. Estimations of FFM x 1.5 g/kg and FFM x 1.9 g/kg were compared with (adjusted)BW x 1.2 and x 1.5, respectively. Differences were assessed with repeated measures ANOVA and Bland-Altman plots. RESULTS Mean protein needs estimated by (adjusted)BW were higher compared to those based on FFM, across all BMI categories (P < 0.01) and most explicitly in obese patients. In females with BMI >30, protein needs were 69 ± 17.4 g/day higher based on BW and 45 ± 9.3 g/day higher based on BMI adjusted BW, compared to FFM. In males with BMI >30, protein needs were 51 ± 20.4 g/day and 23 ± 20.9 g/day higher compared to FFM, respectively. CONCLUSIONS Our data show large differences and possible overestimations of protein needs when comparing BW to FFM. We emphasize the importance of more research and discussion on this topic.
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Affiliation(s)
- Manouk Dam
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Eva Anne Hartman
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Hinke Kruizenga
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands.
| | - Brigit C van Jaarsveld
- Department of Nephrology, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands.
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, Boelelaan 1117, 1081, HV, Amsterdam, the Netherlands; Amsterdam University of Applied Sciences, Faculty of Sports and Nutrition, Department of Nutrition and Dietetics, Dr. Meurerlaan 8, 1067, SM, Amsterdam, the Netherlands.
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Shoji T, Nakatani S, Kabata D, Mori K, Shintani A, Yoshida H, Takahashi K, Ota K, Fujii H, Ueda S, Nishi S, Nakatani T, Yoshiyama M, Goto K, Hamada T, Imanishi M, Ishimura E, Kagitani S, Kato Y, Kumeda Y, Maekawa K, Matsumura T, Nagayama H, Obi Y, Ohno Y, Sai Y, Sakurai M, Sasaki S, Shidara K, Shoji S, Tsujimoto Y, Yamakawa K, Yasuda H, Yodoi S, Inaba M, Emoto M. Comparative Effects of Etelcalcetide and Maxacalcitol on Serum Calcification Propensity in Secondary Hyperparathyroidism: A Randomized Clinical Trial. Clin J Am Soc Nephrol 2021; 16:599-612. [PMID: 33685864 PMCID: PMC8092049 DOI: 10.2215/cjn.16601020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Vitamin D receptor activators and calcimimetics (calcium-sensing receptor agonists) are two major options for medical treatment of secondary hyperparathyroidism. A higher serum calcification propensity (a shorter T50 value) is a novel surrogate marker of calcification stress and mortality in patients with CKD. We tested a hypothesis that a calcimimetic agent etelcalcetide is more effective in increasing T50 value than a vitamin D receptor activator maxacalcitol. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A randomized, multicenter, open-label, blinded end point trial with active control was conducted in patients with secondary hyperparathyroidism undergoing hemodialysis in Japan. Patients were randomly assigned to receive intravenous etelcalcetide 5 mg thrice weekly (etelcalcetide group) or intravenous maxacalcitol 5 or 10 µg thrice weekly (maxacalcitol group). The primary, secondary, and tertiary outcomes were changes in T50 value, handgrip strength, and score of the Dementia Assessment Sheet for Community-Based Integrated Care System from baseline to 12 months, respectively. RESULTS In total, 425 patients from 23 dialysis centers were screened for eligibility, 326 patients were randomized (etelcalcetide, n=167; control, n=159), and 321 were included in the intention-to-treat analysis (median age, 66 years; 113 women [35%]). The median (interquartile range) of T50 value was changed from 116 minutes (interquartile range, 90-151) to 131 minutes (interquartile range, 102-176) in the maxacalcitol group, whereas it was changed from 123 minutes (interquartile range, 98-174) to 166 minutes (interquartile range, 127-218) in the etelcalcetide group. The increase in T50 value was significantly greater in the etelcalcetide group (difference in change, 20 minutes; 95% confidence interval, 7 to 34 minutes; P=0.004). No significant between-group difference was found in the change in handgrip strength or in the Dementia Assessment Sheet for Community-Based Integrated Care System score. CONCLUSIONS Etelcalcetide was more effective in increasing T50 value than maxacalcitol among patients on hemodialysis with secondary hyperparathyroidism. There was no difference in handgrip strength or cognition between the two drugs. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER VICTORY; UMIN000030636 and jRCTs051180156.
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Affiliation(s)
- Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Nakatani
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kanae Takahashi
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Keiko Ota
- Center for Clinical Research and Innovation, Osaka City University Hospital, Osaka, Japan
| | - Hisako Fujii
- Department of Drug and Food Evaluation, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus, Okinawa, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Masaaki Inaba
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka, Japan,Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan,Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanori Emoto
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka, Japan,Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan,Department of Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Lee SW, Kim YS, Kim YH, Chung W, Park SK, Choi KH, Ahn C, Oh KH. Dietary Protein Intake, Protein Energy Wasting, and the Progression of Chronic Kidney Disease: Analysis from the KNOW-CKD Study. Nutrients 2019; 11:nu11010121. [PMID: 30626166 PMCID: PMC6356719 DOI: 10.3390/nu11010121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 12/11/2018] [Accepted: 01/04/2019] [Indexed: 02/06/2023] Open
Abstract
Studies on the effect of dietary protein intake (DPI) on chronic kidney disease (CKD) progression, along with the potential hazard of protein-energy wasting (PEW), are scarce. We evaluated the association between DPI and kidney function both cross-sectionally and longitudinally, particularly emphasizing the role of PEW, in a large-scale, observational, multicenter, prospective study. We enrolled 1572 patients with non-dialysis CKD between 2011 and 2016. CKD progression was defined by a >50% estimated glomerular filtration rate (eGFR) decrease, serum creatinine doubling, or dialysis initiation. A Cox proportional hazard regression analysis was conducted. During the mean follow-up period of 41.6 months, CKD progression was observed in 296 patients. Cross-sectionally, increased DPI was significantly associated with increased eGFR. Similarly, increased DPI tertile was significantly associated with increased renal survival in a Kaplan–Meier curve analysis. In the multivariate Cox proportional hazard regression analysis, the statistical significance of the DPI tertile group in CKD progression was lost when PEW-related variables were added as covariates. In penalized spline curve analysis, the adjusted odds ratio of PEW significantly increased as DPI decreased. DPI, per se was not a major determinant of CKD progression. An intimate association between reduced DPI and PEW may be a more important predictor of CKD progression than DPI.
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Affiliation(s)
- Sung Woo Lee
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea.
| | - Yong-Soo Kim
- Department of Internal Medicine, College of Medicine, Catholic University of Korea, Seoul 06591, Korea.
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University, Busan Paik Hospital, Busan 47392, Korea.
| | - Wookyung Chung
- Department of Internal Medicine, Gachon University, Gil Hospital, Incheon 21565, Korea.
| | - Sue K Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul 03082, Korea.
- Cancer Research Institute, Seoul National University, Seoul 08826, Korea.
- Department of Biomedical Science, Seoul National University Graduate School, Seoul 03081, Korea.
| | - Kyu Hun Choi
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul 03722, Korea.
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
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