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Luo L, Li M, Xi Y, Hu J, Hu W. C-reactive protein-albumin-lymphocyte index as a feasible nutrition-immunity-inflammation marker of the outcome of all-cause and cardiovascular mortality in elderly. Clin Nutr ESPEN 2024; 63:346-353. [PMID: 38985666 DOI: 10.1016/j.clnesp.2024.06.054] [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: 01/19/2024] [Revised: 05/12/2024] [Accepted: 06/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND & AIMS The imbalance of nutrition-immunity-inflammation status might be associated with the mortality risk in the elderly. This study aimed to assess the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index and all-cause and cardiovascular disease (CVD) mortality in the elderly. METHODS The data from records of older adults (≥ 60 years) were derived from 1999 to 2010 and 2015-2018 National Health and Nutrition Examination Survey. Weighted Cox proportional hazard regression was used to analyze the relationship between CALLY and all-cause mortality and CVD mortality in three different models, and the linear trend was analyzed. A restricted cubic spline model was used to evaluate the nonlinear dose-response relationship and determine the critical threshold of CALLY to divide the population into two groups. Kaplan-Meier analysis and log-rank test were used to evaluate the cumulative survival rates of different groups. Subgroup analyses and sensitivity analyses were performed to ensure robustness. RESULTS Compared to the first quartile of natural log-transformation (ln) CALLY, the highest quartile of ln CALLY was negatively correlated with the risk of all-cause mortality (HR = 0.67, 95% CI: 0.56-0.79. P < 0.05) and CVD mortality (HR = 0.65, 95% CI: 0.47-0.89. P < 0.05) in model 3. Ln CALLY was linear dose-response correlated with mortality. We determined that the critical threshold for ln CALLY in elderly was 1.00. Elderly with higher ln CALLY (≥ 1.00) had significantly increased survival rates (P < 0.05). CONCLUSION CALLY showed a significant negative linear association with the risk of all-cause mortality and CVD mortality, and higher CALLY was beneficial to the survival outcomes of the elderly.
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Affiliation(s)
- Ling Luo
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, 523808, China
| | - Mingzi Li
- Department of Epidemiology and Medical Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, 523808, China
| | - Yue Xi
- Department of Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510275, China
| | - Jie Hu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
| | - Wei Hu
- Department of Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, 510275, China.
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Davison SN, Rathwell S. Short-term and long-term survival in patients with prevalent haemodialysis-an integrated prognostic model: external validation. BMJ Support Palliat Care 2024; 14:222-229. [PMID: 36596667 PMCID: PMC11103293 DOI: 10.1136/spcare-2022-003916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Prognostic tools with evidence for external validity in routine clinical practice are needed to align care with patients' preferences and deliver timely supportive services. Current models have limited, if any, evidence for external validity and none have been implemented and evaluated in clinical practice on a large scale. This study sought to provide evidence for external validity in a real life setting of the Cohen prognostic model that integrates actuarial factors with the 'Surprise Question' to assess 6-month, 12-month and 18-month survival of prevalent haemodialysis patients. METHODS Cross-sectional study of 1372 patients in a Canadian university-based programme between 2010 and 2019. Survival probabilities were compared with observed survival. Discrimination and calibration were assessed through predicted risk-stratified observed survival, cumulative AUC, Somer's Dxy and a calibration slope estimate. RESULTS Discrimination performance was moderate with a C statistic of 0.71-0.72 for all three time points. The model overpredicted mortality risk with the best predictive accuracy for 6- month survival. The differences between observed and mean predicted survival at 6 months, 12 months and 18 months were 3.2%, 8.8% and 12.9%, respectively. Kaplan-Meier curves stratified by Cox-based risk group showed good discrimination between high-risk and low-risk patients with HR estimates (95% CI): C2 vs C1 3.07 (1.57-5.99), C3 vs C1 5.85 (3.06-11.17), C4 vs C1 13.24 (6.91-25.34)). CONCLUSIONS The Cohen prognostic model can be incorporated easily into routine dialysis care to identify patients at high risk for death over 6 months, 12 months and 18 months and help target vulnerable patients for timely supportive care interventions.
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Affiliation(s)
- Sara N Davison
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Rathwell
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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ter Meulen KJ, Ye X, Wang Y, Usvyat LA, van der Sande FM, Konings CJ, Kotanko P, Kooman JP, Maddux FW. Variability of Serum Phosphate in Incident Hemodialysis Patients: Association with All-Cause Mortality. KIDNEY360 2023; 4:374-380. [PMID: 36918167 PMCID: PMC10103252 DOI: 10.34067/kid.0000000000000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/20/2022] [Indexed: 03/15/2023]
Abstract
Key Points An increase in serum phosphate variability is an independent risk factor of mortality. The effects of a positive directional range (DR) is most pronounced in patients with high serum phosphate levels whereas the effects of a negative DR is most pronounced in patients with low serum phosphate and/or serum albumin. Background In maintenance hemodialysis (HD) patients, previous studies have shown that serum phosphate levels have a bidirectional relation to outcome. Less is known about the relation between temporal dynamics of serum phosphate in relation to outcome. We aimed to further explore the relation between serum phosphate variability and all-cause mortality. Methods All adult incident HD patients treated in US Fresenius Kidney Care clinics between January 2010 and October 2018 were included. Baseline period was defined as 6 months after initiation of HD and months 7–18 as follow-up period. All-cause mortality was recorded during the follow-up period. The primary metric of variability used was directional range (DR) that is the difference between the largest and smallest values within a time period; DR was positive when the smallest value preceded the largest and negative otherwise. Cox proportional hazards models with spline terms were applied to explore the association between phosphate, DR, and all-cause mortality. In addition, tensor product smoothing splines were computed to further elucidate the interactions of phosphate, DR, and all-cause mortality. Results We included 302,613 patients. Baseline phosphate was 5.1±1.2 mg/dl, and mean DR was +0.6±3.3 mg/dl. Across different levels of phosphate, higher levels of DR of phosphate were associated with higher risk of all-cause mortality. In patients with lower levels of phosphate and serum albumin, the effect of a negative DR was most pronounced, whereas in patients with higher phosphate levels, a positive DR was related to increased mortality. Conclusions Higher variability of serum phosphate is related to mortality at all levels of phosphate, especially in lower levels with a negative DR and in low serum albumin levels. This could possibly reflect dietary intake in patients who are already inflamed or malnourished, where a further reduction in serum phosphate should prompt for nutritional evaluation.
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Affiliation(s)
- Karlien J. ter Meulen
- Maastricht University Medical Center, Maastricht, The Netherlands
- Catharina Hospital, Eindhoven, The Netherlands
| | - Xiaoling Ye
- Renal Research Institute, New York, New York
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California–Santa Barbara, Santa Barbara, California
| | - Len A. Usvyat
- Global Medical Office, Fresenius Medical Care, Waltham, Massachusetts
| | | | | | - Peter Kotanko
- Renal Research Institute, New York, New York
- Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Jeroen P. Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands
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Biphasic Dynamics of Inflammatory Markers Following Hemodialysis Initiation: Results From the International MONitoring Dialysis Outcome Initiative. Kidney Int Rep 2022; 8:75-80. [PMID: 36644346 PMCID: PMC9831940 DOI: 10.1016/j.ekir.2022.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/28/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Inflammation is highly prevalent among patients with end-stage kidney disease and is associated with adverse outcomes. We aimed to investigate longitudinal changes in inflammatory markers in a diverse international incident hemodialysis patient population. Methods The MONitoring Dialysis Outcomes (MONDO) Consortium encompasses hemodialysis databases from 31 countries in Europe, North America, South America, and Asia. The MONDO database was queried for inflammatory markers (total white blood cell count [WBC], neutrophil count, lymphocyte count, serum albumin, and C-reactive protein [CRP]) and hemoglobin levels in incident hemodialysis patients. Laboratory parameters were measured every month. Patients were stratified by survival time (≤6 months, >6 to 12 months, >12 to 18 months, >18 to 24 months, >24 to 30 months, >30 to 36 months, and >36 months) following dialysis initiation. We used cubic B-spline basis function to evaluate temporal changes in inflammatory parameters in relationship with patient survival. Results We studied 18,726 incident hemodialysis patients. Their age at dialysis initiation was 71.3 ± 11.9 years; 10,802 (58%) were males. Within the first 6 months, 2068 (11%) patients died, and 12,295 patients (67%) survived >36 months (survivor cohort). Hemodialysis patients who died showed a distinct biphasic pattern of change in inflammatory markers where an initial decline of inflammation was followed by a rapid rise that was consistently evident approximately 6 months before death. This pattern was similar in all patients who died and was consistent across the survival time intervals. In contrast, in the survivor cohort, we observed initial decline of inflammation followed by sustained low levels of inflammatory biomarkers. Conclusion Our international study of incident hemodialysis patients highlights a temporal relationship between serial measurements of inflammatory markers and patient survival. This finding may inform the development of prognostic models, such as the integration of dynamic changes in inflammatory markers for individual risk profiling and guiding preventive and therapeutic interventions.
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Wong MMY, Zheng Y, Renouf D, Sheriff Z, Levin A. Trajectories of Nutritional Parameters Before and After Prescribed Oral Nutritional Supplements: A Longitudinal Cohort Study of Patients With Chronic Kidney Disease Not Requiring Dialysis. Can J Kidney Health Dis 2022; 9:20543581211069008. [PMID: 35070337 PMCID: PMC8771735 DOI: 10.1177/20543581211069008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The association between oral nutritional supplement use and nutritional parameters among patients with nondialysis chronic kidney disease (CKD-ND) with or at high risk of undernutrition/protein-energy wasting has not been previously studied. The definition of patient subgroups most likely to benefit from oral nutritional supplementation (ONS) is also an area where more research is needed. Objective: To assess nutritional parameter trajectories among patients with CKD-ND prescribed oral nutritional supplements in British Columbia, and to compare trajectories by nutritional phenotype. Design: Longitudinal cohort study, pre-post design. Setting: Multidisciplinary CKD clinics across British Columbia. Patients: A total of 3957 adult patients with CKD-ND, who entered multidisciplinary CKD clinics during 2010 to 2019, met criteria for oral nutritional supplement prescription based on dietitian assessment, and received ≥1 oral nutritional supplement prescription. Measurements: Longitudinal nutritional parameters, including body mass index (BMI), serum albumin, serum bicarbonate, serum phosphate, and neutrophil-to-lymphocyte ratio (NLR). Methods: Using linear mixed models, slopes for nutritional and inflammation parameters were assessed in the 2-year periods before and after the first oral nutritional supplement prescription. Hierarchical cluster analysis was applied to identify nutritional phenotypes using baseline data, and slope analysis was repeated by cluster. Results: In the pre-oral-nutritional-supplement period, declines in BMI (−0.87 kg/m2/year, 95% confidence interval [CI]: −0.99 to −0.75), albumin (−1.11 g/L/year, 95% CI: −1.27 to −0.95), and bicarbonate (−0.49 mmol/L/year; 95% CI: −0.59 to −0.39), and increases in NLR (+0.79/year; 95% CI: 0.60 to 0.98) and phosphate (+0.05 mmol/L/year; 95% CI: 0.04 to 0.06) were observed. Following oral nutritional supplement prescription, there were statistically significant increases in BMI slope (+0.91 kg/m2/year, P < .0001), albumin slope (+0.82 g/L/year, P < .0001), and phosphate slope (+0.02 mmol/L/year, P = .005), as well as a decline in NLR slope of −0.55/year ( P < .0001). There was no significant change in bicarbonate slope. Cluster analysis identified 5 distinct phenotypes. The cluster with the highest mean baseline NLR and lowest mean BMI demonstrated the greatest number of improvements in nutritional parameter slopes in the post-oral-nutritional-supplement period. Limitations: Possibility of residual confounding. Data on dietary intake, muscle mass, and nutritional scoring systems were not available in the registry. Conclusions: Among patients with CKD-ND prescribed oral nutritional supplements, there were improvements in nutrition/inflammation parameters over time following the first ONS prescription. The heterogeneity in response to ONS by cluster subgroup suggests an individualized approach to nutritional management may be beneficial.
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Affiliation(s)
- Michelle M. Y. Wong
- Department of Medicine, The University of British Columbia, Vancouver, Canada
- BC Renal, Vancouver, BC, Canada
| | | | - Dani Renouf
- St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Zainab Sheriff
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Adeera Levin
- BC Renal, Vancouver, BC, Canada
- St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
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Wong MMY, Renouf D, Zheng Y, Sheriff Z, Levin A. Nutritional Status, Nutritional Phenotypes, and Oral Nutritional Supplement Prescription Patterns Among Patients With Non-Dialysis Chronic Kidney Disease in British Columbia. J Ren Nutr 2021; 32:414-422. [PMID: 34924262 DOI: 10.1053/j.jrn.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/25/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Management of protein-energy wasting and undernutrition with oral nutritional supplements (ONS) has not been systematically studied in the non-dialysis chronic kidney disease (CKD-ND) population. We aimed to describe nutritional status, identify phenotypes of patients prescribed ONS, and evaluate ONS prescription patterns among CKD-ND patients in British Columbia. DESIGN AND METHODS This observational study assessed adult CKD-ND patients who entered multidisciplinary CKD clinics during 2013-2018 in British Columbia. Descriptive statistics were used to describe baseline nutrition and inflammation parameters among patients prescribed ONS versus patients not prescribed ONS within 1 year of clinic entry. Hierarchical clustering method with consensus clustering was applied to identify phenotypes of patients prescribed ONS. Multivariable logistic regression was used to assess the associations between ONS prescription and health region/dietitian full-time equivalents per 1,000 CKD patients. RESULTS Of 15,859 CKD-ND patients, 9% of patients entering CKD clinics were prescribed ONS within 1 year of clinic entry, and these patients demonstrated lower baseline estimated glomerular filtration rate, body mass index (BMI), serum albumin, bicarbonate, as well as greater age, serum phosphate, and neutrophil-to-lymphocyte ratio compared with those not receiving ONS. Cluster analysis revealed 5 phenotypes of ONS users: cluster 1 had the highest mean neutrophil-to-lymphocyte ratio; cluster 2 had the lowest mean albumin; cluster 3 had the lowest mean BMI; cluster 4 had the highest mean BMI; and cluster 5 had the lowest mean bicarbonate. There was regional variability in ONS prescription, and an odds ratio for ONS prescription of 1.32 (95% confidence interval 1.16-1.50) for every 1-unit increase in dietitian full-time equivalents per 1,000 patients. Over 3 years of follow-up, overall ONS use among CKD-ND patients remained stable. CONCLUSIONS This study demonstrates appropriate prescribing of ONS to patients with suboptimal nutritional status, although regional variation exists. Patients receiving ONS represent a heterogenous group with phenotypes reflecting several clinical and biochemical features of the protein-energy wasting syndrome. These findings will assist with updating ONS policy, planning quality improvement initiatives, and informing dietitian resource allocation.
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Affiliation(s)
- Michelle M Y Wong
- Department of Medicine, University of British Columbia, Vancouver, BC; BC Renal, Vancouver, BC.
| | | | | | - Zainab Sheriff
- Division of Nephrology, University of British Columbia, Vancouver, BC
| | - Adeera Levin
- BC Renal, Vancouver, BC; St. Paul's Hospital, Vancouver, BC; Division of Nephrology, University of British Columbia, Vancouver, BC
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Sabatino A, Broers NJH, van der Sande FM, Hemmelder MH, Fiaccadori E, Kooman JP. Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis. Front Nutr 2021; 8:697523. [PMID: 34485360 PMCID: PMC8415223 DOI: 10.3389/fnut.2021.697523] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/16/2021] [Indexed: 01/26/2023] Open
Abstract
Assessment of muscle mass (MM) or its proxies, lean tissue mass (LTM) or fat-free mass (FFM), is an integral part of the diagnosis of protein-energy wasting (PEW) and sarcopenia in patients on hemodialysis (HD). Both sarcopenia and PEW are related to a loss of functionality and also increased morbidity and mortality in this patient population. However, loss of MM is a part of a wider spectrum, including inflammation and fluid overload. As both sarcopenia and PEW are amendable to treatment, estimation of MM regularly is therefore of major clinical relevance. Whereas, computer-assisted tomography (CT) or dual-energy X-ray absorptiometry (DXA) is considered a reference method, it is unsuitable as a method for routine clinical monitoring. In this review, different bedside methods to estimate MM or its proxies in patients on HD will be discussed, with emphasis on biochemical methods, simplified creatinine index (SCI), bioimpedance spectroscopy (BIS), and muscle ultrasound (US). Body composition parameters of all methods are related to the outcome and appear relevant in clinical practice. The US is the only parameter by which muscle dimensions are measured. BIS and SCI are also dependent on either theoretical assumptions or the use of population-specific regression equations. Potential caveats of the methods are that SCI can be influenced by residual renal function, BIS can be influenced by fluid overload, although the latter may be circumvented by the use of a three-compartment model, and that muscle US reflects regional and not whole body MM. In conclusion, both SCI and BIS as well as muscle US are all valuable methods that can be applied for bedside nutritional assessment in patients on HD and appear suitable for routine follow-up. The choice for either method depends on local preferences. However, estimation of MM or its proxies should always be part of a multidimensional assessment of the patient followed by a personalized treatment strategy.
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Affiliation(s)
- Alice Sabatino
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Natascha J H Broers
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Frank M van der Sande
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Marc H Hemmelder
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
| | - Enrico Fiaccadori
- Nephrology Unit, Department of Medicine and Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Jeroen P Kooman
- Division on Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
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Martins C, Saeki SL, Nascimento MMD, Lucas Júnior FM, Vavruk AM, Meireles CL, Justino S, Mafra D, Rabito EI, Schieferdecker MEM, Campos LF, Aanholt DPJV, Hordonho AA, Fidelix MSP. Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease. ACTA ACUST UNITED AC 2021; 43:236-253. [PMID: 33836040 PMCID: PMC8257272 DOI: 10.1590/2175-8239-jbn-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
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Affiliation(s)
- Cristina Martins
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil.,Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Grupo de Trabalho Internacional da NCPT, Subcomitê Internacional da Academy of Nutrition and Dietetics (Academy) para a TPCN, Curitiba, PR, Brasil.,Instituto Cristina Martins de Educação e Pesquisa em Saúde, Curitiba, PR, Brasil
| | - Simone L Saeki
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Instituto Cristina Martins de Educação e Pesquisa em Saúde, Curitiba, PR, Brasil
| | - Marcelo Mazza do Nascimento
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fernando M Lucas Júnior
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Hospital das Clínicas da Universidade Federal de Minas Gerais/Grupo Nefroclínicas, Belo Horizonte, MG, Brasil
| | - Ana Maria Vavruk
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Hospital e Maternidade Municipal de São José dos Pinhais, São José dos Pinhais, PR, Brasil
| | - Christiane L Meireles
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,University of Texas Health Science Center, School of Nursing, San Antonio, USA
| | - Sandra Justino
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Complexo do Hospital de Clínicas da UFPR, Curitiba, PR, Brasil
| | - Denise Mafra
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil
| | - Estela Iraci Rabito
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | - Denise P J van Aanholt
- Sociedade Brasileira de Nutrição Parenteral e Enteral, Curitiba, PR, Brasil.,Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo, Ecuador
| | - Ana Adélia Hordonho
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil.,Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Estadual de Ciências da Saúde, Hospital Escola Hélvio Auto e Hospital Metropolitano de Alagoas, Maceió, AL, Brasil
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Uludag K, Boz G, Gunal AI. Lower serum albumin level is associated with increased risk of hospital admission and length of stay in hospital among incident hemodialysis patients by using overdispersed model. Ther Apher Dial 2020; 25:179-187. [DOI: 10.1111/1744-9987.13552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Koray Uludag
- Division of Nephrology, Department of Internal Medicine Kayseri City Hospital Kayseri Turkey
| | - Gulsah Boz
- Division of Nephrology, Department of Internal Medicine Kayseri City Hospital Kayseri Turkey
| | - Ali Ihsan Gunal
- Division of Nephrology, Department of Internal Medicine Kayseri City Hospital Kayseri Turkey
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Infection in Advanced Chronic Kidney Disease and Subsequent Adverse Outcomes after Dialysis Initiation: A Nationwide Cohort Study. Sci Rep 2020; 10:2938. [PMID: 32076027 PMCID: PMC7031239 DOI: 10.1038/s41598-020-59794-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/03/2020] [Indexed: 11/21/2022] Open
Abstract
It remains unclear whether infection events before entering end stage renal disease (ESRD) have a long-term negative impact on patients with advanced chronic kidney disease (CKD) who survive to permanent dialysis. We enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis between January 1, 2004 and December 31, 2013. We used multivariable Cox as well as Fine and Gray models to determine the association of pre-dialysis infection exposure with all-cause mortality after starting dialysis. Compared with no infection during advanced CKD, the presence of infection exposure during that period was independently associated with a higher risk of all-cause mortality in the first year of dialysis (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.27–1.42) and also during the entire follow-up period (HR 1.19, 95% CI 1.16–1.22). The increased risks of all-cause mortality increased incrementally with higher annual number of infections during advanced CKD. Similar results were found for all other adverse outcomes, e.g. post-ESRD infection-related hospitalization and major cardiac and cerebrovascular events. In conclusion, infection events during advanced CKD was associated with increased risks of adverse outcomes after dialysis has been started. Timely interventions in such a vulnerable group may help attenuate these risks.
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Wong MM, Thijssen S, Wang Y, Usvyat LA, Xiao Q, Kotanko P, Maddux FW. Prediction of Mortality and Hospitalization Risk Using Nutritional Indicators and Their Changes Over Time in a Large Prevalent Hemodialysis Cohort. J Ren Nutr 2020; 30:69-78. [DOI: 10.1053/j.jrn.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/10/2019] [Accepted: 01/21/2019] [Indexed: 01/01/2023] Open
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Deleaval P, Luaire B, Laffay P, Jambut-Cadon D, Stauss-Grabo M, Canaud B, Chazot C. Short-Term Effects of Branched-Chain Amino Acids–Enriched Dialysis Fluid on Branched-Chain Amino Acids Plasma Level and Mass Balance: A Randomized Cross-Over Study. J Ren Nutr 2020; 30:61-68. [DOI: 10.1053/j.jrn.2019.03.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/27/2019] [Accepted: 03/13/2019] [Indexed: 11/11/2022] Open
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13
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Ye X, Kooman JP, van der Sande FM, Raimann JG, Usvyat LA, Wang Y, Maddux FW, Kotanko P. Relationship between serum phosphate levels and survival in chronic hemodialysis patients: interactions with age, malnutrition and inflammation. Clin Kidney J 2019; 14:348-357. [PMID: 33564438 PMCID: PMC7857835 DOI: 10.1093/ckj/sfz143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022] Open
Abstract
Background Evidence indicates that the inverse relationships between phosphate levels and mortality maybe modified by age. Furthermore, malnutrition and inflammation could strengthen the risk associated with phosphate abnormalities. This study aimed to assess the associations between phosphate levels and mortality while accounting for the interactions with age and parameters associated with malnutrition and inflammation in hemodialysis (HD) patients. Methods Adult HD patients (n = 245 853) treated in Fresenius Medical Care North America clinics from January 2010 to October 2018 were enrolled. Baseline was defined as Months 4-6 on dialysis, with the subsequent 12 months as the follow-up period. Univariate and multivariate Cox proportional hazard models with spline terms were applied to study the nonlinear relationships between serum phosphate levels and mortality. The interactions of phosphate levels with albumin, creatinine, normalized protein catabolic rate (nPCR) and neutrophil-lymphocyte ratio (NLR) were assessed with smoothing spline analysis of variance Cox proportional hazard models. Results Older patients tended to have lower levels of serum phosphate, albumin, creatinine and nPCR. Additionally, both low (<4.0 mg/dL) and high (>5.5 mg/dL) phosphate levels were associated with higher risk of mortality across all age strata. The U-shaped relationships between phosphate levels and outcome persisted even for patients with low or high levels of serum albumin, creatinine, nPCR and NLR, respectively. Conclusion The consistent U-shaped relationships between serum phosphate and mortality across age strata and levels of inflammatory and nutritional status should prompt the search for underlying causes and potentially nutritional intervention in clinical practice.
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Affiliation(s)
- Xiaoling Ye
- Research Department, Renal Research Institute, New York, NY, USA
| | - Jeroen P Kooman
- Nephrology Department, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frank M van der Sande
- Nephrology Department, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jochen G Raimann
- Research Department, Renal Research Institute, New York, NY, USA
| | - Len A Usvyat
- Research Department, Renal Research Institute, New York, NY, USA.,Global Medical Office, Fresenius Medical Care, Waltham, MA, 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 Mount Sinai, New York, NY, USA
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14
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Kooman JP, Usvyat LA, Dekker MJE, Maddux DW, Raimann JG, van der Sande FM, Ye X, Wang Y, Kotanko P. Cycles, Arrows and Turbulence: Time Patterns in Renal Disease, a Path from Epidemiology to Personalized Medicine? Blood Purif 2018; 47:171-184. [PMID: 30448825 DOI: 10.1159/000494827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 12/13/2022]
Abstract
Patients with end-stage renal disease (ESRD) experience unique patterns in their lifetime, such as the start of dialysis and renal transplantation. In addition, there is also an intricate link between ESRD and biological time patterns. In terms of cyclic patterns, the circadian blood pressure (BP) rhythm can be flattened, contributing to allostatic load, whereas the circadian temperature rhythm is related to the decline in BP during hemodialysis (HD). Seasonal variations in BP and interdialytic-weight gain have been observed in ESRD patients in addition to a profound relative increase in mortality during the winter period. Moreover, nonphysiological treatment patters are imposed in HD patients, leading to an excess mortality at the end of the long interdialytic interval. Recently, new evidence has emerged on the prognostic impact of trajectories of common clinical and laboratory parameters such as BP, body temperature, and serum albumin, in addition to single point in time measurements. Backward analysis of changes in cardiovascular, nutritional, and inflammatory parameters before the occurrence as hospitalization or death has shown that changes may already occur within months to even 1-2 years before the event, possibly providing a window of opportunity for earlier interventions. Disturbances in physiological variability, such as in heart rate, characterized by a loss of fractal patterns, are associated with increased mortality. In addition, an increase in random variability in different parameters such as BP and sodium is also associated with adverse outcomes. Novel techniques, based on time-dependent analysis of variability and trends and interactions of multiple physiological and laboratory parameters, for which machine-learning -approaches may be necessary, are likely of help to the clinician in the future. However, upcoming research should also evaluate whether dynamic patterns observed in large epidemiological studies have relevance for the individual risk profile of the patient.
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Affiliation(s)
- Jeroen P Kooman
- Maastricht University Medical Center, Maastricht, The Netherlands,
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | - Dugan W Maddux
- Fresenius Medical Care North America, Waltham, Massachusetts, USA
| | | | | | - Xiaoling Ye
- Renal Research Institute, New York, New York, USA
| | - Yuedong Wang
- Department of Statistics and Applied Probability, University of California-Santa Barbara, Santa Barbara, California, USA
| | - Peter Kotanko
- Renal Research Institute, New York, New York, USA.,Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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15
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Golestaneh L. Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift. Semin Dial 2018; 31:278-288. [DOI: 10.1111/sdi.12675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ladan Golestaneh
- Nephrology Division; Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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16
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Golestaneh L, Bellin E, Southern W, Melamed ML. Discharge service as a determinant of 30-day readmission in a cohort of maintenance hemodialysis patients: a retrospective cohort study. BMC Nephrol 2017; 18:352. [PMID: 29202796 PMCID: PMC5716258 DOI: 10.1186/s12882-017-0761-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/17/2017] [Indexed: 01/25/2023] Open
Abstract
Background End stage renal disease (ESRD) patients on maintenance hemodialysis, are high utilizers of inpatient services. Because of data showing improved outcomes in medical patients admitted to hospitalist-run, non-teaching services, we hypothesized that discharge from a hospitalist-run, non-teaching service is associated with lower risk of 30-day re-hospitalization in a cohort of patients on hemodialysis. Methods One thousand and 84 consecutive patients with ESRD on maintenance hemodialysis who were admitted to Montefiore, a tertiary care center, in 2014 were analyzed using the electronic medical records. We evaluated factors associated with 30-day readmission in multivariable regression models. We then tested the association of care by a hospitalist-run, non-teaching service with 30-day readmission in a propensity score matched analysis. Results Patients cared for on the hospitalist-run, non-teaching service had lower socio-economic scores (SES) and had longer lengths of stay (LOS), as compared to a standard teaching service, but otherwise the populations were similar. In multivariable testing, severity of illness, (OR 2.40, (95%CI: 1.43–4.03) for highest quartile) number of previous hospitalizations (OR 1.22 (95%CI:1.16–1.28) for each admission), and discharge to a skilled nursing facility (SNF)(OR 1.56 (95%CI:1.01–2.43) were significantly associated with 30-day re-admissions. Care by the non-teaching service was associated with a lower risk of 30-day readmission, even after adjusting for clinical factors and matching based on propensity score (OR 0.65(95%CI:0.46–0.91) and 0.71(95%CI:0.66–0.77) respectively). Conclusions Patients with ESRD on hemodialysis discharged from a hospitalist-run, non-teaching medicine service had lower odds of readmission as compared to those patients discharged from a standard teaching service.
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Affiliation(s)
- Ladan Golestaneh
- Department of Medicine/ Renal Division, Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, Suite 5H, Bronx, NY, 10467, USA.
| | - Eran Bellin
- Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | - William Southern
- Division of Hospitalist Medicine, Montefiore Medical Center, Bronx, USA
| | - Michal L Melamed
- Department of Medicine/ Renal Division, Montefiore Medical Center/Albert Einstein College of Medicine, 3411 Wayne Ave, Suite 5H, Bronx, NY, 10467, USA
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17
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Ye X, Dekker MJE, Maddux FW, Kotanko P, Konings CJAM, Raimann JG, van der Sande FM, Usvyat LA, Kooman JP, Thijssen S. Dynamics of Nutritional Competence in the Last Year Before Death in a Large Cohort of US Hemodialysis Patients. J Ren Nutr 2017; 27:412-420. [PMID: 28943158 DOI: 10.1053/j.jrn.2017.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/02/2017] [Accepted: 06/14/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Recently, a new Nutritional Competence Score (NCS) has been shown to associate with hospitalization and outcome in hemodialysis patients. The aim of this study was to investigate the dynamics, the individual components, and the impact of hospitalizations of this score's trajectory in the year before death. In addition, we investigated whether dynamics in the NCS add additional independent prognostic value over a single cross-sectional assessment. DESIGN We included all Fresenius Medical Care North America patients who initiated hemodialysis between January 1, 2006, and December 31, 2011 with data on all 5 NCS components (serum albumin, creatinine, phosphate, equilibrated normalized protein catabolic rate, and interdialytic weight gain) in at least 1 month. NCS was quantified monthly, and trajectories were compared between nonsurvivors and survivors across different dialysis vintage strata. Survivors and nonsurvivors were matched by dialysis vintage. The association of baseline NCS and NCS dynamics with mortality risk were assessed with Cox proportional hazards models. RESULTS In this cohort of 110,794 patients, we found that across all vintage groups, NCS was lower in patients who died than in survivors. NCS was found to significantly decline before death, whereas survivors showed no decline in NCS. The rate of NCS decline before death was not materially influenced by hospitalization in the months before death. Cox models showed that NCS dynamics over time carry significant predictive power above a cross-sectional NCS assessment. CONCLUSIONS There are distinct differences in NCS values and their trajectories between patients who die and vintage-matched controls. These differences may be able to be exploited for implementation of a routine, prospective monitoring tool for early detection of patients at increased risk of death. Prospective studies are required to validate such an approach.
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Affiliation(s)
- Xiaoling Ye
- Renal Research Institute, New York, New York.
| | - Marijke J E Dekker
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Peter Kotanko
- Renal Research Institute, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Constantijn J A M Konings
- Department of Internal Medicine, Division of Nephrology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | | | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Len A Usvyat
- Fresenius Medical Care North America, Waltham, Massachusetts
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
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Eriguchi R, Obi Y, Streja E, Tortorici AR, Rhee CM, Soohoo M, Kim T, Kovesdy CP, Kalantar-Zadeh K. Longitudinal Associations among Renal Urea Clearance-Corrected Normalized Protein Catabolic Rate, Serum Albumin, and Mortality in Patients on Hemodialysis. Clin J Am Soc Nephrol 2017; 12:1109-1117. [PMID: 28490436 PMCID: PMC5498364 DOI: 10.2215/cjn.13141216] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/29/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES There are inconsistent reports on the association of dietary protein intake with serum albumin and outcomes among patients on hemodialysis. Using a new normalized protein catabolic rate (nPCR) variable accounting for residual renal urea clearance, we hypothesized that higher baseline nPCR and rise in nPCR would be associated with higher serum albumin and better survival among incident hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Among 36,757 incident hemodialysis patients in a large United States dialysis organization, we examined baseline and change in renal urea clearance-corrected nPCR as a protein intake surrogate and modeled their associations with serum albumin and mortality over 5 years (1/2007-12/2011). RESULTS Median nPCRs with and without accounting for renal urea clearance at baseline were 0.94 and 0.78 g/kg per day, respectively (median within-patient difference, 0.14 [interquartile range, 0.07-0.23] g/kg per day). During a median follow-up period of 1.4 years, 8481 deaths were observed. Baseline renal urea clearance-corrected nPCR was associated with higher serum albumin and lower mortality in the fully adjusted model (Ptrend<0.001). Among 13,895 patients with available data, greater rise in renal urea clearance-corrected nPCR during the first 6 months was also associated with attaining high serum albumin (≥3.8 g/dl) and lower mortality (Ptrend<0.001); compared with the reference group (a change of 0.1-0.2 g/kg per day), odds and hazard ratios were 0.53 (95% confidence interval, 0.44 to 0.63) and 1.32 (95% confidence interval, 1.14 to 1.54), respectively, among patients with a change of <-0.2 g/kg per day and 1.62 (95% confidence interval, 1.35 to 1.96) and 0.76 (95% confidence interval, 0.64 to 0.90), respectively, among those with a change of ≥0.5 g/kg per day. Within a given category of nPCR without accounting for renal urea clearance, higher levels of renal urea clearance-corrected nPCR consistently showed lower mortality risk. CONCLUSIONS Among incident hemodialysis patients, higher dietary protein intake represented by nPCR and its changes over time appear to be associated with increased serum albumin levels and greater survival. nPCR may be underestimated when not accounting for renal urea clearance. Compared with the conventional nPCR, renal urea clearance-corrected nPCR may be a better marker of mortality.
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Affiliation(s)
- Rieko Eriguchi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
| | - Amanda R. Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
| | - Connie M. Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
| | - Taehee Kim
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
- Division of Nephrology, Department of Medicine, Inje University, Busan, South Korea
| | - Csaba P. Kovesdy
- Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee; and
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California
- Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California
- Department Epidemiology, University of California, Los Angeles Fielding School of Public Health, University of California, Los Angeles, California
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19
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Chen HS, Cheng CT, Hou CC, Liou HH, Chang CT, Lin CJ, Wu TK, Chen CH, Lim PS. A Practical Standardized Composite Nutrition Score Based on Lean Tissue Index: Application in Nutrition Screening and Prediction of Outcome in Hemodialysis Population. J Ren Nutr 2017; 27:267-274. [PMID: 28431808 DOI: 10.1053/j.jrn.2017.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/02/2017] [Accepted: 01/29/2017] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Rapid screening and monitoring of nutritional status is mandatory in hemodialysis population because of the increasingly encountered nutritional problems. Considering the limitations of previous composite nutrition scores applied in this population, we tried to develop a standardized composite nutrition score (SCNS) using low lean tissue index as a marker of protein wasting to facilitate clinical screening and monitoring and to predict outcome. DESIGN AND METHODS This retrospective cohort used 2 databases of dialysis populations from Taiwan between 2011 and 2014. First database consisting of data from 629 maintenance hemodialysis patients was used to develop the SCNS and the second database containing data from 297 maintenance hemodialysis patients was used to validate this developed score. RESULTS SCNS containing albumin, creatinine, potassium, and body mass index was developed from the first database using low lean tissue index as a marker of protein wasting. When applying this score in the original database, significantly higher risk of developing protein wasting was found for patients with lower SCNS (odds ratio 1.38 [middle tertile vs highest tertile, P < .0001] and 2.40 [lowest tertile vs middle tertile, P < .0001]). The risk of death was also shown to be higher for patients with lower SCNS (hazard ratio 4.45 [below median level vs above median level, P < .0001]). These results were validated in the second database. CONCLUSION We developed an SCNS consisting of 4 easily available biochemical parameters. This kind of scoring system can be easily applied in different dialysis facilities for screening and monitoring of protein wasting. The wide application of body composition monitor in dialysis population will also facilitate the development of specific nutrition scoring model for individual facility.
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Affiliation(s)
| | - Chun-Ting Cheng
- Department of Nephrology, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Chun-Cheng Hou
- Department of Nephrology, Min-Sheng General Hospital, Taoyuan, Taiwan
| | | | | | - Chun-Ju Lin
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Tsai-Kun Wu
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Chang-Hsu Chen
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Paik-Seong Lim
- Department of Nephrology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan.
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20
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Wong MM, McCullough KP, Bieber BA, Bommer J, Hecking M, Levin NW, McClellan WM, Pisoni RL, Saran R, Tentori F, Tomo T, Port FK, Robinson BM. Interdialytic Weight Gain: Trends, Predictors, and Associated Outcomes in the International Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2017; 69:367-379. [DOI: 10.1053/j.ajkd.2016.08.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/13/2016] [Indexed: 11/11/2022]
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21
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Eriguchi R, Obi Y, Rhee CM, Chou JA, Tortorici AR, Mathew AT, Kim T, Soohoo M, Streja E, Kovesdy CP, Kalantar-Zadeh K. Changes in urine volume and serum albumin in incident hemodialysis patients. Hemodial Int 2016; 21:507-518. [PMID: 27885815 DOI: 10.1111/hdi.12517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Hypoalbuminemia is a predictor of poor outcomes in dialysis patients. Among hemodialysis patients, there has not been prior study of whether residual kidney function or decline over time impacts serum albumin levels. We hypothesized that a decline in residual kidney function is associated with an increase in serum albumin levels among incident hemodialysis patients. METHODS In a large national cohort of 38,504 patients who initiated hemodialysis during 1/2007-12/2011, we examined the association of residual kidney function, ascertained by urine volume and renal urea clearance, with changes in serum albumin over five years across strata of baseline residual kidney function, race, and diabetes using case-mix adjusted linear mixed effects models. FINDINGS Serum albumin levels increased over time. At baseline, patients with greater urine volume had higher serum albumin levels: 3.44 ± 0.48, 3.50 ± 0.46, 3.57 ± 0.44, 3.59 ± 0.45, and 3.65 ± 0.46 g/dL for urine volume groups of <300, 300-<600, 600-<900, 900-<1,200, and ≥1,200 mL/day, respectively (Ptrend < 0.001). Over time, urine volume and renal urea clearance declined and serum albumin levels rose, while the baseline differences in serum albumin persisted across groups of urinary volume. In addition, the rate of decline in residual kidney function was not associated with the rate of change in albumin. DISCUSSION Hypoalbuminemia in hemodialysis patients is associated with lower residual kidney function. Among incident hemodialysis patients, there is a gradual rise in serum albumin that is independent of the rate of decline in residual kidney function, suggesting that preservation of residual kidney function does not have a deleterious impact on serum albumin levels.
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Affiliation(s)
- Rieko Eriguchi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Amanda R Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Anna T Mathew
- Division of Kidney Diseases and Hypertension, Hofstra Northwell School of Medicine, Great Neck, New York, USA
| | - Taehee Kim
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA.,Division of Nephrology, Inje University, Busan, Korea
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, Orange, California, USA.,Long Beach Veterans Affairs Healthcare System, Long Beach, California, USA.,Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, USA
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22
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Couchoud C, Hemmelgarn B, Kotanko P, Germain MJ, Moranne O, Davison SN. Supportive Care: Time to Change Our Prognostic Tools and Their Use in CKD. Clin J Am Soc Nephrol 2016; 11:1892-1901. [PMID: 27510452 PMCID: PMC5053799 DOI: 10.2215/cjn.12631115] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In using a patient-centered approach, neither a clinician nor a prognostic score can predict with absolute certainty how well a patient will do or how long he will live; however, validated prognostic scores may improve accuracy of prognostic estimates, thereby enhancing the ability of the clinicians to appreciate the individual burden of disease and the prognosis of their patients and inform them accordingly. They may also facilitate nephrologist's recommendation of dialysis services to those who may benefit and proposal of alternative care pathways that might better respect patients' values and goals to those who are unlikely to benefit. The purpose of this article is to discuss the use as well as the limits and deficiencies of currently available prognostic tools. It will describe new predictors that could be integrated in future scores and the role of patients' priorities in development of new scores. Delivering patient-centered care requires an understanding of patients' priorities that are important and relevant to them. Because of limits of available scores, the contribution of new prognostic tools with specific markers of the trajectories for patients with CKD and patients' health reports should be evaluated in relation to their transportability to different clinical and cultural contexts and their potential for integration into the decision-making processes. The benefit of their use then needs to be quantified in clinical practice by outcome studies including health-related quality of life, patient and caregiver satisfaction, or utility for improving clinical management pathways and tailoring individualized patient-centered strategies of care. Future research also needs to incorporate qualitative methods involving patients and their caregivers to better understand the barriers and facilitators to use of these tools in the clinical setting. Information given to patients should be supported by a more realistic approach to what dialysis is likely to entail for the individual patient in terms of likely quality and quantity of life according to the patient's values and goals and not just the possibility of life prolongation.
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Affiliation(s)
- Cécile Couchoud
- French End-Stage Renal Disease Registry Renal Epidemiology and Information Network, Agence de la Biomédecine, St. Denis La Plaine, France
| | - Brenda Hemmelgarn
- Departments of Community Health Sciences and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter Kotanko
- Renal Research Institute, New York, New York
- Nephrology Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael J. Germain
- Division of Nephrology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Olivier Moranne
- Service de Néphrologie-Suppélance rénale, Hôpital Caremeau, Centre Hospitalo-universitaire Nîmes, Nîmes France
- Equipe d'accueil 2415, Biostatistique, Epidémiologie et Santé Publique, Institut Universitaire de Recherche Clinique, Université de Montpellier, Montpellier, France; and
| | - Sara N. Davison
- Division of Nephrology and Immunology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
The treatment of chronically ill patients with end stage renal disease (ESRD) receiving dialysis therapies has advanced greatly over the years and accomplished many successes in prolonging the life of patients with ESRD, yet has had considerable failures due to the inability to compensate for all functions of the kidneys. In addition, the focus to achieve quality goals for laboratories and vascular access measures may indicate a good quality of care from providers, but meeting these clinical and physiological goals may not fully maximize individual benefit to a patient, may not be aligned with the patient's care goals, and could conceivably impact negatively the patient's experience of care and quality of life. The age of individualized patient centered care is forthcoming with advancements in technology and our understanding of the treatment of renal diseases. The future holds promise for enhancing the quality provided to each patient but will require nephrologists to overcome numerous hurdles. This article provides an opinion on principles that may fundamentally improve the quality of renal disease care in the future and represents themes that can enhance quality, safety, and efficiency in the health care delivery system. It is believed that quality measured from a patient centric perspective will shift the treatment for these chronic disorders to better meet each patient's needs and goals, while evolving an enhanced delivery system for the care of all ESRD patients.
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