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Wu Y, Lu J, Wang T, Zhu X, Xue J, You L. Association of frequent intradialytic hypotension with the clinical outcomes of patients on hemodialysis: a prospective cohort study. Ren Fail 2024; 46:2296612. [PMID: 38178566 PMCID: PMC10773638 DOI: 10.1080/0886022x.2023.2296612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD), but there is no consensus on its definition. In 2015, Flythe proposed a definition of IDH (Definition 1 in this study): nadir systolic blood pressure (SBP) <90 mmHg during hemodialysis for patients with pre-dialysis SBP <159 mmHg, and nadir SBP <100 mmHg during hemodialysis for patients with pre-dialysis SBP ≥160 mmHg. This prospective observational cohort study investigated the association of frequent IDH based on Definition 1 with clinical outcomes and compared Definition 1 with a commonly used definition (nadir SBP <90 mmHg during hemodialysis, Definition 2). The incidence of IDH was observed over a 3-month exposure assessment period. Patients with IDH events ≥30% were classified as 'frequent IDH'; the others were 'infrequent IDH'. All-cause mortality, cardiovascular mortality, and all-cause hospitalization events were followed up for 36 months. This study enrolled 163 HD patients. The incidence of IDH was 11.1% according to Definition 1 and 10.5% according to Definition 2. The Kaplan-Meier curves showed that frequent IDH patients had higher risks of all-cause mortality (p = 0.009, Definition 1; p = 0.002, Definition 2) and cardiovascular mortality (p = 0.021, Definition 1). Multivariable Cox regression analysis indicated that frequent IDH was independently associated with a higher risk of all-cause mortality (Model 1: HR = 2.553, 95%CI 1.334-4.886, p = 0.005; Model 2: HR = 2.406, 95%CI 1.253-4.621, p = 0.008). In conclusion, HD patients classified as frequent IDH are at a greater risk of all-cause mortality. This highlights the significance of acknowledging and proactively managing frequent IDH within the HD patients.
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Affiliation(s)
- Yuanhao Wu
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jianda Lu
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Tingting Wang
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xiaoye Zhu
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jun Xue
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Li You
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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Ye T, Du J, Li P, Rong D, Gu W, Yao Y, Shen N. Modified creatinine index for predicting prognosis in hemodialysis patients: a systematic review and meta-analysis. Ren Fail 2024; 46:2367026. [PMID: 39120108 PMCID: PMC11318488 DOI: 10.1080/0886022x.2024.2367026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/24/2024] [Accepted: 06/06/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Currently, several studies have explored the association between the modified creatinine index (mCI) and prognosis in patients on hemodialysis (HD). However, some of their results are contradictory. Therefore, this study was conducted to comprehensively assess the role of mCI in predicting prognosis in HD patients through meta-analysis. METHODS We searched and screened literature from PubMed, Embase, Web of Science, and Cochrane databases from their establishment until March 2024. Relevant data were extracted. The statistical analysis was performed using Stata 15.0, RevMan 5.4, and Meta DiSc 1.4 software. RESULTS The results showed a positive association between mCI and nutritional status in HD patients (BMI r = 0.19, 95% CI: 0.1-0.28, p = .000; albumin r = 0.36, 95% CI: 0.33-0.39, p = .000; normalized protein catabolic rate (nPCR) r = 0.25, 95% CI: 0.13-0.38, p = .000). In addition, mCI in deceased HD patients was significantly lower than that in HD survivors (SMD = -0.94, 95% CI: -1.46 to -0.42, p = .000). A low mCI was associated with an increased risk of all-cause death in HD patients (HR = 1.95, 95% CI: 1.57-2.42, p = .000). In addition, a low mCI was significantly associated with decreased overall survival (OS) in HD patients (HR = 3.01, 95% CI: 2.44-3.70, p = .000). mCI showed moderate diagnostic accuracy for sarcopenia in both male and female HD patients (male AUC = 0.7891; female AUC = 0.759). CONCLUSIONS The mCI can be used as a prognostic marker for HD patients, and monitoring mCI may help to optimize the management of HD and improve overall prognosis in patients.
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Affiliation(s)
- Tao Ye
- School of Clinical Medicine, Hebei University of Engineering, Handan, China
| | - Jingfang Du
- School of Clinical Medicine, Hebei University of Engineering, Handan, China
| | - Pian Li
- School of Clinical Medicine, Hebei University of Engineering, Handan, China
| | - Dan Rong
- School of Clinical Medicine, Hebei University of Engineering, Handan, China
| | - Wang Gu
- Emergency Department of Wangcang County People’s Hospital, Guangyuan City, China
| | - Yao Yao
- Affiliated Hospital of Hebei Engineering University, Handan, China
| | - Na Shen
- Affiliated Hospital of Hebei Engineering University, Handan, China
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Tsujimoto N, Matsuzawa R, Kakita D, Imai H, Harada M, Yoshikoshi S, Yamabe S, Osada S, Shimokado K, Matsunaga A, Tamaki A. Concomitant sarcopenia and undernutrition: Impact on clinical outcomes in patients undergoing hemodialysis. Clin Nutr ESPEN 2024; 63:651-658. [PMID: 39098604 DOI: 10.1016/j.clnesp.2024.07.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Sarcopenia and undernutrition are crucial in the cycle of frailty in patients requiring hemodialysis therapy, and their deleterious clinical consequences are well documented. However, little attention has been directed towards examining their combined impact on clinical outcomes. OBJECTIVE This study aimed to elucidate the effects of concomitant sarcopenia and undernutrition on clinical outcomes in patients undergoing hemodialysis. METHODS This prospective cohort study recruited outpatients undergoing hemodialysis from four facilities. Sarcopenia was diagnosed according to the criteria of the Asian Working Group for Sarcopenia, 2019. Undernutrition was determined using the Geriatric Nutritional Risk Index, with a score of <92 classified as undernutrition. Patients were classified into four groups according to the presence or absence of sarcopenia and undernutrition. Cox proportional hazards analysis was used to assess the independent association between concomitant sarcopenia and undernutrition, all-cause mortality, and cardiovascular (CV) events after adjusting for baseline characteristics. RESULTS We included 450 patients in this analysis. Of the 450 patients, 69 (15.3%) had concomitant sarcopenia and undernutrition. The mean follow-up period was 1067 days, and there were 61 deaths and 60 CV events. The cumulative survival rate was significantly lower in the sarcopenia with undernutrition group (P = 0.011). The overlap of sarcopenia and undernutrition was significantly associated with a risk of mortality (hazard ratio 2.10; 95% confidence interval 1.05-4.21; P = 0.037). However, no association was observed between the co-occurrence of sarcopenia and undernutrition and the risk of CV events. CONCLUSIONS Concomitant sarcopenia and undernutrition were significantly associated with an increased mortality risk among patients undergoing hemodialysis. This finding reaffirms the importance of managing sarcopenia and undernutrition in patients undergoing hemodialysis in daily clinical practice.
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Affiliation(s)
- Naoyuki Tsujimoto
- Course of Health Science, Hyogo Medical University Graduate School of Health Science, Kobe, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan.
| | - Daisuke Kakita
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Medical Science Division, Department of Medical Sciences, Graduate School of Medicine, Science and Technology, Shinshu University, Matsumoto, Nagano, Japan
| | - Hiroto Imai
- Obara Hospital, Department of Rehabilitation, Kobe, Japan
| | - Manae Harada
- Department of Rehabilitation, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Shun Yoshikoshi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Sachi Yamabe
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Shiwori Osada
- Department of Nephrology, Tokyo Ayase Kidney Center, Katsushika, Japan
| | | | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Akira Tamaki
- Department of Physical Therapy, School of Rehabilitation, Hyogo Medical University, Kobe, Japan
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Zeng J, Wang Y, Li H, Wen H. Association of the modified creatinine index with quality of life in haemodialysis patients. Br J Hosp Med (Lond) 2024; 85:1-10. [PMID: 39347661 DOI: 10.12968/hmed.2024.0298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
Aims/Background The evaluation of health-related quality of life in patients undergoing maintenance haemodialysis has garnered increasing attention. The modified creatinine index, a surrogate marker for muscle mass, has been linked to various clinical outcomes. However, the relationship between modified creatinine index and health-related quality of life in maintenance haemodialysis patients remains unclear. This study aims to elucidate the association between modified creatinine index and health-related quality of life in individuals receiving maintenance haemodialysis. Methods This cross-sectional study included 217 maintenance haemodialysis patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life Instrument. Collected data included general patient information, laboratory results, and haemodialysis-related parameters. The modified creatinine index was calculated based on gender, age, single-pool Kt/V (spKt/V), and pre-dialysis serum creatinine levels. Multiple linear regression models and smooth curve fitting were used to investigate the relationship between modified creatinine index and health-related quality of life. Subgroup analyses and interaction tests were performed to identify potential effect modifiers. Results The 217 maintenance haemodialysis patients had a mean age of 53.66±13.15 years and a median dialysis vintage of 39 (25-84) months; 120 (55.30%) were male. The mean health-related quality of life score was 55.76±10.33, and the mean modified creatinine index was 22.72±2.95 mg/kg/day. After adjusting for confounding factors, an increase in modified creatinine index was associated with an improvement in health-related quality of life (β=0.55, 95% CI: 0.04, 1.06, p = 0.033). No nonlinear relationship was identified between modified creatinine index and health-related quality of life by smooth curve fitting. Subgroup and interaction analyses indicated that the relationship between modified creatinine index and health-related quality of life was stable and not significantly influenced by age, gender, dialysis vintage, diabetes status, or body mass index (p > 0.05). Conclusion Modified creatinine index is positively correlated with health-related quality of life in maintenance haemodialysis patients, suggesting its potential utility in evaluating patient quality of life. Modified creatinine index could be clinically useful to improve the predictability of health-related quality of life in maintenance haemodialysis patients.
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Affiliation(s)
- Jie Zeng
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Yijing Wang
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hong Li
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hongying Wen
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Sivagnanam H, Senthilkumar PK, Velu KB, Anand M, Viswanathan R. Comparative Analysis of Tools for Assessment of Protein-Energy Wasting in Chronic Kidney Disease Patients on Maintenance Hemodialysis. Indian J Nephrol 2024; 34:453-460. [PMID: 39372618 PMCID: PMC11450822 DOI: 10.4103/ijn.ijn_57_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/02/2023] [Indexed: 10/08/2024] Open
Abstract
Background Patients with chronic kidney disease have muscle wasting, sarcopenia, and cachexia that contribute to frailty and morbidity. The present study assessed the prevalence of protein-energy wasting in dialysis-dependent chronic kidney disease population and evaluated the validity of various nutritional assessment tools in diagnosing protein-energy wasting. Materials and Methods All patients above 18 years undergoing dialysis for more than 3 months without any active infection or malignancy were included in our study. Data from anthropometric measurements, dietary assessment, and blood investigations were collected. Protein-energy wasting was assessed by the International Society of Renal Nutrition and Metabolism 2008 criteria. Diagnostic validity of the nutritional assessment tools to predict protein-energy wasting was estimated by area under the curve, sensitivity, specificity, and accuracy statistics. Results A total of 146 patients were studied. The prevalence of protein-energy wasting was 56.8%. Protein-energy wasting was significantly associated with socioeconomic status, hospitalization days, and catheter days. Normalized protein catabolism rate had the highest sensitivity (90.4%) for predicting protein-energy wasting. Malnutritional inflammatory score had the highest area under the curve (0.858), specificity (82.5%), and accuracy (82.2%). Mid-upper arm circumference, Dialysis Malnutrition Score, and albumin were also found to be significant predictors of protein-energy wasting. Conclusion Lack of advanced equipment in suburban and rural centers to detect protein-energy wasting in India can be overcome by using the various stand-alone and combination nutrition assessment tools which have been validated in the present study.
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Affiliation(s)
- Harish Sivagnanam
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - PK. Senthilkumar
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - Kannan Bhaba Velu
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
| | - Murugesh Anand
- Department of Nephrology, Tirunelveli Medical College and Hospital, Tirunelveli, Tamil Nadu, India
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Bandiara R, Takaryanto D, Andhika R, Makmun A, Supriyadi R, Sukesi L. Simplified Creatinine Index as Predictor of Malnutrition in Stage 5 Chronic Kidney Disease Patients on Maintenance Haemodialysis. Int J Nephrol Renovasc Dis 2024; 17:205-213. [PMID: 39101046 PMCID: PMC11296508 DOI: 10.2147/ijnrd.s465294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024] Open
Abstract
Background Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly. Purpose This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD. Methods This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients. Results Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%). Conclusion A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.
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Affiliation(s)
- Ria Bandiara
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Davin Takaryanto
- Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rizky Andhika
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Afiatin Makmun
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Rudi Supriyadi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Lilik Sukesi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Padjadjaran University/Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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Yamada S, Arase H, Taniguchi M, Kitazono T, Nakano T. A simple score for malnutrition-inflammation complex syndrome (MICS) is associated with the risk of mortality in Japanese patients undergoing maintenance hemodialysis. Ther Apher Dial 2024; 28:206-217. [PMID: 37945327 DOI: 10.1111/1744-9987.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Malnutrition-inflammation complex syndrome (MICS) is highly prevalent in patients undergoing hemodialysis. We determined the prognostic value of the Simple MICS score, calculated using a combination of age, body mass index, and serum concentrations of albumin, creatinine, and C-reactive protein. METHODS We retrospectively recruited 218 Japanese patients undergoing maintenance hemodialysis. The primary outcome was all-cause mortality, and the main exposure was the Simple MICS score. Cox proportional hazard regression analysis and logistic regression analysis were used to characterize the relationship between the Simple MICS score and mortality. RESULTS During a median 4.4-year follow-up period, 56 patients died. Multivariable-adjusted models showed that a higher Simple MICS score was associated with higher risks of mortality. The predictability for all-cause mortality of the Simple MICS score was significantly better than conventional nutrition-related indices. CONCLUSION The Simple MICS score can be used to stratify mortality risk in patients undergoing maintenance hemodialysis.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Internal Medicine, Nishida Hospital, Saga, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Chandler S, MacLaughlin H, Wolley M. Creatinine index: a retrospective cohort study in an urban Australian dialysis context. Intern Med J 2023; 53:2291-2297. [PMID: 36878887 DOI: 10.1111/imj.16054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023]
Abstract
AIM This study aimed to described the relationship between the CI and mortality in an Australian context. INTRODUCTION Maintenance haemodialysis is a catabolic state associated with a significant decrease in lean body mass (LBM) and protein energy wasting. LBM can be derived or estimated from creatinine kinetic modelling, specifically the creatinine index (CI). This has been demonstrated in cohort studies to predict mortality. METHODS One hundred seventy-nine patients undergoing haemodialysis in 2015 were included in this cohort. They were followed for 5 years with pertinent clinical data collected to calculate the CI as of December 2015. For analysis, patients were split into a high and low CI group based on the median (18.32 mg/kg/day). The primary outcome of interest was all-cause mortality, and secondary outcomes included myocardial infarction, stroke and transplantation. RESULTS During follow-up, 69 (76.7%) patients in the low CI group and 28 (31.5%) patients in the high CI group died (P < 0.001). The relative risk (RR) of mortality within the low compared with the high CI group was 2.43 (95% confidence interval, 1.75-3.38). Fully adjusted Cox proportional hazards modelling demonstrated a hazard ratio (HR) of 0.498 (95% CI, 0.292-0.848) for survival in the high CI group. Lower CI was associated with increased risk of stroke (RR, 5.43 [95% CI, 1.24-23.84]), whereas transplant was more likely in the high CI group (RR, 6.4 [95% confidence interval, 1.96-20.88]). CONCLUSIONS In a single-centre Australian haemodialysis cohort, the CI was strongly associated with mortality and stroke risk. The CI is an accurate and simple method to identify patients with low LBM at risk for significant morbidity and mortality.
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Affiliation(s)
- Shaun Chandler
- Kidney Health Service Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Helen MacLaughlin
- Kidney Health Service Royal Brisbane and Women's Hospital, Brisbane, Australia
- Queensland University of Technology, School of Exercise & Nutrition Sciences, Brisbane, Australia
| | - Martin Wolley
- Kidney Health Service Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Gradel KO. Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review. J Clin Med 2023; 12:6132. [PMID: 37834777 PMCID: PMC10573484 DOI: 10.3390/jcm12196132] [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: 07/07/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, 5000 Odense, Denmark; ; Tel.: +45-21-15-80-85
- Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
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Yamada S, Arase H, Taniguchi M, Kitazono T, Nakano T. Simplified geriatric nutritional risk index for assessing nutritional status and stratifying mortality risk in patients receiving maintenance hemodialysis. Ther Apher Dial 2023; 27:253-263. [PMID: 35818886 DOI: 10.1111/1744-9987.13908] [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: 04/11/2022] [Revised: 05/29/2022] [Accepted: 07/09/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The geriatric nutritional risk index (GNRI) is a widely used tool for nutritional assessment in patients receiving hemodialysis. The simplification of the GNRI calculation would be more useful for easier screening of malnutrition and for providing an intuitive stratification of mortality risk. METHODS We retrospectively evaluated 218 Japanese patients receiving maintenance hemodialysis at two hemodialysis centers. The primary outcome was all-cause mortality. The main exposure was a simplified GNRI (sGNRI) calculated as follows: sGNRI = serum albumin (g/dL) + 0.1 × body mass index (kg/m2 ). RESULTS During the median 4.4-year follow-up, 56 patients died. Multivariable-adjusted Cox proportional hazard risk models showed that patients with a lower sGNRI showed a significantly increased mortality risk. No significant difference was observed between the original GNRI and sGNRI regarding mortality predictability. CONCLUSION sGNRI is as useful as the original GNRI for screening for malnutrition and stratifying hemodialysis patients at increased mortality risk.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Internal Medicine, Nishida Hospital, Saga, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tsai MT, Yang RB, Ou SM, Tseng WC, Lee KH, Yang CY, Chang FP, Tarng DC. Plasma Galectin-9 Is a Useful Biomarker for Predicting Renal Function in Patients Undergoing Native Kidney Biopsy. Arch Pathol Lab Med 2023; 147:167-176. [PMID: 35687787 DOI: 10.5858/arpa.2021-0466-oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 02/05/2023]
Abstract
CONTEXT.— Galectin-9 reduces tissue damage in certain immune-mediated glomerular diseases. However, its role in structural and functional renal changes in patients with varying types of chronic kidney disease (CKD) is less clear. OBJECTIVE.— To investigate the association between plasma galectin-9 levels, proteinuria, tubulointerstitial lesions, and renal function in different CKD stages. DESIGN.— We measured plasma galectin-9 levels in 243 patients undergoing renal biopsy for determining the CKD etiology. mRNA and protein expression levels of intrarenal galectin-9 were assessed by quantitative real-time polymerase chain reaction and immunostaining. Relationships between plasma galectin-9, clinical characteristics, and tubulointerstitial damage were analyzed with logistic regression. We investigated galectin-9 expression patterns in vitro in murine J774 macrophages treated with differing stimuli. RESULTS.— To analyze the relationship between galectin-9 and clinical features, we divided the patients into 2 groups according to median plasma galectin-9 levels. The high galectin-9 group tended to be older and to have decreased renal function, higher proteinuria, and greater interstitial fibrosis. After multivariable adjustment, elevated plasma galectin-9 levels were independently associated with stage 3b or higher CKD. An analysis of gene expression in the tubulointerstitial compartment in the biopsy samples showed a significant positive correlation between intrarenal galectin-9 mRNA expression and plasma galectin-9 levels. Immunohistochemistry confirmed increased galectin-9 expression in the renal interstitium of patients with advanced CKD, and most galectin-9-positive cells were macrophages, as determined by double-immunofluorescence staining. In vitro experiments showed that galectin-9 expression in macrophages was significantly increased after interferon-γ stimulation. CONCLUSIONS.— Our findings suggest that plasma galectin-9 is a good biomarker for diagnosing advanced CKD.
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Affiliation(s)
- Ming-Tsun Tsai
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan.,Tsai and R-B Yang contributed equally to this manuscript
| | - Ruey-Bing Yang
- From the Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan (R-B Yang).,Tsai and R-B Yang contributed equally to this manuscript
| | - Shuo-Ming Ou
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Cheng Tseng
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuo-Hua Lee
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Yu Yang
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Pang Chang
- From the Department of Pathology and Laboratory Medicine (Chang), Taipei Veterans General Hospital, Taipei, Taiwan
| | - Der-Cherng Tarng
- From the Division of Nephrology, Department of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), Taipei Veterans General Hospital, Taipei, Taiwan.,From the Institute of Clinical Medicine, School of Medicine (Tsai, Ou, Tseng, Lee, C-Y Yang, Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan.,From the Department and Institute of Physiology (Tarng), National Yang Ming Chiao Tung University, Taipei, Taiwan
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12
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Yajima T, Yajima K. Ratio of extracellular water to intracellular water and simplified creatinine index as predictors of all-cause mortality for patients receiving hemodialysis. PLoS One 2023; 18:e0282864. [PMID: 36897875 PMCID: PMC10004563 DOI: 10.1371/journal.pone.0282864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
The bioelectrical impedance analysis-measured ratio of extracellular water (ECW) to intracellular water (ICW) reflects fluid volume and malnutrition. It may be an indicator of protein-energy wasting and muscle wasting in hemodialysis patients. We examined the association between the ECW/ICW ratio and simplified creatinine index, which is a new surrogate marker of protein-energy wasting and muscle wasting, and whether their combination can accurately predict mortality. A total of 224 patients undergoing hemodialysis for more than 6 months and having undergone bioelectrical impedance analysis for the assessment of body composition were included. Patients were divided into two groups based on the cut-off values of the ECW/ICW ratio (0.57) and simplified creatinine index (20.4 mg/kg/day) for maximumly predicting mortality. Thereafter, they were cross-classified into four groups with each cut-off point. The ECW/ICW ratio was independently associated with the simplified creatinine index (β = -0.164; P = 0.042). During a follow-up of 3.5 years (2.0-6.0 years), 77 patients died. A higher ECW/ICW ratio (adjusted hazard ratio, 3.66, 95% confidence interval 1.99-6.72, P <0.0001) and lower simplified creatinine index (adjusted hazard ratio, 2.25, 95% confidence interval 1.34-3.79, P = 0.0021) were independently associated with an increased risk of all-cause mortality. The adjusted hazard ratio for the higher ECW/ICW ratio and lower simplified creatinine index group vs. the lower ECW/ICW ratio and higher simplified creatinine index group was 12.22 (95% confidence interval 3.68-40.57, p <0.0001). Furthermore, the addition of the ECW/ICW ratio and simplified creatinine index to the baseline risk model significantly improved the C-index from 0.831 to 0.864 (p = 0.045). In conclusion, the ECW/ICW ratio may be a surrogate marker of muscle wasting. Moreover, combining the ECW/ICW ratio and simplified creatinine index may improve the accuracy of predicting all-cause mortality and help stratify the mortality risk of hemodialysis patients.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, Japan
- * E-mail:
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, Japan
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13
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Ou SM, Tsai MT, Chen HY, Li FA, Lee KH, Tseng WC, Chang FP, Lin YP, Yang RB, Tarng DC. Urinary Galectin-3 as a Novel Biomarker for the Prediction of Renal Fibrosis and Kidney Disease Progression. Biomedicines 2022; 10:biomedicines10030585. [PMID: 35327386 PMCID: PMC8945118 DOI: 10.3390/biomedicines10030585] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma galectin-3 (Gal-3) is associated with organ fibrosis, but whether urinary Gal-3 is a potential biomarker of kidney disease progression has never been explored. Between 2018 and 2021, we prospectively enrolled 280 patients who underwent renal biopsy and were divided into three groups based on their urinary Gal-3 levels (<354.6, 354.6−510.7, and ≥510.8 pg/mL) to assess kidney disease progression (defined as ≥40% decline in the estimated glomerular filtration rate or end-stage renal disease) and renal histology findings. Patients in the highest urinary Gal-3 tertile had the lowest eGFRs and highest proteinuria levels. In multivariate Cox regression models, patients in the highest tertile had the highest risk of kidney disease progression (adjusted hazard ratio, 4.60; 95% confidence interval, 2.85−7.71) compared to those in the lowest tertile. Higher urinary Gal-3 levels were associated with more severe renal fibrosis. Intrarenal mRNA expression of LGALS3 (Gal-3-encoded gene) was most correlated with the renal stress biomarkers (IGFBP7 and TIMB2), renal function biomarkers (PTGDS) and fibrosis-associated genes (TGFB1). The urinary Gal-3 level may be useful for the identification of patients at high risk of kidney disease progression and renal fibrosis, and for the early initiation of treatments for these patients.
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Affiliation(s)
- Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Huan-Yuan Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (H.-Y.C.); (F.-A.L.)
| | - Fu-An Li
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (H.-Y.C.); (F.-A.L.)
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Fu-Pang Chang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- Inflammation and Immunity Research Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Ruey-Bing Yang
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan; (H.-Y.C.); (F.-A.L.)
- Correspondence: (R.-B.Y.); (D.-C.T.); Tel.: +886-2-2871-2121 (D.-C.T.); Fax: +886-2-2873-2131 (D.-C.T.)
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan; (S.-M.O.); (M.-T.T.); (K.-H.L.); (W.-C.T.); (Y.-P.L.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Correspondence: (R.-B.Y.); (D.-C.T.); Tel.: +886-2-2871-2121 (D.-C.T.); Fax: +886-2-2873-2131 (D.-C.T.)
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14
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Yajima T, Yajima K, Arao M. Combined Evaluation of Geriatric Nutritional Risk Index and Modified Creatinine Index for Predicting Mortality in Patients on Hemodialysis. Nutrients 2022; 14:nu14040752. [PMID: 35215402 PMCID: PMC8878910 DOI: 10.3390/nu14040752] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
The geriatric nutritional risk index (GNRI) and modified creatinine index (mCI) are surrogate markers of protein-energy wasting in patients receiving hemodialysis. We aimed to examine whether a combined evaluation of these indices improved mortality prediction in this population. We retrospectively investigated 263 hemodialysis patients divided into two groups, using 91.2 and 20.16 mg/kg/day as cut-off values of GNRI and mCI, respectively. The resultant four groups were reshuffled into four subgroups defined using combinations of cut-off values of both indices and were followed up. During the follow-up period (median: 3.1 years), 103 patients died (46/103, cardiovascular causes). Lower GNRI and lower mCI were independently associated with all-cause mortality (adjusted hazard ratio (aHR) 4.96, 95% confidence intervals (CI) 3.10–7.94, and aHR 1.92, 95% CI 1.22–3.02, respectively). The aHR value for the lower GNRI and lower mCI group vs. the higher GNRI and higher mCI group was 7.95 (95% CI 4.38–14.43). Further, the addition of GNRI and mCI to the baseline risk assessment model significantly improved the C-index of all-cause mortality (0.801 to 0.835, p = 0.025). The simultaneous evaluation of GNRI and mCI could be clinically useful to stratify the risk of mortality and to improve the predictability of mortality in patients on hemodialysis.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan;
- Correspondence: ; Tel.: +81-58-388-0111
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan;
| | - Maiko Arao
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan;
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15
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Inaba M, Mori K, Tsujimoto Y, Yamada S, Yamazaki Y, Emoto M, Shoji T. Association of Reduced Free T3 to Free T4 Ratio with Lower Serum Creatinine in Japanese Hemodialysis Patients. Nutrients 2021; 13:nu13124537. [PMID: 34960089 PMCID: PMC8703624 DOI: 10.3390/nu13124537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Low T3 syndrome is defined by a fall in free triiodothyronine (FT3) in spite of normal serum thyroid-stimulating hormone (TSH) and often normal free thyroxin (FT4). A low FT3/FT4 ratio, a relevant marker for low T3 syndrome, is known as a risk of mortality in hemodialysis (HD) patients, as well as low muscle mass in the general population. Because of the local activation of T4 to FT3 in muscle tissue, we examined the association of FT3/FT4 ratio with serum creatinine, a marker of muscle mass and strength in HD patients to investigate the significance of muscle tissue in the development of low T3 syndrome in HD patients. METHODS This was a cross-sectional study derived from our prospective cohort study, named DREAM, of Japanese HD patients. After the exclusion of patients with treated and untreated thyroid dysfunction, 332 patients were analyzed in the study. RESULTS The serum FT4 and TSH of HD patients (n = 332) were 0.9 ± 0.1 ng/dL. and 2.0 ± 0.9 μIU/mL, which were within the respective normal range, while serum FT3 was 2.2 ± 0.3 pg/mL. As many as 101 out of 332 (30.4%) HD patients exhibited a serum FT3 less than the normal lower limit of 2.2 pg/mL. The serum FT3/FT4 ratio correlated significantly positively with serum creatinine, and inversely with serum log CRP and total cholesterol, while it exhibited a tendency towards positive correlation with serum albumin. Multiple regression analysis, which included serum creatinine, albumin, and log CRP, simultaneously, in addition to sex, age, diabetic kidney disease or not, log HD duration, body mass index, systolic blood pressure, and Kt/V, as independent variables, revealed an independent and significant positive association of serum creatinine, but not serum albumin or CRP, with the serum FT3/FT4 ratio. CONCLUSIONS The present study demonstrated an independent and positive correlation of serum creatinine with the serum FT3/FT4 ratio in HD patients. The lack of association of the serum FT3/FT4 ratio with serum albumin and CRP suggested the presence of a creatinine-specific mechanism to associate with serum FT3/FT4 ratio. Because of the local activation of T4 to T3 at muscle tissue, a lower muscle mass may be causatively associated with low T3 syndrome.
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Affiliation(s)
- Masaaki Inaba
- Renal Center, Ohno Memorial Hospital, 1-26-10, Minami-Horie Nishi-ku, Osaka 550-0015, Japan
- Correspondence: ; Tel.: +81-6-6531-1805; Fax: +81-6-6531-1807
| | - Katsuhito Mori
- Department of Nephrology, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
| | - Yoshihiro Tsujimoto
- Division of Internal Medicine, Inoue Hospital, 16-17 enoki-machi, Osaka 564-0053, Japan;
| | - Shinsuke Yamada
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
| | - Yuko Yamazaki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan; (S.Y.); (Y.Y.); (M.E.)
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
| | - Tetsuo Shoji
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan;
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 550-0015, Japan
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16
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Ou SM, Tsai MT, Chen HY, Li FA, Tseng WC, Lee KH, Chang FP, Lin YP, Yang RB, Tarng DC. Identification of Galectin-3 as Potential Biomarkers for Renal Fibrosis by RNA-Sequencing and Clinicopathologic Findings of Kidney Biopsy. Front Med (Lausanne) 2021; 8:748225. [PMID: 34869439 PMCID: PMC8633540 DOI: 10.3389/fmed.2021.748225] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Galectin-3 (Gal-3) is a multifunctional glycan-binding protein shown to be linked to chronic inflammation and fibrogenesis. Plasma Gal-3 is associated with proteinuria and renal dysfunction, but its role has never been confirmed with kidney biopsy results. In our study, we aimed to explore the expression of Gal-3 in biopsy-proven patients, and we tested the hypothesis that chronic kidney disease (CKD) leads to upregulation of plasma Gal-3 expression in corresponding biopsy findings and RNA sequencing analysis. Method: In 249 patients (male/female: 155/94, age: 57.2 ± 16.3 years) who underwent kidney biopsy, plasma levels of Gal-3 were measured to estimate the association of renal fibrosis. Relationships between plasma Gal-3 levels, estimated glomerular filtration rate (eGFR) and renal histology findings were also assessed. We further examined the gene expression of Gal-3 in RNA-sequencing analysis in biopsy-proven patients. Results: Compared to patients without CKD, CKD patients had higher levels of plasma Gal-3 (1,016.3 ± 628.1 pg/mL vs. 811.6 ± 369.6 pg/ml; P = 0.010). Plasma Gal-3 was inversely correlated with eGFR (P = 0.005) but not with proteinuria. Higher Gal-3 levels were associated with interstitial fibrosis, tubular atrophy and vascular intimal fibrosis. RNA-sequencing analysis showed the upregulation of Gal-3 in fibrotic kidney biopsy samples, and the differentially expressed genes were mainly enhanced in immune cell activation and the regulation of cell-cell adhesion. Conclusions: Plasma Gal-3 levels are inverse correlated with eGFR but positively correlated with renal fibrosis, which may be involved in the immune response and associated pathways. These findings support the role of Gal-3 as a predictive marker of renal fibrosis.
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Affiliation(s)
- Shuo-Ming Ou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ming-Tsun Tsai
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Huan-Yuan Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Fu-An Li
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Wei-Cheng Tseng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Kuo-Hua Lee
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Fu-Pang Chang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Inflammation and Immunity Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Ping Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ruey-Bing Yang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan
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17
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Peng H, Aoieong C, Tou T, Tsai T, Wu J. Clinical assessment of nutritional status using the modified quantified subjective global assessment and anthropometric and biochemical parameters in patients undergoing hemodialysis in Macao. J Int Med Res 2021; 49:3000605211045517. [PMID: 34559009 PMCID: PMC8485299 DOI: 10.1177/03000605211045517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Malnutrition is widespread among patients undergoing hemodialysis and is linked to high morbidity and mortality rates. We evaluated the nutritional status and malnutrition markers in patients undergoing hemodialysis in Macao. METHODS We performed a cross-sectional analysis of 360 patients in a hemodialysis center. The modified quantitative subjective global assessment (MQSGA), anthropometric indices and related biochemical test data were used to evaluate nutritional status. RESULTS The sample's mean age was 63.47 ± 13.95 years. There were 210 well-nourished (58.3%), 139 mild-to-moderately malnourished (38.6%) and 11 severely malnourished (3.1%) patients. Older patients had a higher incidence of severe malnutrition, but there were no significant differences between diabetic and non-diabetic patients. Mid-arm circumference (MAC); mid-arm muscle circumference; body mass index; triceps skin fold thickness; serum albumin, creatinine and urea; and hemoglobin were all valid for assessing nutritional status. MAC and the serum albumin and creatinine concentrations significantly negatively correlated with MQSGA. CONCLUSIONS Malnutrition is commonplace in patients undergoing hemodialysis in Macao, but their nutritional status is not affected by diabetes. Serum creatinine, serum albumin and MAC, and especially pre-dialysis creatinine concentration, represent effective, readily available, and easily remembered screening measures of nutritional status for patients undergoing maintenance dialysis.
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Affiliation(s)
- Hongquan Peng
- Department of Nephrology, 105130Kiang Wu Hospital, Kiang Wu Hospital, Macau
| | - Chiwa Aoieong
- Department of Nephrology, 105130Kiang Wu Hospital, Kiang Wu Hospital, Macau
| | - Tou Tou
- Department of Nephrology, 105130Kiang Wu Hospital, Kiang Wu Hospital, Macau
| | - Tsungyang Tsai
- Department of Nephrology, 105130Kiang Wu Hospital, Kiang Wu Hospital, Macau
| | - Jianxun Wu
- Department of Nephrology, 105130Kiang Wu Hospital, Kiang Wu Hospital, Macau
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18
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Yajima T, Arao M, Yajima K, Takahashi H. Usefulness of computed tomography-measured psoas muscle thickness per height for predicting mortality in patients undergoing hemodialysis. Sci Rep 2021; 11:19070. [PMID: 34561527 PMCID: PMC8463703 DOI: 10.1038/s41598-021-98613-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/13/2021] [Indexed: 01/16/2023] Open
Abstract
Computed tomography (CT)-measured psoas muscle thickness standardized for height (PMTH) has emerged as a promising predictor of mortality. The study aimed to investigate whether PMTH could accurately predict mortality in patients undergoing hemodialysis. We examined 207 patients (mean age: 63.1 years; men: 66.2%) undergoing hemodialysis for more than 6 months in hospital affiliated clinic. PMTH was calculated at the L3 vertebra level using CT. Patients were divided according to the PMTH cut-off points: 8.44 mm/m in women and 8.85 mm/m in men; thereafter, they were combined into low and high PMTH groups. PMTH was independently correlated with the simplified creatinine index (β = 0.213, P = 0.021) and geriatric nutritional risk index (β = 0.295, P < 0.0001) in multivariate regression analysis. During a median follow-up of 3.7 (1.8–6.4) years, 76 patients died, including 41 from cardiovascular causes. In the multivariate Cox regression analysis, low PMTH (adjusted hazard ratio, 2.48; 95% confidence interval, 1.36–4.70) was independently associated with an increased risk of all-cause mortality. The addition of binary PMTH groups to the baseline risk model tended to improve net reclassification improvement (0.460, p = 0.060). In conclusion, PMTH may be an indicator of protein energy wasting and a useful tool for predicting mortality in patients undergoing hemodialysis.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
| | - Maiko Arao
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, 501-6062, Japan
| | - Hiroshi Takahashi
- Division of Medical Statistics, Fujita Health University School of Medicine, Aichi, 470-1192, Japan
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Relationship between Circulating Galectin-3, Systemic Inflammation, and Protein-Energy Wasting in Chronic Hemodialysis Patients. Nutrients 2021; 13:nu13082803. [PMID: 34444962 PMCID: PMC8398098 DOI: 10.3390/nu13082803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 02/07/2023] Open
Abstract
Galectin-3 reportedly participates in the inflammatory process that causes insulin resistance in the target tissues. However, the role of high plasma galectin-3 levels as an indicator of protein-energy wasting (PEW) in patients undergoing maintenance hemodialysis remains unclear. This study included 240 hemodialysis patients (64.5 [55.3−74.0] years, 35.8% women) from a tertiary medical center. A baseline assessment of demographic and clinical data, biochemical parameters, and body composition was conducted. Plasma galectin-3 and other biomarkers were measured using a multiplex bead-based immunoassay. Participants were then divided into two subgroups depending on the median value of plasma galectin-3. Malnutrition was identified using the geriatric nutritional risk index (GNRI) and the criteria of the International Society of Renal Nutrition and Metabolism. Independent risk factors for elevated plasma galectin-3 and malnutrition were identified by multivariate logistic regression. The high galectin-3 group was more likely to be older, have lower lean tissue mass and GNRI scores, be diagnosed with PEW, dialyze through a tunneled catheter, and have higher circulating IL-6, TNF-α, and MCP-1 concentrations than the low galectin-3 group. After multivariate adjustment, only low mean arterial pressure, dialyzing with tunneled cuffed catheters, and elevated systemic inflammatory markers correlated with high galectin-3 levels. Plasma galectin-3 concentrations also increased significantly in hemodialysis patients with PEW. However, compared with other commonly used nutritional indicators, galectin-3 did not show superiority in predicting PEW. Although the plasma galectin-3 levels correlated with PEW severity, this correlation disappeared after adjustment for potential confounding variables (OR, 1.000; 95% CI, 0.999–1.001). In conclusion, plasma galectin-3 is a valuable biomarker for systemic inflammation but is less prominent for PEW in patients with maintenance hemodialysis. Further identification of novel biomarkers is required to detect patients at risk for malnutrition and implement appropriate interventions.
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