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Whillier M, Hinton N, Balcerek M, MacLaughlin HL, Donovan P. Queensland Inpatient Diabetes Survey (QuIDS): patient experience survey evaluation. Intern Med J 2024; 54:639-646. [PMID: 37792317 DOI: 10.1111/imj.16247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Measurement of inpatient experience can allow for treatment tailored to patient preferences and needs. The patient experience of diabetes care has not been explored in Queensland hospitals. AIMS To investigate the experiences of patients with diabetes when hospitalised using the Queensland Inpatient Diabetes Survey (QuIDS). METHODS In 2019 and 2021, patient experience surveys were collected as part of the statewide QuIDS, a cross-sectional study assessing the quality of inpatient care received by people with diabetes in Queensland, Australia. Patient responses were categorised and frequencies reported as percentages. Free text comments were analysed using thematic analysis methods. Pooled descriptive data were presented. RESULTS Responses were collected from 27 hospitals in 2019 (n = 526, 52.4% of all patients with diabetes) and 35 hospitals in 2021 (n = 709, 55.5%). Overall, patients were satisfied with their inpatient diabetes care. Areas for improvement identified by surveyed patients include the choice and timing of meals, staff knowledge about diabetes and increased diabetes self-management. Access to a specialist diabetes team was also identified as being potentially underutilised. Patient comments fell into four major themes: communication, food choices, patient autonomy and education. CONCLUSION Many patients reported positive inpatient experiences; however, patients also expressed dissatisfaction with their inpatient diabetes care. Our data provide unique insight and an opportunity to improve standards of care and service provision for inpatients with diabetes.
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Affiliation(s)
- Margaret Whillier
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Nicola Hinton
- Cairns Diabetes Service, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Matthew Balcerek
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Nutrition Research Collaborative, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter Donovan
- Department of Endocrinology and Diabetes, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, Unversity of Queensland, Brisbane, Queensland, Australia
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MacLaughlin HL, McAuley E, Fry J, Pacheco E, Moran N, Morgan K, McGuire L, Conley M, Johnson DW, Ratanjee SK, Mason B. Re-Thinking Hyperkalaemia Management in Chronic Kidney Disease-Beyond Food Tables and Nutrition Myths: An Evidence-Based Practice Review. Nutrients 2023; 16:3. [PMID: 38201833 PMCID: PMC10780359 DOI: 10.3390/nu16010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Potassium dysregulation can be life-threatening. Dietary potassium modification is a management strategy for hyperkalaemia. However, a 2017 review for clinical guidelines found no trials evaluating dietary restriction for managing hyperkalaemia in chronic kidney disease (CKD). Evidence regarding dietary hyperkalaemia management was reviewed and practice recommendations disseminated. A literature search using terms for potassium, hyperkalaemia, and CKD was undertaken from 2018 to October 2022. Researchers extracted data, discussed findings, and formulated practice recommendations. A consumer resource, a clinician education webinar, and workplace education sessions were developed. Eighteen studies were included. Observational studies found no association between dietary and serum potassium in CKD populations. In two studies, 40-60 mmol increases in dietary/supplemental potassium increased serum potassium by 0.2-0.4 mmol/L. No studies examined lowering dietary potassium as a therapeutic treatment for hyperkalaemia. Healthy dietary patterns were associated with improved outcomes and may predict lower serum potassium, as dietary co-factors may support potassium shifts intracellularly, and increase excretion through the bowel. The resource recommended limiting potassium additives, large servings of meat and milk, and including high-fibre foods: wholegrains, fruits, and vegetables. In seven months, the resource received > 3300 views and the webinar > 290 views. This review highlights the need for prompt review of consumer resources, hospital diets, and health professionals' knowledge.
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Affiliation(s)
- Helen L. MacLaughlin
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Erynn McAuley
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Jessica Fry
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Elissa Pacheco
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Natalie Moran
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Kate Morgan
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Lisa McGuire
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
| | - Marguerite Conley
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Nutrition and Dietetics Department, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
| | - David W. Johnson
- Department of Kidney and Transplant Services, Division of Medicine, Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia
- Centre for Health Services Research, The University of Queensland, St. Lucia, QLD 4067, Australia
| | - Sharad K. Ratanjee
- Kidney Health Service, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia
| | - Belinda Mason
- Nutrition Research Collaborative, Department of Dietetics and Foodservices, Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia (E.P.)
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Cheung HC, Strodl E, Musial J, MacLaughlin HL, Byrnes A, Lewis CA, Ross LJ. Associations between diet composition, dietary pattern, and weight outcomes after bariatric surgery: a systematic review. Int J Obes (Lond) 2023; 47:764-790. [PMID: 37407830 PMCID: PMC10439005 DOI: 10.1038/s41366-023-01333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/12/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Literature describing the impact of dietary intake on weight outcomes after bariatric surgery has not been synthesized. This study aimed to synthesize the evidence regarding any association between diet composition and weight outcomes post-bariatric surgery. METHODS CINAHL, Cochrane, Embase, MEDLINE and Scopus were searched for adult studies up to June 2021 that assessed any association between dietary intakes (≥1-macronutrient, food group, or dietary pattern) and weight outcomes at 12-months or longer after bariatric surgery. Risk of bias and quality assessments were conducted using the Scottish Intercollegiate Guidelines Network checklists and the NHMRC's Level of Evidence and Grades for Recommendations. Study findings were presented according to the time of post-surgery dietary intake assessment (≤12months, between 12 and 24 months, ≥24months). RESULTS 5923 articles were identified, 260 were retrieved for full text screening, and 36 were eligible for inclusion (9 interventional including five randomized-controlled trials, and 27 observational cohort studies; sample sizes: 20-1610; total sample: 5065; follow-up periods: 1 year-12 years; level of evidence: II to IV, risk of bias: low to high). Findings on the association between long-term weight outcomes and dietary composition up to 24-months were mixed. After 24-months, studies consistently suggested no significant associations between weight loss and macronutrient composition or core food group patterns, or between carbohydrate, protein or food group patterns and weight recurrence. A single cohort study reported a weak association between diet quality score and weight-recurrence after 24-months. CONCLUSION There was no strong evidence to support significant associations between diet composition and weight outcomes post-bariatric surgery. The heterogeneity in study design and quality may reduce generalizability to external populations. Individualized dietary recommendations may be useful to support long-term post-surgery weight outcomes. More studies are needed to define and measure diet quality in this patient cohort. REGISTRATION PROSPERO (CRD42021264120).
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Affiliation(s)
- H C Cheung
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Brisbane, QLD, Australia.
| | - E Strodl
- Queensland University of Technology, School of Psychology and Counselling, Faculty of Health, Brisbane, QLD, Australia
| | - J Musial
- Department of Nutrition and Dietetics, Clinical Support Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - H L MacLaughlin
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Brisbane, QLD, Australia
- Nutrition Research Collaborative, Department of Dietetics and Food Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - A Byrnes
- Nutrition Research Collaborative, Department of Dietetics and Food Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - C-A Lewis
- Nutrition Research Collaborative, Department of Dietetics and Food Service, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD, Australia
| | - L J Ross
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Faculty of Health, Brisbane, QLD, Australia
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McAuley EA, MacLaughlin HL, Hannan-Jones MT, King N, Ross LJ. Effectiveness of diet quality indices in measuring a change in diet quality over time: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev 2023; 81:361-383. [PMID: 36102824 DOI: 10.1093/nutrit/nuac063] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
CONTEXT Diet quality indices (DQIs) were developed to score and rank adherence to dietary patterns in observational studies, but their use to measure changes in diet quality in intervention trials is becoming common in the literature. OBJECTIVE This systematic review and meta-analysis aimed to assess the effectiveness of DQIs to measure change in diet quality in intervention trials. DATA SOURCES MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials databases were searched from January 1994 to June 2020. Two reviewers independently completed full-text screening. Eligible studies were randomized controlled trials that used validated a priori DQIs to measure change in diet quality in adults. DATA EXTRACTION Data were extracted by an independent reviewer and reviewed by the research team. Risk of bias was assessed by the Cochrane Collaboration's Risk of Bias 2.0 tool. DATA ANALYSIS The 34 included studies (52% of reviewed studies, 0.6% of initially identified studies) used 10 different DQIs, 7 of which were able to measure significant change in diet quality. Meta-analyses of pooled results demonstrated change in the Healthy Eating Index (MD 5.35; 95%CI, 2.74-7.97; P < 0.001) and the Mediterranean Dietary Adherence Screener (MD 1.61; 95%CI, 1.00-2.23; P < 0.001) scores. DQIs were more likely to measure change in diet quality if they reflected the diet pattern being implemented, if the intervention was significantly different from the baseline and control diets, and if the study was adequately powered to detect change. CONCLUSION DQIs are responsive to change in diet quality in intervention trials when the index used reflects the dietary changes made and the study is adequately powered. The appropriate selection of a DQI to suitably match dietary changes and study populations is important for future dietary intervention trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42020181357.
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Affiliation(s)
- Erynn A McAuley
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Helen L MacLaughlin
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Mary T Hannan-Jones
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Neil King
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Lynda J Ross
- are with the School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,are with the Department of Dietetics and Foodservices, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Abstract
As chronic kidney disease (CKD) progresses, the requirements and utilization of different nutrients change substantially. These changes are accompanied by multiple nutritional and metabolic abnormalities that are observed in the continuum of kidney disease. To provide optimal care to patients with CKD, it is essential to have an understanding of the applicable nutritional principles: methods to assess nutritional status, establish patient-specific dietary needs, and prevent or treat potential or ongoing nutritional deficiencies and derangements. This installment of AJKD's Core Curriculum in Nephrology provides current information on these issues for the practicing clinician and allied health care workers and features basic, practical information on epidemiology, assessment, etiology, and prevention and management of nutritional considerations in patients with kidney disease. Specific emphasis is made on dietary intake and recommendations for dietary patterns, and macro- and micronutrients. In addition, special conditions such as acute kidney injury and approaches to obesity treatment are reviewed.
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Affiliation(s)
- Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, and Royal Brisbane and Women's Hospital, Herston, Australia
| | - Allon N Friedman
- Division of Nephrology, Indiana University, Indianapolis, Indiana
| | - T Alp Ikizler
- Division of Nephrology and Hypertension and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee.
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Whillier M, Musial J, MacLaughlin HL. Evaluation of patient experience post structured education for diabetes self management (Dose Adjustment For Normal Eating-OzDAFNE). Diabetes Res Clin Pract 2021; 181:109065. [PMID: 34562511 DOI: 10.1016/j.diabres.2021.109065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
AIMS To examine OzDAFNE participant feedback to determine if OzDAFNE results in positive participant reported outcomes and experiences, improves quality of life; and to identify areas for improvement. METHODS Quantitative and qualitative evaluations of participants' experience were undertaken prior to, and at the end of, every OzDAFNE program from 2010 to 2019. Evaluations included Likert scale and open-ended questions. Responses were analysed descriptively, for response rates and to identify themes. Mean difference in Problem Area in Diabetes (PAID) score was calculated from pre-course to 12 months. RESULTS 189 participants attended OzDAFNE. 93% rated the overall quality of OzDAFNE as "Excellent". Confidence in managing diabetes increased from 25% pre-OzDAFNE to 96% at completion. Major themes identified as most useful and relevant were carbohydrate counting (89/189), insulin adjustment (87/189) and exercise (46/189). At 12 months (n = 44), 97% were "mostly"/ "always" using OzDAFNE principles; 72% reported their diabetes control was "a lot better" than pre-OzDAFNE due to increased knowledge and implementation of principles. The value of the shared patient experience was reported at all time points. By 12 months, mean PAID score decreased significantly (p < 0.001). CONCLUSIONS The OzDAFNE patient experience was very positive, with high satisfaction reported. Increased confidence and knowledge and ongoing implementation of principles resulted in improved diabetes management. OzDAFNE offers a patient-centred approach that is valued by participants.
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Affiliation(s)
| | - Jane Musial
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Helen L MacLaughlin
- Royal Brisbane and Women's Hospital, Brisbane, Australia; Queensland University of Technology, School of Exercise and Nutrition Sciences, Brisbane, Australia
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Sandhu SA, Angel CA, Campbell KL, Hickman IJ, MacLaughlin HL. Standardised Outcome Reporting for the Nutrition Management of Complex Chronic Disease: A Rapid Review. Nutrients 2021; 13:3388. [PMID: 34684389 PMCID: PMC8538850 DOI: 10.3390/nu13103388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 11/05/2022] Open
Abstract
Individuals with coexisting chronic diseases or with complex chronic disease are among the most challenging and costly patients to treat, placing a growing demand on healthcare systems. Recommending effective treatments, including nutrition interventions, relies on standardised outcome reporting from randomised controlled trials (RCTs) to enable data synthesis. This rapid review sought to determine how the scope and consistency of the outcomes reported by RCTs investigating nutrition interventions for the management of complex chronic disease compared to what is recommended by the core outcome sets (COS) for individual disease states. Peer-reviewed RCTs published between January 2010 and July 2020 were systematically sourced from PubMed, CINAHL and Embase, and COS were sourced from the International Consortium for Health Outcomes Measurements (ICHOM) and the Core Outcome Measures in Effectiveness Trials (COMET) database. A total of 45 RCTs (43 studies) and 7 COS were identified. Outcomes were extracted from both the RCTs and COS and were organised using COMET Taxonomy Core Areas. A total of 66 outcomes and 439 outcome measures were reported by the RCTs. The RCTs demonstrated extensive outcome heterogeneity, with only five outcomes (5/66, 8%) being reported with relative consistency (cited by ≥50% of publications). Furthermore, the scope of the outcomes reported by studies was limited, with a notable paucity of patient-reported outcomes. Poor agreement (25%) was observed between the outcomes reported in the RCTs and those recommended by the COS. This review urges greater uptake of the existing COS and the development of a COS for complex chronic disease to be considered so that evidence can be better synthesised regarding effective nutrition interventions.
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Affiliation(s)
- Savita A Sandhu
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Chloe A Angel
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
| | - Katrina L Campbell
- Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane 4029, Australia;
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane 4102, Australia;
- Faculty of Medicine, University of Queensland, Brisbane 4006, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology (QUT), Brisbane 4059, Australia;
- Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
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Pinto AM, MacLaughlin HL, Hall WL. Heart Rate Variability and Long Chain n-3 Polyunsaturated Fatty Acids in Chronic Kidney Disease Patients on Haemodialysis: A Cross-Sectional Pilot Study. Nutrients 2021; 13:nu13072453. [PMID: 34371962 PMCID: PMC8308541 DOI: 10.3390/nu13072453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/21/2022] Open
Abstract
Low heart rate variability (HRV) is independently associated with increased risk of sudden cardiac death (SCD) and all cardiac death in haemodialysis patients. Long chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) may exert anti-arrhythmic effects. This study aimed to investigate relationships between dialysis, sleep and 24 h HRV and LC n-3 PUFA status in patients who have recently commenced haemodialysis. A cross-sectional study was conducted in adults aged 40–80 with chronic kidney disease (CKD) stage 5 (n = 45, mean age 58, SD 9, 20 females and 25 males, 39% with type 2 diabetes). Pre-dialysis blood samples were taken to measure erythrocyte and plasma fatty acid composition (wt % fatty acids). Mean erythrocyte omega-3 index was not associated with HRV following adjustment for age, BMI and use of β-blocker medication. Higher ratios of erythrocyte eicosapentaenoic acid (EPA) to docosahexaenoic acid (DHA) were associated with lower 24 h vagally-mediated beat-to-beat HRV parameters. Higher plasma EPA and docosapentaenoic acid (DPAn-3) were also associated with lower sleep-time and 24 h beat-to-beat variability. In contrast, higher plasma EPA was significantly related to higher overall and longer phase components of 24 h HRV. Further investigation is required to investigate whether patients commencing haemodialysis may have compromised conversion of EPA to DHA, which may impair vagally-mediated regulation of cardiac autonomic function, increasing risk of SCD.
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Affiliation(s)
- Ana M Pinto
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, UK;
| | - Helen L MacLaughlin
- School of Exercise & Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia;
| | - Wendy L Hall
- Department of Nutritional Sciences, School of Life Course Sciences, King’s College London, 150 Stamford Street, London SE1 9NH, UK;
- Correspondence:
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MacLaughlin HL, Pike M, Selby NM, Siew E, Chinchilli VM, Guide A, Stewart TG, Himmelfarb J, Go AS, Parikh CR, Ghahramani N, Kaufman J, Ikizler TA, Robinson-Cohen C. Body mass index and chronic kidney disease outcomes after acute kidney injury: a prospective matched cohort study. BMC Nephrol 2021; 22:200. [PMID: 34049502 PMCID: PMC8161937 DOI: 10.1186/s12882-021-02400-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. METHODS This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size. RESULTS The cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25-29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20-24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87-3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76-2.92) and similarly, there was no detectable effect of BMI modifying this risk. CONCLUSIONS In this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.
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Affiliation(s)
- Helen L MacLaughlin
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Victoria Park Road, Kelvin Grove, QLD, Australia.
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Mindy Pike
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | - Edward Siew
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vernon M Chinchilli
- Division of Biostatistics and Informatics, Pennsylvania State University, Hershey, PA, USA
| | - Andrew Guide
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Alan S Go
- Kaiser Permanente Northern California, Oakland, CA, USA
- University of California, San Francisco, San Francisco, CA, USA
| | - Chirag R Parikh
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - James Kaufman
- Renal Section, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, NY, USA
| | - T Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, USA
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Conley MM, McFarlane CM, Johnson DW, Kelly JT, Campbell KL, MacLaughlin HL. Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database Syst Rev 2021; 3:CD013119. [PMID: 33782940 PMCID: PMC8094234 DOI: 10.1002/14651858.cd013119.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Obesity and chronic kidney disease (CKD) are highly prevalent worldwide and result in substantial health care costs. Obesity is a predictor of incident CKD and progression to kidney failure. Whether weight loss interventions are safe and effective to impact on disease progression and clinical outcomes, such as death remains unclear. OBJECTIVES This review aimed to evaluate the safety and efficacy of intentional weight loss interventions in overweight and obese adults with CKD; including those with end-stage kidney disease (ESKD) being treated with dialysis, kidney transplantation, or supportive care. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 December 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of more than four weeks duration, reporting on intentional weight loss interventions, in individuals with any stage of CKD, designed to promote weight loss as one of their primary stated goals, in any health care setting. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility and extracted data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess the certainty of evidence. We estimated treatment effects using random-effects meta-analysis. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardised mean difference (SMD) for continuous outcomes or in descriptive format when meta-analysis was not possible. MAIN RESULTS We included 17 RCTs enrolling 988 overweight or obese adults with CKD. The weight loss interventions and comparators across studies varied. We categorised comparisons into three groups: any weight loss intervention versus usual care or control; any weight loss intervention versus dietary intervention; and surgical intervention versus non-surgical intervention. Methodological quality was varied, with many studies providing insufficient information to accurately judge the risk of bias. Death (any cause), cardiovascular events, successful kidney transplantation, nutritional status, cost effectiveness and economic analysis were not measured in any of the included studies. Across all 17 studies many clinical parameters, patient-centred outcomes, and adverse events were not measured limiting comparisons for these outcomes. In studies comparing any weight loss intervention to usual care or control, weight loss interventions may lead to weight loss or reduction in body weight post intervention (6 studies, 180 participants: MD -3.69 kg, 95% CI -5.82 to -1.57; follow-up: 5 weeks to 12 months, very low-certainty evidence). In very low certainty evidence any weight loss intervention had uncertain effects on body mass index (BMI) (4 studies, 100 participants: MD -2.18 kg/m², 95% CI -4.90 to 0.54), waist circumference (2 studies, 53 participants: MD 0.68 cm, 95% CI -7.6 to 6.24), proteinuria (4 studies, 84 participants: 0.29 g/day, 95% CI -0.76 to 0.18), systolic (4 studies, 139 participants: -3.45 mmHg, 95% CI -9.99 to 3.09) and diastolic blood pressure (4 studies, 139 participants: -2.02 mmHg, 95% CI -3.79 to 0.24). Any weight loss intervention made little or no difference to total cholesterol, high density lipoprotein cholesterol, and inflammation, but may lower low density lipoprotein cholesterol. There was little or no difference between any weight loss interventions (lifestyle or pharmacological) compared to dietary-only weight loss interventions for weight loss, BMI, waist circumference, proteinuria, and systolic blood pressure, however diastolic blood pressure was probably reduced. Furthermore, studies comparing the efficacy of different types of dietary interventions failed to find a specific dietary intervention to be superior for weight loss or a reduction in BMI. Surgical interventions probably reduced body weight (1 study, 11 participants: MD -29.50 kg, 95% CI -36.4 to -23.35), BMI (2 studies, 17 participants: MD -10.43 kg/m², 95% CI -13.58 to -7.29), and waist circumference (MD -30.00 cm, 95% CI -39.93 to -20.07) when compared to non-surgical weight loss interventions after 12 months of follow-up. Proteinuria and blood pressure were not reported. All results across all comparators should be interpreted with caution due to the small number of studies, very low quality of evidence and heterogeneity across interventions and comparators. AUTHORS' CONCLUSIONS All types of weight loss interventions had uncertain effects on death and cardiovascular events among overweight and obese adults with CKD as no studies reported these outcome measures. Non-surgical weight loss interventions (predominately lifestyle) appear to be an effective treatment to reduce body weight, and LDL cholesterol. Surgical interventions probably reduce body weight, waist circumference, and fat mass. The current evidence is limited by the small number of included studies, as well as the significant heterogeneity and a high risk of bias in most studies.
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Affiliation(s)
- Marguerite M Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | | | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Jaimon T Kelly
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
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11
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Brown TJ, Williams H, Mafrici B, Jackson HS, Johansson L, Willingham F, McIntosh A, MacLaughlin HL. Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review. J Hum Nutr Diet 2021; 34:747-757. [PMID: 33682964 DOI: 10.1111/jhn.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A comprehensive evidence base is needed to support recommendations for the dietetic management of adults with chronic kidney disease (CKD). The present study aimed to determine the effect of dietary interventions with dietitian involvement on nutritional status, well-being, kidney risk factors and clinical outcomes in adults with CKD. METHODS Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO and EMBASE.com were searched from January 2000 to November 2019. Intentional weight loss and single nutrient studies were excluded. Risk of bias was assessed using the Cochrane risk-of-bias tool. Effectiveness was summarised using the mean difference between groups for each outcome per study. RESULTS Twelve controlled trials (1906 participants) were included. High fruit and vegetable intake, as well as a multidisciplinary hospital and community care programme, slowed the decline in glomerular filtration rate in adults with stage 3-4 CKD. Interventions addressing nutrition-related barriers increased protein and energy intake in haemodialysis patients. A Mediterranean diet and a diet with high n-3 polyunsaturated fatty acids improved the lipid profile in kidney transplant recipients. CONCLUSIONS A limited number of studies suggest benefits as a result of dietary interventions that are delivered by dietitians and focus on diet quality. We did not identify any studies that focussed on our primary outcome of nutritional status or studies that examined the timing or frequency of the nutritional assessment. This review emphasises the need for a wider body of high-quality evidence to support recommendations on what and how dietetic interventions are delivered by dietitians for adults with CKD.
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Affiliation(s)
- Tamara J Brown
- Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Harriet Williams
- Department of Nutrition and Dietetics, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Bruno Mafrici
- Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helena S Jackson
- Renal and Transplantation Unit (Nutrition & Dietetics), St George's University Hospitals NHS Trust, London, UK
| | - Lina Johansson
- Department of Metabolism, Digestion and Reproduction, Imperial Healthcare NHS Trust, London, UK
| | - Fiona Willingham
- Dietetic department, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Ashleigh McIntosh
- Faculty of Health Sciences and Medicine, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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12
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Patel VN, Dijk G, Malarkey B, Brooke JR, Whelan K, MacLaughlin HL. Glycemic Response to a Renal-Specific Oral Nutritional Supplement in Patients With Diabetes Undergoing Hemodialysis: A Randomized Crossover Trial. JPEN J Parenter Enteral Nutr 2020; 45:267-276. [PMID: 32713006 DOI: 10.1002/jpen.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Diabetes and malnutrition are common in patients with kidney failure. We aimed to evaluate the postprandial glucose response to oral nutritional supplement drinks (ONSs) in patients with diabetes undergoing hemodialysis treatment. METHODS A randomized, single-blind crossover study was conducted in patients with diabetes, and requiring chronic hemodialysis. Patients consumed either a renal-specific ONS, macronutrient-matched ONS, or standard ONS on 3 separate study days, during dialysis, following an overnight fast. Blood was collected before and 15, 30, 45, 60, 90, 120, and 180 minutes post ingestion. Mean net incremental area under the curve (iAUC) and peak incremental blood glucose concentration were compared across conditions, using analyses of variance. RESULTS Consumption of the renal-specific ONS resulted in the lowest mean net iAUC (87.9 ± 169.0 mmol/L per 3 hours) compared with macronutrient-matched (188.0 ± 127.5 mmol/L per 3 hours) and standard ONS (199.5 ± 169.2 mmol/L per 3 hours) (F2,30 = 5.115, P = 0.012, partial n2 = 0.254). Pairwise comparisons demonstrated a mean difference of 100.1 mmol/L per 3 hours (95% CI, -2.8 to 202.9) in mean iAUC between the renal-specific ONS and macronutrient-matched ONS (P = 0.058). Peak blood glucose concentration, corrected for baseline, was significantly lower after the renal-specific ONS (1.40 ± 1.0 mmol/L) compared with both macronutrient-matched (2.02 ± 0.71 mmol/L, P = 0.036) and standard ONS (2.3 ± 1.06 mmol/L, P = 0.017). CONCLUSION A renal-specific ONS elicits a lower postprandial glucose response than either macronutrient-matched ONS or standard ONS in patients with diabetes during hemodialysis.
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Affiliation(s)
| | - Giulia Dijk
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK
| | - Bridget Malarkey
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jennifer R Brooke
- Department of Nutritional Sciences, King's College London, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Helen L MacLaughlin
- Department of Nutritional Sciences, King's College London, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, Denmark Hill, London, UK.,Queensland University of Technology (QUT) School of Exercise and Nutrition Sciences, Brisbane, Australia
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13
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Greenwood SA, Castle E, Lindup H, Mayes J, Waite I, Grant D, Mangahis E, Crabb O, Shevket K, Macdougall IC, MacLaughlin HL. Mortality and morbidity following exercise-based renal rehabilitation in patients with chronic kidney disease: the effect of programme completion and change in exercise capacity. Nephrol Dial Transplant 2020; 34:618-625. [PMID: 30500926 PMCID: PMC6452180 DOI: 10.1093/ndt/gfy351] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 12/12/2022] Open
Abstract
Background Twelve weeks of renal rehabilitation (RR) have been shown to improve exercise capacity in patients with chronic kidney disease (CKD); however, survival following RR has not been examined. Methods This study included a retrospective longitudinal analysis of clinical service outcomes. Programme completion and improvement in exercise capacity, characterised as change in incremental shuttle walk test (ISWT), were analysed with Kaplan–Meier survival analyses to predict risk of a combined event including death, cerebrovascular accident, myocardial infarction and hospitalisation for heart failure in a cohort of patients with CKD. Time to combined event was examined with Kaplan–Meier plots and log rank test between ‘completers’ (attended >50% planned sessions) and ‘non-completers’. In completers, time to combined event was examined between ‘improvers’ (≥50 m increase ISWT) and ‘non-improvers’ (<50 m increase). Differences in time to combined event were investigated with Cox proportional hazards models (adjusted for baseline kidney function, body mass index, diabetes, age, gender, ethnicity, baseline ISWT and smoking status). Results In all, 757 patients (male 54%) (242 haemodialysis patients, 221 kidney transplant recipients, 43 peritoneal dialysis patients, 251 non-dialysis CKD patients) were referred for RR between 2005 and 2017. There were 193 events (136 deaths) during the follow-up period (median 34 months). A total of 43% of referrals were classified as ‘completers’, and time to event was significantly greater when compared with ‘non-completers’ (P = 0.009). Responding to RR was associated with improved event-free survival time (P = 0.02) with Kaplan–Meier analyses and log rank test. On multivariate analysis, completing RR contributed significantly to the minimal explanatory model relating clinical variables to the combined event (overall χ2 = 38.0, P < 0.001). ‘Non-completers’ of RR had a 1.6-fold [hazard ratio = 1.6; 95% confidence interval (CI) 1.00–2.58] greater risk of a combined event (P = 0.048). Change in ISWT of >50 m contributed significantly to the minimal explanatory model relating clinical variables to mortality and morbidity (overall χ2 = 54.0, P < 0.001). ‘Improvers’ had a 40% (hazard ratio = 0.6; 95% CI 0.36–0.98) independent lower risk of a combined event (P = 0.041). Conclusions There is an association between completion of an RR programme, and also RR success, and a lower risk of a combined event in this observational study. RR interventions to improve exercise capacity in patients with CKD may reduce risk of morbidity and mortality, and a pragmatic randomised controlled intervention trial is warranted.
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Affiliation(s)
- Sharlene A Greenwood
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK.,Renal Sciences, Department of Transplantation, Immunology and Mucosal Biology, King's College London University, London, UK
| | - Ellen Castle
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Herolin Lindup
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Juliet Mayes
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Iain Waite
- Department of Therapies, King's College Hospital, London, UK
| | - Denise Grant
- Department of Therapies, King's College Hospital, London, UK
| | - Emmanuel Mangahis
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Olivia Crabb
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Kamer Shevket
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK
| | - Iain C Macdougall
- Department of Therapies, King's College Hospital, London, UK.,Department of Renal Medicine, King's College Hospital, London, UK.,Renal Sciences, Department of Transplantation, Immunology and Mucosal Biology, King's College London University, London, UK
| | - Helen L MacLaughlin
- Renal Sciences, Department of Transplantation, Immunology and Mucosal Biology, King's College London University, London, UK.,Department of Nutrition and Dietetics, King's College Hospital, London, UK.,Department of Nutritional Sciences, School of Life Sciences, King's College London University, London, UK
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14
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Abstract
There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long-term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international guidelines. Therefore, in clinical practice, obesity, and recommendations for weight loss, remain a controversial issue when assessing suitability for kidney transplantation. Obesity management interventions in end-stage kidney disease (ESKD), whether for weight loss for transplantation listing or for slowing kidney disease progression, are under-explored in trial settings. Bariatric surgery is the most successful treatment for obesity, but carries increased risk in the ESKD population, and the desired outcome of kidney transplant listing is not guaranteed. Centers that limit transplants to those meeting arbitrary levels of body mass, rather than adopting an individualized assessment approach, may be unfairly depriving many ESKD patients of the survival and quality of life benefits derived from kidney transplantation. However, robotic kidney transplantation surgery holds promise for reducing perioperative risks related to obesity, and may therefore represent an opportunity to remove listing criteria based on size.
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Affiliation(s)
- Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital, London, UK.,Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Katrina L Campbell
- Allied Health Services, Metro North Hospital and Health Services, Herston, QLD, Australia.,Centre for Applied Health Economics, Menzies Health Institute, Griffith University, Brisbane, QLD, Australia
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15
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MacLaughlin HL, Blacklock RM, Wright K, Pot G, Jayawardene S, McIntyre CW, Macdougall IC, Selby NM. Obesity and recovery from acute kidney injury (Ob AKI): a prospective cohort feasibility study. BMJ Open 2019; 9:e024033. [PMID: 30898807 PMCID: PMC6528015 DOI: 10.1136/bmjopen-2018-024033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/17/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To test the methodology of recruitment, retention and data completeness in a prospective cohort recruited after a hospitalised episode of acute kidney injury (AKI), to inform a future prospective cohort study examining the effect of obesity on AKI outcomes. DESIGN Feasibility study. SETTING Single centre, multi-site UK tertiary hospital. PARTICIPANTS 101 participants (67M; 34F) with a median age of 64 (IQR 53-73) years, with and without obesity, recruited within 3 months of a hospitalised episode of AKI. OUTCOME MEASURES Feasibility outcomes were recruitment (>15% meeting inclusion criteria recruited), participant retention at 6 and 12 months (≥80%) and completeness of data collection. Exploratory measures included recovery from AKI (regaining >75% of pre-AKI estimated glomerular filtration rate [eGFR]) at 6 months, development or progression of chronic kidney disease (CKD) (kidney function decrease of ≥25% + rise in CKD category) at 12 months, and associations with poorer kidney outcomes. RESULTS 41% of eligible patients consented to take part, exceeding the target recruitment uptake rate of 15%. Retention was 86% at 6 months and 78% at 12 months; 10 patients died and three commenced dialysis during the study. Data were 90%-100% complete. Median BMI was 27.9 kg/m2 (range 18.1 kg/m2-54.3 kg/m2). 50% of the cohort had stage 3 AKI and 49% had pre-existing CKD. 46% of the cohort met the AKI recovery definition at 6 months. At 12 months, 20/51 patients developed CKD (39%) and CKD progression occurred in 11/49 patients (22%). Post-AKI interleukin-6 and cystatin-C were associated with 12 months decline in eGFR. CONCLUSIONS Feasibility to conduct a long-term observational study addressing AKI outcomes associated with obesity was demonstrated. A fully powered prospective cohort study to examine the relationships between obesity and outcomes of AKI is warranted.
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Affiliation(s)
- Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital NHS Foundation Trust, London, UK
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rochelle M Blacklock
- Department of Nutrition and Dietetics, King's College Hospital NHS Foundation Trust, London, UK
- Department of Nutritional Sciences, King's College London, London, UK
| | - Kelly Wright
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Gerda Pot
- Department of Nutritional Sciences, King's College London, London, UK
| | - Satish Jayawardene
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham Faculty of Medicine and Health Sciences, Derby, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
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16
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Greenwood SA, Castle E, Lindup H, Mayes J, Waite I, Grant D, Mangahis E, Crabb O, Shevket K, Macdougall IC, MacLaughlin HL. Erratum. Nephrol Dial Transplant 2019; 35:1452. [PMID: 30770707 PMCID: PMC7462721 DOI: 10.1093/ndt/gfz032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Jackson HS, MacLaughlin HL, Vidal-Diez A, Banerjee D. A new renal inpatient nutrition screening tool (Renal iNUT): a multicenter validation study. Clin Nutr 2018; 38:2297-2303. [PMID: 30390999 DOI: 10.1016/j.clnu.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 09/20/2018] [Accepted: 10/02/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Screening of patients with renal disease for malnutrition risk on hospital admission provides an opportunity to improve prognosis. This study aimed to assess the validity and reliability of the Renal iNUT, a novel renal-specific inpatient nutrition screening tool. METHODS Adult inpatient admissions to three renal units were screened using the Renal Inpatient Nutrition Screening Tool (iNUT) and the generic Malnutrition Universal Screening Tool (MUST) and compared against nutritional status using Subjective Global Assessment (SGA) as the standard. Construct validity was assessed by Handgrip Strength (HGS), reliability by repeated iNUT administration and nurse opinion by questionnaire. RESULTS Of 141 admissions, 45% were malnourished (SGA score B or C). Using iNUT, 49% patients had increased malnutrition risk (score ≥1), 35.5% requiring dietetic referral (score ≥2). MUST indicated 20% at increased malnutrition risk and dietetic referral in 7%. iNUT was more sensitive than MUST in identifying increased malnutrition risk (92.1% vs 44.4%) and dietetic referral (69.8% vs 15.9%). Specificity of iNUT for increased risk was 82.1% and 92.3% for dietetic referral. 47% patients had sarcopenic-range HGS, with significant difference between iNUT score ≥2 and 0 (p < 0.001). iNUT reliability assessed by kappa was 0.74 (95% CI, 0.58 to 0.9), indicating substantial agreement. Nurse evaluation (n = 71) was highly favorable. CONCLUSIONS The Renal iNUT is a valid and reliable nutrition screening tool when used by nurses admitting patients to specialist renal wards. In comparison with MUST, use of iNUT is likely to improve the identification of malnourished patients for nutritional intervention and dietetic referral.
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Affiliation(s)
- Helena S Jackson
- Renal and Transplantation Unit (Nutrition & Dietetics), St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, UK.
| | - Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital, London SE5 9RS, UK.
| | - Alberto Vidal-Diez
- Population Health Research Institute (PHRI), St George's, University of London, Cranmer Terrace, London SW17 0RE, UK.
| | - Debasish Banerjee
- Renal and Transplantation Unit, St George's University Hospitals NHS Foundation Trust, Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, UK.
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18
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Conley MM, McFarlane CM, MacLaughlin HL, Johnson DW, Campbell KL. Interventions for weight loss in people with chronic kidney disease who are overweight or obese. Cochrane Database of Systematic Reviews 2018. [DOI: 10.1002/14651858.cd013119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Marguerite M Conley
- Princess Alexandra Hospital; Department of Nutrition and Dietetics; 199 Ipswich Road Woolloongabba QLD Australia 4102
| | - Catherine M McFarlane
- Sunshine Coast Hospital and Health Service; Renal Department; Birtinya QLD Australia 4575
| | - Helen L MacLaughlin
- King's College Hospital NHS Foundation Trust; Department of Nutrition and Dietetics; London UK SE5 9RS
| | - David W Johnson
- Princess Alexandra Hospital; Department of Nephrology; Ipswich Road Woolloongabba Queensland Australia 4102
| | - Katrina L Campbell
- Bond University; Faculty of Health Science and Medicine; 2 Promenthean Way Robina Queensland Australia 4226
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19
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MacLaughlin HL, Macdougall IC, Hall WL, Dew T, Mantzoukis K, Oben JA. Does Intragastric Balloon Treatment for Obesity in Chronic Kidney Disease Heighten Acute Kidney Injury Risk? Am J Nephrol 2016; 44:411-418. [PMID: 27784008 DOI: 10.1159/000450765] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/30/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The outcomes of intragastric balloon (IGB) placement to achieve weight loss in obese patients with chronic kidney disease (CKD) have not been reported to date. This study aimed to assess the safety and efficacy of the IGB as a weight-loss treatment among this patient population. METHODS A prospective, single-arm, 'first in CKD' interventional study was conducted in patients with a body mass index >35 kg/m2 and CKD stages 3-4, referred for weight loss. After clinical assessment, the IGB was endoscopically inserted into the stomach and kept in place for 6 months. Complications, adverse events, acceptability, weight loss and metabolic responses were monitored over 6 months. RESULTS Eleven participants were recruited over 18 months. Two patients withdrew (1 prior to IGB insertion and 1 early removal after 3 days due to persistent vomiting) from the study; 9 patients completed the study. There were 5 episodes of acute kidney injury (AKI), occurring in 3 patients. After 6 months, the mean body mass decreased by 9.6% (SD ±6.8). Median waist circumference and total cholesterol decreased significantly (-7.7 cm; interquartile range (IQR) -15.3 to -3.9; and -0.2 mmol/l; IQR -0.6 to -0.05, respectively), with no changes in estimated glomerular filtration rate, blood pressure, triglycerides, adipokines, inflammation, or arterial stiffness measured by carotid-femoral pulse wave velocity. At IGB removal, there was 1 new case each of gastritis and esophagitis. CONCLUSIONS Treatment with IGB has only moderate efficacy on weight loss; yet it results in a high rate of complications in obese patients with established CKD. The risk of AKI may be raised due to increased risk of dehydration secondary to gastrointestinal symptoms associated with IGB placement and reduced baseline kidney function.
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Affiliation(s)
- Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital NHS Foundation Trust, London, UK
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20
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MacLaughlin HL, Hall WL, Condry J, Sanders TAB, Macdougall IC. Participation in a Structured Weight Loss Program and All-Cause Mortality and Cardiovascular Morbidity in Obese Patients With Chronic Kidney Disease. J Ren Nutr 2015; 25:472-9. [PMID: 26143293 DOI: 10.1053/j.jrn.2015.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/06/2015] [Accepted: 05/07/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To determine if participation in a weight loss program impacted upon a composite end point of all-cause mortality and cardiovascular morbidity in obese patients with chronic kidney disease (CKD). DESIGN Retrospective cohort study. SUBJECTS All patients with a body mass index (BMI) >30 kg/m(2) or >28 kg/m(2) with at least 1 comorbidity (hypertension, diabetes, or dyslipidemia) referred to an established weight management program (WMP) from 2005 to 2009 at a metropolitan tertiary teaching hospital were eligible for inclusion in the study cohort. INTERVENTION Twelve-month structured weight loss program. MAIN OUTCOME MEASURES Combined outcome of all-cause mortality, myocardial infarction, stroke, and hospitalization for congestive heart failure; kidney transplantation waitlisting. RESULTS A total of 169 obese patients with CKD commenced the WMP and 169 did not-becoming the observational control group (CON). There were no significant differences between groups for age, BMI, sex, ethnicity, smoking, hypertension, or kidney function at baseline, although CON included more patients with diabetes than WMP (49% vs. 38%, P = .03). Kaplan-Meier survival analysis with log-rank test differed between groups for the combined outcome (P = .03). Cox regression analysis with adjustment for age, sex, ethnicity, hypertension, diabetes, kidney function, baseline BMI, and smoking status, indicated that patients in WMP had a significantly longer event-free period for the combined outcome, than those in CON (adjusted hazard ratio 0.53; 95% confidence interval [CI] 0.29-0.97; P = .04). Participation in the WMP did not increase the likelihood of kidney transplantation waitlisting (odds ratio [OR] 1.06; 95% CI 0.39-2.87; P = .9). Lower baseline BMI and greater weight loss over 12 months were the only factors related to kidney transplantation waitlisting (adjusted R(2) = 0.426). CONCLUSIONS Participation in a structured weight loss program may be associated with improved outcomes in obese patients with CKD.
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Affiliation(s)
- Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital, London, UK; Diabetes and Nutritional Sciences Division, King's College London, London, UK.
| | - Wendy L Hall
- Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - Jerome Condry
- School of Medicine, King's College London, London, UK
| | - Thomas A B Sanders
- Diabetes and Nutritional Sciences Division, King's College London, London, UK
| | - Iain C Macdougall
- School of Medicine, King's College London, London, UK; Department of Renal Medicine, King's College Hospital, London, UK
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Clackson H, Kariyawasam D, Kenny S, Marsh N, MacLaughlin HL. SP493NUTRITIONAL ASSESSMENT OF A PERITONEAL DIALYSIS POPULATION: AN ANALYSIS OF THE DIETETIC INTERVENTION AND NUTRITION EDUCATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv196.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Greenwood SA, Koufaki P, Mercer TH, MacLaughlin HL, Rush R, Lindup H, O'Connor E, Jones C, Hendry BM, Macdougall IC, Cairns HS. Effect of exercise training on estimated GFR, vascular health, and cardiorespiratory fitness in patients with CKD: a pilot randomized controlled trial. Am J Kidney Dis 2014; 65:425-34. [PMID: 25236582 DOI: 10.1053/j.ajkd.2014.07.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/22/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Exercise capacity, which is predictive of all-cause mortality and cardiovascular disease risk, is reduced significantly in patients with non-dialysis-dependent chronic kidney disease. This pilot study examined the effect of moderate-intensity exercise training on kidney function and indexes of cardiovascular risk in patients with progressive chronic kidney disease stages 3 to 4. STUDY DESIGN Single-blind, randomized, controlled, parallel trial. SETTING & PARTICIPANTS 20 patients (aged 18-80 years; 17 men) randomly assigned to rehabilitation (n=10) or usual care (n=10). Participants were included if they were 18 years or older and had evidence of rate of decline in creatinine-based estimated glomerular filtration rate (eGFRcr)≥2.9mL/min/1.73m(2) per year for 12 months preintervention. Patients were excluded if they had unstable medical conditions or had recently started regular exercise. INTERVENTION The rehabilitation group received resistance and aerobic training (3 days per week) for a 12-month period. The usual care group received standard care. OUTCOMES Kidney function assessed by comparing mean rate of change in eGFRcr (mL/min/1.73m(2) per year) from a 12-month preintervention period against the 12-month intervention period. Pulse wave velocity (PWV), peak oxygen uptake (Vo2peak), and waist circumference assessed at 0, 6, and 12 months. MEASUREMENTS eGFR assessed using creatinine, cystatin C (eGFRcys), and a combination of both values (eGFRcr-cys). RESULTS 18 participants (rehabilitation, 8; usual care, 10) completed the study. A significant mean difference in rate of change in eGFRcr (+7.8±3.0 [95% CI, 1.1-13.5] mL/min/1.73m(2) per year; P=0.02) was observed between the rehabilitation and usual care groups, with the rehabilitation group demonstrating a slower decline. No significant between-group mean differences existed in absolute eGFRcr, eGFRcr-cys, or eGFRcys at 12 months of study intervention. Significant between-group mean differences existed in PWV (-2.30 [95% CI, -3.02 to -1.59] m/s), waist circumference (-7.1±12.8 [95% CI, -12.4 to -3.2] cm), and Vo2peak (5.7 [95% CI, 1.34-10.10] mL/kg/min). Change in eGFRcr was correlated inversely with PWV (r=-0.5; P=0.04) at 12 months. LIMITATIONS Small sample size, inconsistency between primary and secondary measures of kidney function. CONCLUSIONS The effect of a 1-year exercise intervention on progression of kidney disease is inconclusive. A larger study with longer follow-up may be necessary.
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Affiliation(s)
- Sharlene A Greenwood
- Department of Renal Medicine, King's College Hospital, London, United Kingdom; Renal Medicine, King's College Hospital, London, United Kingdom.
| | - Pelagia Koufaki
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Thomas H Mercer
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Helen L MacLaughlin
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Robert Rush
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Herolin Lindup
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Ellen O'Connor
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Christopher Jones
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Bruce M Hendry
- Renal Medicine, King's College Hospital, London, United Kingdom
| | - Iain C Macdougall
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
| | - Hugh S Cairns
- Department of Renal Medicine, King's College Hospital, London, United Kingdom
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MacLaughlin HL, Hall WL, Patel AG, Blacklock RM, Swift PA, Phanish MK, Dew T, Chowdhury P, Sanders TAB, Macdougall IC. Weight loss, adipokines, and quality of life after sleeve gastrectomy in obese patients with stages 3-4 CKD: a randomized controlled pilot study. Am J Kidney Dis 2014; 64:660-3. [PMID: 25085646 DOI: 10.1053/j.ajkd.2014.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/09/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Helen L MacLaughlin
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Diabetes and Nutritional Sciences Division, King's College London, London, United Kingdom.
| | - Wendy L Hall
- Diabetes and Nutritional Sciences Division, King's College London, London, United Kingdom
| | - Ameet G Patel
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Pauline A Swift
- Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Mysore K Phanish
- Epsom and St Helier University Hospitals NHS Trust, Surrey, United Kingdom
| | - Tracy Dew
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Paramit Chowdhury
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Tom A B Sanders
- Diabetes and Nutritional Sciences Division, King's College London, London, United Kingdom
| | - Iain C Macdougall
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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Sarafidis PA, Rumjon A, Ackland D, MacLaughlin HL, Bansal SS, Brasse-Lagnel C, Macdougall IC. Obesity does not influence hepcidin and hemojuvelin levels in hemodialysis patients. Nephron Clin Pract 2013; 124:159-66. [PMID: 24356769 DOI: 10.1159/000355545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Clinical studies have shown increased levels of hepcidin causing functional iron deficiency in obese individuals. This study examined whether obesity contributes to increased hepcidin and hemojuvelin levels in adult hemodialysis patients. METHODS In a case-control design, 37 obese [body mass index (BMI) >30 kg/m(2)] stable hemodialysis patients and 37 patients with normal BMI (20-25 kg/m(2)), matched for age, gender and race, who fulfilled a strict set of inclusion and exclusion criteria were included in the study. Serum hepcidin and hemojuvelin, markers of iron status and inflammation, and routine hematological and biochemical variables were measured on samples obtained prior to the midweek hemodialysis session. RESULTS Obese and nonobese patients (BMI 35.1 ± 3.4 vs. 22.8 ± 1.4 kg/m(2); p < 0.001) were similar with regard to basic comorbidities and use of erythropoietin and iron. Levels of hemoglobin, hypochromic red cells and reticulocytes were similar in the two groups. Serum iron and transferrin saturation levels were on the low side and not different between obese and lean individuals; total iron-binding capacity showed a trend towards higher levels in obese patients (48.4 ± 8.3 vs. 44.9 ± 7.4 μmol/l; p = 0.065). Levels of serum ferritin (651 ± 302 vs. 705 ± 327 μg/l; p = 0.46), hepcidin (118.3 ± 67.7 vs. 119.3 ± 78.0 ng/ml; p = 0.95) and hemojuvelin (1.90 ± 1.11 vs. 1.94 ± 1.24 mg/l; p = 0.90) were high but similar between the two groups. Serum hepcidin showed a significant correlation only with ferritin (r = 0.287, p = 0.013). CONCLUSIONS Hepcidin and hemojuvelin levels are already considerably elevated in dialysis patients, but obesity does not have an additional impact. Further studies should examine whether increased weight contributes towards hepcidin elevation in predialysis individuals, in whom there is a lesser burden of systemic inflammation.
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Naylor HL, Jackson H, Walker GH, Macafee S, Magee K, Hooper L, Stewart L, MacLaughlin HL. British Dietetic Association evidence-based guidelines for the protein requirements of adults undergoing maintenance haemodialysis or peritoneal dialysis. J Hum Nutr Diet 2013; 26:315-28. [PMID: 23731266 DOI: 10.1111/jhn.12052] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Existing nutritional guidelines suggest that protein requirements of adults with stage five chronic kidney disease undergoing haemodialysis (HD) or peritoneal dialysis (PD) are increased as a result of protein losses during dialysis. The present review aimed to update previous guidance and develop evidence-based practice guidelines on the protein requirements of adults undergoing maintenance dialysis. METHODS Following a PICO approach (Participants or Population, Intervention or Exposure, Comparison and Outcome), four research questions were formulated to investigate the total protein requirement and protein quality required by adults undergoing HD and PD. A comprehensive, systematic review was undertaken using the databases Medline, EMBASE and the Cochrane Library from 2005 to September 2009 for HD studies and from 1997 to September 2009 for PD studies. RESULTS The literature search yielded 2931 studies, which were assessed for inclusion. Following appraisal, 19 studies in HD and 18 studies in PD met the inclusion criteria and were systematically reviewed. Limited good quality evidence supports the recommendations that: (i) adults undergoing maintenance HD require a minimum protein intake of 1.1 g kg(-1) ideal body weight (IBW) per day; and (ii) adults undergoing maintenance PD require a minimum protein intake of 1.0-1.2 kg(-1) IBW per day, in conjunction with an adequate energy intake. There were no studies that addressed the quality of protein for either HD or PD. CONCLUSIONS Evidence suggests that nutritional status may be maintained with lower protein intakes than previously recommended. However, the evidence base is limited and further randomised controlled trials are required to establish the optimal protein intake for dialysis patients.
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Affiliation(s)
- H L Naylor
- Betsi Cadwaladr University Health Board, Bangor, UK.
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Sarafidis PA, Rumjon A, MacLaughlin HL, Macdougall IC. Obesity and iron deficiency in chronic kidney disease: the putative role of hepcidin. Nephrol Dial Transplant 2011; 27:50-7. [PMID: 22180541 DOI: 10.1093/ndt/gfr686] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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MacLaughlin HL, Hall WL, Patel AG, Macdougall IC. Laparoscopic Sleeve Gastrectomy is a Novel and Effective Treatment for Obesity in Patients with Chronic Kidney Disease. Obes Surg 2011; 22:119-23. [DOI: 10.1007/s11695-011-0448-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Campbell KL, MacLaughlin HL. Unintentional weight loss is an independent predictor of mortality in a hemodialysis population. J Ren Nutr 2010; 20:414-8. [PMID: 20833072 DOI: 10.1053/j.jrn.2010.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE This study investigated common components of classification of nutrition screening risk in the prediction of clinical end-points (mortality and morbidity) in hemodialysis patients over a 3-year period (2005 to 2008). DESIGN This was a retrospective cohort study. SETTING This study was conducted at a Hemodialysis centre. PARTICIPANTS The study included patients on maintenance hemodialysis in June 2005. INTERVENTION Assessment of nutrition risk was carried out using components of Protein-Energy Wasting criteria. MAIN OUTCOME MEASURE Clinical outcome at the 3-year follow-up (June 2008) was measured as mortality and morbidity (as unplanned hospital admissions). Risk of mortality was investigated independent of comorbidities, age, gender, ethnicity, and dialysis vintage using Cox proportional hazards model. RESULTS A total of 217 patients met the inclusion criteria (143 male [66%]; age, 60.5 ± 15.6 years). Patients who lost ≥5% body weight in the 6 months before the study commenced, had a 3-fold (Hazard Ratio = 3.0; 95% confidence interval: 1.2 to 7.5) independent greater risk of death (P = .02). Low serum albumin (<38 g/L) resulted in higher morbidity and mortality; however, this was not statistically significant when adjusted for confounders. Body mass index was only available in 64% (138 of 217) of the cohort at baseline, and was not related to clinical outcome at the 3-year follow-up. CONCLUSION Unintentional weight loss is independently predictive of clinical outcome in this cohort of dialysis patients. It is recommended that nutrition screening tools include weight loss as a key component in classification of risk and for prioritizing patient care.
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MacLaughlin HL, Cook SA, Kariyawasam D, Roseke M, van Niekerk M, Macdougall IC. Nonrandomized trial of weight loss with orlistat, nutrition education, diet, and exercise in obese patients with CKD: 2-year follow-up. Am J Kidney Dis 2009; 55:69-76. [PMID: 19926371 DOI: 10.1053/j.ajkd.2009.09.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 09/04/2009] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obesity increases the comorbidity-adjusted relative risk of developing end-stage renal disease. Body mass index (BMI) > 30 kg/m(2) was a contraindication for transplant in our renal unit until 2008. STUDY DESIGN Open-label prospective nonrandomized intervention. SETTING & PARTICIPANTS All men and women aged 18-75 years with chronic kidney disease (CKD) and BMI > 30 or > 28 kg/m(2) with diabetes, hypertension, or dyslipidemia and otherwise suitable for kidney transplant if on dialysis therapy were eligible to enroll in the weight-management program. 64 patients were referred; 44 agreed to participate in the intervention group and 20 did not wish to take part and constitute the usual-care group. INTERVENTION 24-month weight-management program that included a low-fat renal-specific diet, exercise, and orlistat, 120 mg, 3 times daily. OUTCOMES Body weight, blood pressure (BP), kidney transplant wait listing. MEASUREMENTS Body weight, BP, estimated glomerular filtration rate (eGFR; calculated using the 4-variable Modification of Diet in Renal Disease [MDRD] Study equation). RESULTS 32 patients (73%) in the weight-management program group completed the follow-up evaluation. Baseline mean BMI was 35.7 +/- 4.5 (SD) kg/m(2) in the weight-management program group and 34.1 +/- 4.2 kg/m(2) in the usual-care group. 12 (38%) patients in the weight-management program and 9 (45%) in usual care had stages 3-4 CKD, with the remainder in stage 5 CKD on dialysis therapy. There were no differences in body weight, BP, or eGFR between groups at baseline. After 24 months, mean body weight was 94.6 +/- 16.1 kg in the weight-management program group versus 101.0 +/- 26.8 kg in the usual-care group (P < 0.001), and eGFR was 43 mL/min in the weight-management program group versus 18 mL/min in the usual-care group (P < 0.001). 9 of 26 (35%) otherwise eligible patients in the weight-management program and 1 of 18 (6%) patients in usual care were accepted for kidney transplant listing, with 3 transplants performed in the weight-management program group and 1 in the usual-care group. LIMITATIONS Nonrandomized trial, small number of participants. CONCLUSIONS The weight-management program group showed significant weight loss and weight-loss maintenance in obese patients with CKD and potentially enables obese patients with CKD to undergo kidney transplant.
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Affiliation(s)
- Helen L MacLaughlin
- Department of Nutrition and Dietetics, King's College Hospital, London SE5 9RS, UK.
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