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Zhou Y, Hellberg M, Svensson P, Höglund P, Clyne N. Sarcopenia and relationships between muscle mass, measured glomerular filtration rate and physical function in patients with chronic kidney disease stages 3-5. Nephrol Dial Transplant 2019; 33:342-348. [PMID: 28340152 DOI: 10.1093/ndt/gfw466] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/20/2016] [Indexed: 12/23/2022] Open
Abstract
Background Sarcopenia and poor physical function are common in patients with chronic kidney disease (CKD). Our aim was to investigate the relationships between muscle mass and measured glomerular filtration rate (GFR) and between muscle mass and strength and balance, respectively, in patients with CKD stages 3-5. Methods This is a baseline data analysis of a randomized controlled clinical trial. A total of 148 adult patients with an estimated GFR <30 mL/min/1.72 m2, not on renal replacement therapy, irrespective of the number of comorbidities were included from the Department of Nephrology, Skåne University Hospital, Lund, from 2011 to 2016. Body composition was measured by dual-energy X-ray absorptiometry (DEXA). GFR was measured by iohexol clearance. Balance was measured by functional reach and the Berg balance test and strength by handgrip strength and isometric quadriceps strength. Results Measured GFR ranged from 8 to 55 mL/min/1.73 m2. Lean mass (P < 0.05), fat mass (P < 0.05), appendicular skeletal muscle (P < 0.001) and appendicular skeletal muscle index (P < 0.05) were associated with GFR. Functional reach was associated with leg lean mass (P < 0.05) and the Berg balance test score was associated with trunk lean mass (P < 0.05). Handgrip strength was associated with arm lean mass (P < 0.001). Isometric quadriceps strength was associated with leg lean mass (P < 0.001). More men (44%) suffered from low muscle mass than women (22%), whereas more women (36%) suffered from low muscle strength than men (26%). However, when combining both, men (16%) suffered from sarcopenia to a greater extent than women (8%). Conclusions Among patients with CKD stages 3-5, loss of lean body mass, especially appendicular skeletal muscle, was significantly related to GFR decline. Two important markers of physical function, balance and strength, were significantly related to muscle mass. Moreover, men were more prone to sarcopenia than women during kidney function decline.
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Affiliation(s)
- Yunan Zhou
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Division of Nephrology, Lund, Sweden
| | - Matthias Hellberg
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Division of Nephrology, Lund, Sweden
| | - Philippa Svensson
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Division of Nephrology, Lund, Sweden
| | - Peter Höglund
- Lund University, Skåne University Hospital, Department of Laboratory Medicine, Division of Clinical Chemistry & Pharmacology, Lund, Sweden
| | - Naomi Clyne
- Lund University, Skåne University Hospital, Department of Clinical Sciences, Division of Nephrology, Lund, Sweden
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Tsao YC, Chen JY, Yeh WC, Li WC. Gender- and Age-Specific Associations between Visceral Obesity and Renal Function Impairment. Obes Facts 2019; 12:67-77. [PMID: 30726849 PMCID: PMC6465737 DOI: 10.1159/000496626] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 01/05/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Although obesity is associated with an increased risk of chronic kidney disease, this trend becomes nonsignificant following adjustment for cardiovascular risk factors. The present study aims to investigate whether visceral obesity is independently associated with renal function impairment. METHOD The medical records of 14,529 male and 10,561 female Chinese adults undergoing health check-ups during 2013-2015 were retrospectively collected. The baseline characteristics, including the degree of visceral fat and the percentage of body fat, were compared. The association between study groups and renal function impairment was investigated using regression models adjusted for confounding factors. RESULTS All variables differed significantly among non-obese, peripheral, and central type obese subjects, both younger and older, and of both genders, except for hsCRP in older male subjects (p = 0.053) and eGFR in older female subjects (p = 0.098). Unadjusted univariate analysis showed that central obesity contributed significantly to renal function impairment in all age groups and in both genders. After adjusting for possible confounding factors, only central obesity was found to be an independent factor of renal function impairment in all groups, except for men under 45 years of age. CONCLUSION Visceral obesity is independently associated with renal function impairment in all ages and both genders, except for males younger than 45 years.
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Affiliation(s)
- Yu-Chung Tsao
- Department of Occupational Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chung Yeh
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Cheng Li
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Health Management, Xiamen Chang-Gung Hospital, Xiamen, China
- *Wen-Cheng Li, MD, and Jau-Yuan Chen, MD, Department of Family Medicine, Chang Gung Memorial Hospital, No. 5, Fu-Hsing Street, Guei-Shan District, Taoyuan 333 (Taiwan), E-Mail
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Tsai YW, Chan YL, Chen YC, Cheng YH, Chang SS. Association of elevated blood serum high-sensitivity C-reactive protein levels and body composition with chronic kidney disease: A population-based study in Taiwan. Medicine (Baltimore) 2018; 97:e11896. [PMID: 30200074 PMCID: PMC6133564 DOI: 10.1097/md.0000000000011896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/20/2018] [Indexed: 11/25/2022] Open
Abstract
Chronic kidney disease (CKD) is a risk factor for cardiovascular diseases and is associated with an increase in all-cause mortality. Studies regarding association among various body compositions in different inflamed states and the risk of CKD were rare. We aimed to evaluate the relationship among body composition, high-sensitivity C-reactive protein (hsCRP) level, and the risk of CKD.This was a retrospective cross-sectional study using annual health examination data from 2 medical centers in northern and southern Taiwan between January and December 2015. We performed a variance analysis of the estimated glomerular filtration rate (eGFR) distribution in groups based on hsCRP and body fat percentage (BFP), and a multivariate logistic regression model was used to assess the relationship among BFP, hsCRP levels, and CKD.A total of 10,267 subjects aged ≥18 years undergoing health examination were analyzed. In our study, overweight/obese patients were associated with increased risk of CKD. Nevertheless, in subjects with elevated hsCRP level, overweight/obese group with a higher BFP had a lower risk of CKD as compared with overweight/obese with normal BFP group (for BMI ≧ 23 kg/m, high BFP/high hsCRP: odds ratio [OR] for CKD 1.86, 95% confidence interval [CI] = 1.10-3.17, P = .02; normal BFP/high hsCRP group: OR 2.32, 95% CI = 1.23-4.37, P = .01) after adjusting for various confounders.Our findings suggest that various body compositions in different inflamed states may interfere with the risk of CKD. These results provide an important method for the early detection of impaired renal function by identifying various body compositions and inflammation states to detect CKD at an earlier stage.
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Affiliation(s)
- Yi-Wen Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine
| | | | - Yi-Chuan Chen
- Departments of Family Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Linkou, Taoyuan
| | - Yiu-Hua Cheng
- Department of Family Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University College of Medicine
| | - Shy-Shin Chang
- Department of Family Medicine, Taipei Medical University Hospital and Taipei Medical University College of Medicine, Taipei, Taiwan
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Ye Q, Yin W, Zhang L, Xiao H, Qi Y, Liu S, Qian B, Wang F, Han T. The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis. PLoS One 2017; 12:e0175165. [PMID: 28384211 PMCID: PMC5383249 DOI: 10.1371/journal.pone.0175165] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/21/2017] [Indexed: 02/06/2023] Open
Abstract
The liver is essential for the regulation of energy, protein and amino acids, as well as in other aspects of metabolism. To identify efficient indexes for evaluation of nutritional status and metabolic characteristics during different Child-Pugh stages of hepatitis B cirrhosis, 83 patients and 35 healthy individuals were enrolled in our study. We found that grip strength, triceps skinfold thickness (TSF), body fat and skeletal muscle of the patients were reduced compared to the control group (P<0.05). Ultra-high-performance liquid chromatography data combined with mass spectrometry (UPLC-MS) showed that levels of a variety of metabolites, including lysophosphatidylcholines (LysoPCs), glycerophosphocholine, ornithine and glucuronic acid were reduced in the serum of patients with hepatitis B cirrhosis (P<0.001). However, glycerophosphoserine and taurocholic acid levels were higher than in the control group (P<0.001). Moreover, grip strength was correlated with the Child-Pugh score (P<0.05). Serum albumin, total cholesterol, LDL, LysoPCs, glycerophosphocholine, ornithine, glucuronic acid, glycerophosphoserine and taurocholic acid were correlated with the Child-Pugh score (P<0.01). These findings suggested that grip strength and the above small molecular substances might be considered as sensitive and important indexes for evaluating nutritional status and metabolic characteristics of patients with hepatitis B cirrhosis, which may help assess prognosis and adjust nutritional treatment.
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Affiliation(s)
- Qing Ye
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Gastroenterology and Hepatology, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, PR China
| | - Weili Yin
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Gastroenterology and Hepatology, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, PR China
| | - Lei Zhang
- Clinical Laboratory of Tianjin Third Central Hospital, Tianjin, China
| | - Huijuan Xiao
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Nutriology, Tianjin Third Central Hospital, Tianjin, China
| | - Yumei Qi
- Department of Nutriology, Tianjin Third Central Hospital, Tianjin, China
| | - Shuye Liu
- Clinical Laboratory of Tianjin Third Central Hospital, Tianjin, China
| | - Baoxin Qian
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Gastroenterology and Hepatology, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, PR China
| | - Fengmei Wang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Gastroenterology and Hepatology, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, PR China
| | - Tao Han
- The Third Central Clinical College of Tianjin Medical University, Tianjin, PR China
- Department of Gastroenterology and Hepatology, Tianjin Key Laboratory of Artificial Cells, Tianjin Institute of Hepatobiliary Disease, Tianjin Third Central Hospital, Tianjin, PR China
- * E-mail:
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Tsai YW, Lu MC, Lin YH, Lee YC, Li WC, Chen JY, Chang SS. Combined body mass index with high-sensitivity C-reactive protein as independent predictors for chronic kidney disease in a relatively healthy population in Taiwan. Eur J Clin Nutr 2016; 70:766-71. [PMID: 26979987 DOI: 10.1038/ejcn.2016.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity, a chronic inflammatory state, increases risk of cardiovascular disease and insulin resistance, which are the leading cause of end-stage renal disease (ESRD). We evaluated the relationship between body mass index (BMI) and high-sensitivity C-reactive protein (hsCRP) level and impaired kidney function to determine the predictive value of both markers for estimating chronic kidney disease (CKD) risk in a healthy adult population in Taiwan. SUBJECTS/METHODS In a retrospective cross-sectional study of 4100 subjects ⩾18 years, a multivariate logistic regression model was used to assess the relationship among BMI, high hsCRP levels and CKD. Receiver-operating characteristic curve and Youden index were developed to define the discrimination power of combining BMI with hsCRP for CKD prediction and to determine the best predictive index. RESULTS Overweight/obese subjects with high hsCRP levels had the highest odds ratio for CKD (P=0.048). In females, combining BMI with hsCRP for CKD prediction was superior to that of males (0.890 vs 0.623, respectively; both P<0.001). For females, the Youden index was 25.65 kg/m(2) for BMI and 1.04 μg/ml for hsCRP. CONCLUSIONS Overweight/obesity with higher hsCRP levels is associated with reduced renal function and increased risk for CKD. BMI and hsCRP levels can be used as surrogate markers for CKD risk, especially for females.
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Affiliation(s)
- Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - M-C Lu
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Y-H Lin
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Y-C Lee
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - W-C Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Taipei, Taipei City, Taiwan
| | - J-Y Chen
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Lu JL, Molnar MZ, Naseer A, Mikkelsen MK, Kalantar-Zadeh K, Kovesdy CP. Association of age and BMI with kidney function and mortality: a cohort study. Lancet Diabetes Endocrinol 2015; 3:704-14. [PMID: 26235959 PMCID: PMC4547884 DOI: 10.1016/s2213-8587(15)00128-x] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Compared with normal weight, obesity might be associated with worse clinical outcomes, including chronic kidney disease. Whether this association is modified by age is not known. We investigated the association of BMI with progressive loss of kidney function and all-cause mortality in US veterans. METHODS In a national cohort of 3,376,187 US veterans with an estimated glomerular filtration rate (eGFR) of more than 60 mL/min per 1·73 m(2), we assessed the association of BMI in patients of different ages (<40 years, 40 years to <50 years, 50 years to <60 years, 60 years to <70 years, 70 years to <80 years, and ≥80 years) with loss of kidney function and with all-cause mortality in logistic regression models and Cox proportional hazards models adjusted for ethnic origin, sex, comorbidities, medications, and baseline eGFR. FINDINGS 274,764 (8·1%) of 3,376,187 veterans had a rapid decline in kidney function (decrease in slope of >5 mL/min per 1·73 m(2)). The lowest risk for loss of kidney function was noted in patients with BMI of at least 25 kg/m(2) but less than 30 kg/m(2). A generally consistent U-shaped association was noted between BMI and rapid loss of kidney function that was more prominent with increasing age, except in the patients younger than 40 years, in whom BMI did not seem to be predictive of renal function impairment. 672,341 veterans died (28·7 per 1000 patient-years, 95% CI 28·6-28·7) over a median follow-up of 6·8 years (IQR 6·5-7·7). BMI also showed a U-shaped association with mortality, which was similar in all age groups. INTERPRETATION A BMI of 30 kg/m(2) or more is associated with rapid loss of kidney function in patients with eGFR of at least 60 mL/min per 1·73 m(2), and this association is accentuated in older patients. A BMI of 35 kg/m(2) or more is also associated with high mortality. A BMI of at least 25 kg/m(2) but less than 30 kg/m(2) is associated with the best clinical outcomes. FUNDING National Institute of Health, Memphis VA Medical Center, Long Beach VA Healthcare System, Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, and VA Information Resource Center.
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Affiliation(s)
- Jun Ling Lu
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Miklos Z Molnar
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adnan Naseer
- Division of Nephrology, Memphis Veteran Affairs Medical Center, Memphis, TN, USA
| | - Margit K Mikkelsen
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Nephrology, Memphis Veteran Affairs Medical Center, Memphis, TN, USA.
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