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Deniz Güneş B, Köksal E. Screening of malnutrition with malnutrition inflammation score and geriatric nutritional risk index in hemodialysis patients. Hemodial Int 2022; 26:562-568. [PMID: 35831957 DOI: 10.1111/hdi.13032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/16/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Screening malnutrition, which is the most common complication in hemodialysis patients, is extremely important for these patients. Malnutrition inflammation score (MIS) and geriatric nutritional risk index (GNRI) are malnutrition screening tests used in hemodialysis patients in recent years. The purposes of this study are to evaluate the nutritional status of hemodialysis patients with different screening tests and to determine the cutoff values for this disease-specific MIS and GNRI. METHODS The study was conducted with 194 adult patients including 98 males and 96 females whose mean age was 53.1 ± 10.96. Subjective global assessment (SGA) and MIS tests were applied, and the GNRI value was calculated for screening malnutrition. MIS and GNRI cutoff values were obtained by adopting the SGA scores as a standard and drawing a receiver operating characteristic curve. The tatistical Package for the Social Sciences-22.0 package program was used in the analysis. RESULTS According to SGA, 70.7% of the patients were nourished, 21.1% were mildly-moderately malnourished, and 8.2% were found to be severely malnourished. The optimal cutoff value predicted for malnutrition was 6.5 points (94.7% sensitivity and 98.5% specificity) for MIS and 86.0 points (64.9% sensitivity and 62.8% specificity) for GNRI. Based on these cutoff values, 28.9% of the patients were determined to be malnourished according to MIS and 45.4% according to GNRI. CONCLUSION In conclusion, screening tests are very important in the early identification of malnutrition in hemodialysis patients. This study was conducted to evaluate the malnutrition of hemodialysis patients with different screening tests. At the end of the study, the availability of MIS was found to be high in detecting malnutrition in hemodialysis patients because of its high accuracy and sensitivity of MIS. The cutoff points we identified for both MIS and GNRI are thought to facilitate the determination of malnutrition.
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Affiliation(s)
- Burcu Deniz Güneş
- Department of Nutrition and Dietetics, Adnan Menderes University Faculty of Health Sciences, Aydın, Turkey
| | - Eda Köksal
- Department of Nutrition and Dietetics, Gazi University Faculty of Health Sciences, Ankara, Turkey
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Gunarathne TGNS, Tang LY, Lim SK, Nanayakkara N, Damayanthi HDWT, Abdullah KL. Factors Associated with Symptom Burden in Adults with Chronic Kidney Disease Undergoing Hemodialysis: A Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095540. [PMID: 35564935 PMCID: PMC9105408 DOI: 10.3390/ijerph19095540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/01/2023]
Abstract
People with end stage renal disease and undergoing hemodialysis experience a high symptom burden that impairs quality of life. This study aimed to assess the prevalence, dynamicity and determinants of symptom burden among middle-aged and older adult hemodialysis patients. A descriptive cross-sectional study together with a longitudinal assessment was used. A total of 118 and 102 hemodialysis patients were assessed at baseline and at a 6-month follow-up. Validated questionnaires were used to assess the symptom burden, stress, illness perception and social support. Multiple linear regression analysis was used to determine the factors associated with symptom burden. The median number of symptoms experienced was 21 (Interquartile Range (IQR); 18−23) and 19 (IQR; 13−22) at baseline and 6 months, respectively. Having elevated stress (β = 0.65, p ≤ 0.005) and illness perception (β = 0.21, p = 0.02) were significantly predicted symptom burden at baseline (F (4, 112) = 55.29, p < 0.005, R2 = 0.664). Stress (β = 0.28, p = 0.003), illness perception (β = 0.2, p = 0.03), poor social support (β = −0.22, p = 0.01) and low body weight (β = −0.19, p = 0.03) were the determinants for symptom burden at 6 months (F (5, 93) = 4.85, p ≤ 0.005, R2 = 0.24). Elevated stress, illness perception level, poor social support and low post-dialysis body weight were found to be determinants for symptom burden. Attention should be given to psychosocial factors of hemodialysis patients while conducting assessment and delivering care to patients.
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Affiliation(s)
- Thalwaththe Gedara Nadeeka Shayamalie Gunarathne
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; or
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya 20400, Sri Lanka;
| | - Li Yoong Tang
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; or
- Correspondence: ; Tel.: +603-7949-3646
| | - Soo Kun Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia;
| | | | | | - Khatijah L. Abdullah
- Department of Nursing, School of Medical and Life Science, Sunway University, Bandar Sunway 47500, Malaysia;
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3
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Baker JF, Reed G, Kremer J. Weight Fluctuation and the Risk of Cardiovascular Events in Patients with Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2020; 74:229-235. [PMID: 33002323 DOI: 10.1002/acr.24469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Fluctuations in weight have been linked to cardiovascular (CV) outcomes in the general population. We evaluated whether weight fluctuation was independently predictive of CV events in patients with rheumatoid arthritis (RA). METHODS We studied patients with RA from the Corrona registry. Weight change was categorized as loss of ≥10%, loss of 5-10%, stable, gain of 5-10%, and gain of ≥10%. We also categorized patients by quintile of variability in weight in prior observation periods. Cox proportional hazard models explored independent associations between time-varying weight change and weight variability and risk of CV events before and after adjusting for CV risk factors, RA disease features, and disability. RESULTS Among 31,381 participants, those that lost or gained 10% of their weight had greater disease activity, worse physical function, and were more likely to smoke, have diabetes, use corticosteroids, and be disabled. In adjusted models, a greater risk of CV events was observed in those that experienced 10% weight loss [HR: 1.18 (1.03,1.36) p=0.02] or weight gain [HR 1.20 (1.04,1.38) p=0.01]. The association between weight change and CV events was stronger among participants with BMI <25 kg/m2 for 10% weight loss [HR: 1.34 (1.08,1.66) p=0.001] and 10% weight gain [1.74 (1.41,2.24) p<0.001]. Patients with greater variability in weight had a higher risk of CV events. CONCLUSIONS Recent changes and high variability in weight predict CV events in RA, particularly among thin patients. Further study is necessary to determine if weight fluctuation has adverse cardiometabolic consequences that are independent of other risk factors.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, PA, USA.,Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - George Reed
- Corrona Research Foundation, Albany, NY, USA.,University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel Kremer
- University of Alabama at Birmingham, Birmingham, Alabama, USA.,Albany Medical College and the Center for Rheumatology, Albany, NY, USA
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Wu ECH, Huang YT, Chang YM, Chen IL, Yang CL, Leu SC, Su HL, Kao JL, Tsai SC, Jhen RN, Shiao CC. The Association between Nutritional Markers and Heart Rate Variability Indices in Patients Undergoing Chronic Hemodialysis. J Clin Med 2019. [PMCID: PMC6832240 DOI: 10.3390/jcm8101700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The associations between nutritional markers and heart rate variability (HRV) are poorly addressed. This study aimed to evaluate whether malnutrition is associated with the altered autonomic nervous system (ANS) function. This cross-sectional study was conducted enrolling 175 patients (100 women, mean age 65.1 ± 12.9 years) receiving chronic hemodialysis in a teaching hospital from June to August 2010. We performed HRV measurements before and during the index hemodialysis and compared these HRV values between two groups categorized by the individual nutritional marker. By using the multivariate generalized estimating equation with adjustment, we exhibited the independent associations between HRV and poor nutritional status defined by serum albumin < 3.8 g/dL, total cholesterol < 100 mg/dL, body mass index < 23 kg/m2, bodyweight loss within six months > 10%, bodyweight loss within three months > 5%, and normalized protein catabolic rate < 1.1 g/kg BW/day. The current study disclosed ANS impairment in hemodialysis patients with poor nutritional status. The impaired ANS function might be a potential mechanism linking malnutrition to subsequent adverse prognoses in hemodialysis patients. Further investigations are warranted to confirm these findings and clarify the causal association among this complex issue.
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Affiliation(s)
- Eric Chien-Hwa Wu
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Ya-Ting Huang
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Yu-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - I-Ling Chen
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Chuan-Lan Yang
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Show-Chin Leu
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Hung-Li Su
- Department of Nursing, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan
| | - Jsun-Liang Kao
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Shih-Ching Tsai
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Rong-Na Jhen
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Saint Mary’s Hospital Luodong, No. 160, Zhongheng S. Rd., Luodong, Yilan 26546, Taiwan (Y.-M.C.)
- Saint Mary’s Junior College of Medicine, Nursing and Management, No.100, Ln. 265, Sec. 2, Sanxing Rd., Sanxing Township, Yilan County 266, Taiwan
- Correspondence: ; Tel.: +886-3-9544106 (ext. 7951)
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Baker JF, England BR, Mikuls TR, Sayles H, Cannon GW, Sauer BC, George MD, Caplan L, Michaud K. Obesity, Weight Loss, and Progression of Disability in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1740-1747. [PMID: 29707921 DOI: 10.1002/acr.23579] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/10/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Cross-sectional studies have demonstrated that obese patients with rheumatoid arthritis (RA) often report greater disability. The longitudinal effects of obesity, however, are not well-characterized. We evaluated associations between obesity, weight loss, and worsening of disability in patients of 2 large registry studies, which included patients who were followed for longer periods of time. METHODS This study included patients with RA from the National Data Bank for Rheumatic Diseases (FORWARD) (n = 23,323) and the Veterans Affairs RA (VARA) registry study (n = 1,697). Results of the Health Assessment Questionnaire (HAQ) or Multidimensional HAQ (MD-HAQ) were recorded through follow-up. Significant worsening of disability was defined as an increase of >0.2 in HAQ or MD-HAQ scores. The Cox proportional hazards model was used to evaluate the risk of worsening of disability from baseline and to adjust for demographics, baseline disability, comorbidity, disease duration, and other disease features. RESULTS At enrollment, disability scores were higher among severely obese patients compared to those who were overweight both in FORWARD (β = 0.17 [95% confidence interval (95% CI) 0.14, 0.20]; P < 0.001) and in the VARA registry (β = 0.17 [95% CI 0.074, 0.27]; P = 0.001). In multivariable models, patients who were severely obese at enrollment had a greater risk of progressive disability compared to overweight patients in FORWARD (HR 1.25 [95% CI 1.18, 1.33] P < 0.001) and in the VARA registry (HR 1.33 [95% CI 1.07, 1.66]; P = 0.01). Weight loss following enrollment was also associated with a greater risk in both cohorts. In the VARA registry, associations were independent of other clinical factors, including time-varying C-reactive protein and swollen joint count. CONCLUSION Severe obesity is associated with a more rapid progression of disability in RA. Weight loss is also associated with worsening disability, possibly due to it being an indication of chronic illness and the development of age-related or disease-related frailty.
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Affiliation(s)
- Joshua F Baker
- Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania, and University of Pennsylvania, Philadelphia
| | - Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska
| | - Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, Omaha, Nebraska, University of Nebraska Medical Center, Omaha
| | | | - Grant W Cannon
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, and University of Utah, Salt Lake City
| | - Brian C Sauer
- Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah, and University of Utah, Salt Lake City
| | | | | | - Kaleb Michaud
- University of Nebraska Medical Center, Omaha, and the National Data Bank for Rheumatic Diseases, Wichita, Kansas
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Sutcliffe BK, Bennett PN, Fraser SF, Mohebbi M. The deterioration in physical function of hemodialysis patients. Hemodial Int 2017; 22:245-253. [DOI: 10.1111/hdi.12570] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brianna K. Sutcliffe
- Institute for Physical Activity and Nutrition; School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University; Geelong Victoria Australia
| | - Paul N. Bennett
- School of Nursing and Midwifery, Faculty of Health; Deakin University; Geelong Victoria Australia
- Satellite Healthcare; San Jose California USA
| | - Steve F. Fraser
- Institute for Physical Activity and Nutrition; School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University; Geelong Victoria Australia
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Ekart R, Hojs R. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis? Eur J Intern Med 2016; 32:1-6. [PMID: 27067614 DOI: 10.1016/j.ejim.2016.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/20/2016] [Accepted: 03/18/2016] [Indexed: 12/13/2022]
Abstract
Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed.
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Affiliation(s)
- Robert Ekart
- University Medical Centre Maribor, Clinic for Internal Medicine, Department of Dialysis, Maribor, Slovenia; University of Maribor, Faculty of Medicine, Maribor, Slovenia.
| | - Radovan Hojs
- University of Maribor, Faculty of Medicine, Maribor, Slovenia; University Medical Centre Maribor, Clinic for Internal Medicine, Department of Nephrology, Maribor, Slovenia
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8
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Baker JF, Billig E, Michaud K, Ibrahim S, Caplan L, Cannon GW, Stokes A, Majithia V, Mikuls TR. Weight Loss, the Obesity Paradox, and the Risk of Death in Rheumatoid Arthritis. Arthritis Rheumatol 2015; 67:1711-7. [PMID: 25940140 PMCID: PMC4826750 DOI: 10.1002/art.39136] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 03/24/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE In contrast to what is observed in the general population, a low body mass index (BMI) has been associated with accelerated mortality in patients with rheumatoid arthritis (RA). The aim of this study was to assess whether weight loss might explain these seemingly paradoxical observations. METHODS Our study included patients identified from the Veterans Affairs (VA) RA Registry. Dates of death were abstracted from VA electronic medical records. The BMI at each study visit and the change from the previous visit were determined. The maximum BMI of each patient was also obtained from medical records. The annualized rate of BMI loss was determined from the slope of change (per year) in BMI over visits within the preceding 13 months. Cox multivariable proportional hazards models were used to assess associations between BMI measures and mortality. RESULTS In a sample of 1,674 patients, 312 deaths occurred over 9,183 person-years. A loss in BMI of ≥1 kg/m(2) was associated with a greater risk of death, after adjustment for demographics, comorbidities, BMI, smoking, and RA therapies (hazard ratio [HR] 1.99, 95% confidence interval [95% CI] 1.53-2.59, P < 0.001). This association remained significant in a subsample analysis adjusting for C-reactive protein and physical function (HR 1.81, 95% CI 1.36-2.41, P < 0.001). Weight loss at an annualized rate of ≥3 kg/m(2) was associated with the greatest risk of death (HR 2.49, 95% CI 1.73-3.57, P < 0.001). Low BMI (<20 kg/m(2) ) in patients with a history of obesity (>30 kg/m(2) ) was associated with the greatest risk (HR 8.52, 95% CI 4.10-17.71, P < 0.001). CONCLUSION Weight loss is a strong predictor of death in patients with RA. These observations may explain the observed obesity paradox and do not support a biologically protective role of obesity.
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Affiliation(s)
- Joshua F. Baker
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | | | - Kaleb Michaud
- Nebraska–Western Iowa VA Medical Center, Omaha, Nebraska, University of Nebraska Medical Center, Omaha, and National Data Bank for Rheumatic Diseases, Wichita, Kansas
| | - Said Ibrahim
- Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | | | - Grant W. Cannon
- Salt Lake City VA Medical Center, Salt Lake City, Utah, and University of Utah, Salt Lake City
| | - Andrew Stokes
- Boston University School of Public Health, Boston, Massachusetts
| | - Vikas Majithia
- G. V. (Sonny) Montgomery VA Medical Center, Montgomery, Mississippi, and University of Mississippi Medical Center, Jackson
| | - Ted R. Mikuls
- Nebraska–Western Iowa VA Medical Center, Omaha, Nebraska, and University of Nebraska Medical Center, Omaha
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Westland GJ, Grootendorst DC, Halbesma N, Dekker FW, Verburgh CA. The Nutritional Status of Patients Starting Specialized Predialysis Care. J Ren Nutr 2015; 25:265-70. [DOI: 10.1053/j.jrn.2014.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 11/11/2022] Open
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Badve SV, Paul SK, Klein K, Clayton PA, Hawley CM, Brown FG, Boudville N, Polkinghorne KR, McDonald SP, Johnson DW. The association between body mass index and mortality in incident dialysis patients. PLoS One 2014; 9:e114897. [PMID: 25513810 PMCID: PMC4267775 DOI: 10.1371/journal.pone.0114897] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To study the body mass index (BMI) trajectory in patients with incident end-stage kidney disease and its association with all-cause mortality. METHODS This longitudinal cohort study included 17022 adult patients commencing hemodialysis [HD] (n = 10860) or peritoneal dialysis [PD] (n = 6162) between 2001 and 2008 and had ≥6-month follow-up and ≥2 weight measurements, using the Australia and New Zealand Dialysis and Transplant Registry data. The association of time-varying BMI with all-cause mortality was explored using multivariate Cox regression models. RESULTS The median follow-up was 2.3 years. There was a non-linear change in the mean BMI (kg/m2) over time, with an initial decrease from 27.6 (95% confidence interval [CI]: 27.5, 27.7) to 26.7 (95% CI: 26.6, 26.9) at 3-month, followed by increments to 27.1 (95% CI: 27, 27.2) at 1-year and 27.2 (95% CI: 26.8, 27.1) at 3-year, and a gradual decrease subsequently. The BMI trajectory was significantly lower in HD patients who died than those who survived, although this pattern was not observed in PD patients. Compared to the reference time-varying BMI category of 25.1-28 kg/m2, the mortality risks of both HD and PD patients were greater in all categories of time-varying BMI <25 kg/m2. The mortality risks were significantly lower in all categories of time-varying BMI >28.1 kg/m2 among HD patients, but only in the category 28.1-31 kg/m2 among PD patients. CONCLUSIONS BMI changed over time in a non-linear fashion in incident dialysis patients. Time-varying measures of BMI were significantly associated with mortality risk in both HD and PD patients.
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Affiliation(s)
- Sunil V. Badve
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sanjoy K. Paul
- Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Kerenaftali Klein
- Clinical Trials & Biostatistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Philip A. Clayton
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Carmel M. Hawley
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Fiona G. Brown
- Department of Nephrology & Medicine, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Kevan R. Polkinghorne
- Department of Nephrology & Medicine, Monash Medical Centre and Monash University, Melbourne, Victoria, Australia
| | - Stephen P. McDonald
- Australia and New Zealand Dialysis and Transplant Registry, University of Adelaide at Central Northern Adelaide Renal & Transplant Services, Adelaide, South Australia, Australia
| | - David W. Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Vega A, Ruiz C, Abad S, Quiroga B, Velázquez K, Yuste C, Aragoncillo I, López Gómez JM. Body composition affects the response to erythropoiesis-stimulating agents in patients with chronic kidney disease in dialysis. Ren Fail 2014; 36:1073-7. [PMID: 24846345 DOI: 10.3109/0886022x.2014.917937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The response to erythropoiesis-stimulating agents (ESA) in patients with chronic kidney disease (CKD) is variable. The body mass index (BMI) variations can modify the response to ESA. The objective was to assess the effect of body composition on the response to ESA in dialysis patients. METHODS This is an observational cross-sectional study. Prevalent hemodialysis and peritoneal dialysis (PD) patients were selected. In the same day, a single blood test, a body composition analysis using bioimpedance spectroscopy and anthropometric measurements were performed. We collected ESA doses. We analyzed erythropoietin resistance index (ERI). The ERI was calculated dividing the weekly weight-adjusted (kg) dose of ESA (IU) by the hemoglobin level (g/dL). RESULTS The study was comprised of 218 patients (58% men; age 65 (16) years old; 80% hemodialysis, 20% PD). There was an inverse correlation between ERI and BMI (p=0.01), fat tissue index (FTI) (p=0.01) and prealbumin (p=0.04). We found an independent association between higher ERI levels and lower FTI and prealbumin values. CONCLUSION Response to ESA is influenced by body composition. Fat tissue favors the body's response to ESA.
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Affiliation(s)
- Almudena Vega
- Nephrology Department, Hospital General Universitario Gregorio Marañón , Madrid , Spain and
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12
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Campbell R, Augustine T, Hurst H, Pararajasingam R, van Dellen D, Armstrong S, Bartley C, Birtles L, Summers A. Anthropometrics Identify Wasting in Patients Undergoing Surgery for Encapsulating Peritoneal Sclerosis. Perit Dial Int 2014; 35:471-80. [PMID: 24584612 DOI: 10.3747/pdi.2013.00098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 11/11/2013] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED ♦ INTRODUCTION Encapsulating peritoneal sclerosis (EPS) is a serious complication of peritoneal dialysis in which gastrointestinal (GI) symptoms reduce appetite and dietary intake. Adequate nutrition is important, especially if surgery is required. Although the incidence of EPS is low, the present report is able to detail preoperative nutrition status and treatment in a large cohort of patients from a national EPS referral center. ♦ METHODS Of 51 patients admitted to this EPS specialist center hospital for their first peritonectomy in the study period, 50 had a preoperative dietetic assessment, and 49 underwent upper-arm anthropometry. ♦ RESULTS Mean body mass index (BMI) was 20.6 kg/m(2). Mean weight loss was 14% of body weight in the preceding 6 months, with 35 of 50 patients losing more than 10%. On anthropometry, 25 of 49 patients were below the 5th percentile for mid-arm circumference (MAC), 17 of 49 were below for triceps skinfold thickness (TSF), and 21 of 49 were below for mid-arm muscle circumference (MAMC). Mean handgrip strength (HGS) was 60% of normal, with 43 of 49 patients being below 85% of normal. Appetite was poor in 21 of 50 patients, and 37 of 50 had upper and 40 of 50 had lower GI symptoms. By subjective global assessment, 27 of 51 patients were graded as severely malnourished, and 5 of 51, as well-nourished. Mean serum albumin was 28 g/L and did not correlate with BMI, MAC, TSF, MAMC, or HGS. In most patients, C-reactive protein was elevated (mean: 111 mg/L). Preoperative parenteral nutrition was given to 46 of 51 patients for a mean of 21 days. ♦ DISCUSSION Our findings demonstrate the poor nutrition status of patients admitted for EPS surgical intervention. Anthropometrics reveal depleted fat and lean body mass in EPS patients, which might be a result of anorexia and inflammation, and the reason that albumin was not an accurate marker of nutrition. Poor nutrition status is likely to negatively affect outcome in this patient group. ♦ CONCLUSIONS Early recognition of GI symptoms may herald a diagnosis of EPS. Optimization of preoperative nutrition status with intensive nutrition support is needed.
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Affiliation(s)
- Rosalind Campbell
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Titus Augustine
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Helen Hurst
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Ravi Pararajasingam
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David van Dellen
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sheilagh Armstrong
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Carol Bartley
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Linda Birtles
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Angela Summers
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Campbell KL, Bauer JD, Ikehiro A, Johnson DW. Role of Nutrition Impact Symptoms in Predicting Nutritional Status and Clinical Outcome in Hemodialysis Patients: A Potential Screening Tool. J Ren Nutr 2013; 23:302-7. [DOI: 10.1053/j.jrn.2012.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/18/2012] [Accepted: 07/27/2012] [Indexed: 12/19/2022] Open
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Toledo FR, Antunes AA, Vannini FCD, Silveira LVA, Martin LC, Barretti P, Caramori JCT. Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients. Int Urol Nephrol 2013; 45:1747-52. [PMID: 23793618 DOI: 10.1007/s11255-013-0482-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/28/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Malnutrition is a strong predictor of mortality in hemodialysis patients. Several scoring systems for evaluating nutritional status have been proposed. However, they rely on different sets of anthropometric and laboratory markers to make a diagnosis of malnutrition and assess its impact on prognosis. To validate them, nutritional scores should be compared with clinical outcomes. Thus, the purpose of this study was to assess malnutrition by three different nutrition scoring systems and determine which best predicts mortality in hemodialysis patients. METHODS This prospective study included 106 adult chronic hemodialysis patients. Their mean age was 56.3 ± 14.9 years and mean body mass index 24.8 (21.8-28.9); 52 % were men and they had been on dialysis for 24 (5-55) months. Nutritional status was classified according to the diagnostic systems proposed by Wolfson et al. (Am J Clin Nutr 39(4):547-555, 1984), International Society of Renal Nutrition and Metabolism (ISRNM) (Fouque et al. in Kidney Int 73(4):391-398, 2008), and Beberashvili et al. (Nephrol Dial Transplant 25(8):2662-2671, 2010). During about 2 years of follow-up, mortality was assessed by Kaplan-Meier curves, log-rank, and Cox's models adjusted for diabetes, sex, C-reactive protein, time on dialysis, age, and fractional urea clearance. RESULTS Twenty-three deaths (21.5 %) occurred during the study period. According to the systems of Wolfson, Beberashvili, and the ISRNM, 54, 32, and 20 % of patients, respectively, had malnutrition. Both univariate and multivariate analyses showed that the ISRNM system was the only one that predicted poorer survival (fourfold higher death risk) in malnourished patients. CONCLUSIONS The scoring system proposed by the ISRNM most accurately identifies patients at higher risk of death.
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Affiliation(s)
- Flavia R Toledo
- Department of Internal Medicine, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Rubião Junior, Botucatu, São Paulo, 18618-000, Brazil
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Chan M, Kelly J, Batterham M, Tapsell L. Malnutrition (Subjective Global Assessment) Scores and Serum Albumin Levels, but not Body Mass Index Values, at Initiation of Dialysis are Independent Predictors of Mortality: A 10-Year Clinical Cohort Study. J Ren Nutr 2012; 22:547-57. [DOI: 10.1053/j.jrn.2011.11.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/26/2011] [Accepted: 11/27/2011] [Indexed: 01/04/2023] Open
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16
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Hall-McMahon EJ, Campbell KL. Have Renal Dietitians Successfully Implemented Evidence-Based Guidelines Into Practice? A Survey of Dietitians Across Australia and New Zealand. J Ren Nutr 2012; 22:584-91. [DOI: 10.1053/j.jrn.2011.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 01/04/2023] Open
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Bennett PN, Miller MD, Woodman RJ, Hill K, Murray S, Gleadle JM. Nutrition screening by nurses in dialysis. J Clin Nurs 2012; 22:723-32. [PMID: 23039313 DOI: 10.1111/j.1365-2702.2012.04286.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To determine whether a nurse-completed dialysis nutritional screening tool improves referral rates for nutritional support and compare nutrition sensitive biochemical indices, mortality rates and patient-centred quality of life outcomes between referred and non-referred dialysis patients. BACKGROUND People with chronic kidney disease requiring dialysis are nutritionally at risk. Nutrition screening has been shown to identify dialysis patients who are nutritionally at risk to refer to dietitian expertise. DESIGN Prospective cluster-randomised control trial. METHODS Monthly nurse-completed nutrition screening was completed for six consecutive months using a validated four-item instrument measuring weight change, serum phosphate, serum potassium and appetite. Participants (n = 81) were haemodialysis patients from four satellite haemodialysis centres in one Australian metropolitan health service. Primary outcome measure was rate of referral to dietetic services for nutrition support for intervention vs. control groups at six months. Secondary outcome measures were blood pressure, biochemical indices and mortality for referred vs. non-referred patients at six and nine months, and generic and dialysis-specific quality of life for referred vs. non-referred at nine months was examined. RESULTS There were three times as many dietetic referrals in the intervention group than in the control group (26·3 vs. 9·3%). Serum phosphate increased significantly more in the referred patients than the non-referred patients. There were no clinically significant changes between groups in quality of life, blood pressure, mortality rates or other biochemical indices at either six or nine months. CONCLUSION Nurse-completed nutritional screening can lead to appropriate dietetic referrals for nutritional support by nutritional expert clinicians. RELEVANCE TO CLINICAL PRACTICE This study is the first to demonstrate that monthly systematic nurse-completed nutritional screening can facilitate appropriate dietetic referrals that may lead to increased nutritional care for people in satellite dialysis centres.
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Affiliation(s)
- Paul N Bennett
- Department of Nursing, Deakin University and Southern Health Nursing Research Centre, Melbourne, Vic., Australia.
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Cardio-renal cachexia syndromes (CRCS): pathophysiological foundations of a vicious pathological circle. J Cachexia Sarcopenia Muscle 2011; 2:135-142. [PMID: 21966640 PMCID: PMC3177036 DOI: 10.1007/s13539-011-0038-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/05/2011] [Indexed: 10/31/2022] Open
Abstract
Cardio-renal syndromes (CRS) are defined as disorders of the heart and kidney whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction of the other. CRS have been classified into five categories, where types 2 and 4 represent respectively chronic cardio-renal and chronic reno-cardiac syndromes. In these conditions, the chronic disorder of either the heart or kidney has been shown to induce some degree of cachexia. At the same time, cachexia has been proposed as a possible mechanism contributing to the worsening of such pathological organ cross talk. Common pathogenetic mechanisms underlie body wasting in cachectic states of different chronic heart and kidney diseases. In these circumstances, a vicious circle could arise, in which cachexia associated with either heart failure or chronic kidney disease may contribute to further damage of the other organ. In chronic CRS, activation of the immune and neuroendocrine systems contributes to the genesis of cachexia, which in turn can negatively affect the heart and kidney function. In patients with cardiac sustained activation of the immune and neuroendocrine systems and oxidative stress, renal vascular resistance can increase and therefore impair renal perfusion, leading to worsening kidney function. Similarly, in renal cachexia, increased levels of pro-inflammatory cytokines can cause progressive left ventricular systolic dysfunction, myocardial cell death, endothelial dysfunction and increased myocardial fibrosis, with consequent impairment of the chronic reno-cardiac syndrome type 4. Thus, we speculate that the occurrence of different types of chronic CRS could represent a fundamental step in the genesis of cachexia, being renal and cardiac dysfunction closely related to the occurrence of systemic disorders leading to a final common pathway. Therefore, the heart and kidney and cachexia represent a triad causing a vicious circle that increases mortality and morbidity: In such circumstances, we may plausibly talk about cardio-renal cachexia syndrome. Complex interrelations may explain the transition from CRS to cachexia and from cachexia to CRS. Identification of the exact mechanisms occurring in these conditions could potentially help in preventing and treating this deadly combination.
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