Mode of renal replacement therapy determines endotoxemia and neutrophil dysfunction in chronic kidney disease.

Bacterial infection and sepsis are common complications of chronic kidney disease (CKD). A vicious cycle of increased gut permeability, endotoxemia, inadequate activation of the innate immune system and resulting innate immune dysfunction is hypothesized. We assessed endotoxemia, neutrophil function and its relation to oxidative stress, inflammation and gut permeability in patients with CKD grade 3-5 without renal replacement therapy (CKD group, n = 57), patients with CKD stage 5 undergoing haemodialysis (HD, n = 32) or peritoneal dialysis (PD, n = 28) and patients after kidney transplantation (KT, n = 67) in a cross-sectional observational study. In HD patients, endotoxin serum levels were elevated and neutrophil phagocytic capacity was decreased compared to all other groups. Patients on HD had a significantly higher mortality, due to infections during follow up, compared to PD (p = 0.022). Oxidative stress, neutrophil energy charge, systemic inflammation and gut permeability could not completely explain these differences. Our findings suggest that dialysis modality and not renal function per se determine the development of neutrophil dysfunction and endotoxemia in CKD-patients. HD patients are particularly prone to neutrophil dysfunction and endotoxemia whereas neutrophil function seems to improve after KT. Multi-target approaches are therefore warranted to improve neutrophil function and potentially reduce the rate of infections with patients undergoing haemodialysis.

Validity of optical device lipometer and bioelectric impedance analysis for body fat assessment in men and women.

The aims of this study were to validate different subcutaneous adipose tissue layers (SAT-layers) measured by lipometer for body fat percentage (BF%) assessment with dual-energy X-ray absorptiometry (DXA) and to compare the validity of lipometer and bioelectrical impedance analysis (BIA). The subjects were 21 male (18-60 years) and 19 female (23-54 years) healthy Estonian volunteers. SAT-layers were measured by lipometer using 15 standardized SAT-layers. Sum of arms, legs and trunk SAT-layers were calculated and compared with arms, legs and trunk fat percentage measured by DXA. BF% was calculated by BIA using the equations of Lukaski et al. and Chumlea et al. for both genders and the equations of Segal et al. for males and Van Loan and Mayclin for females. BF% measured by DXA was significantly higher than calculated by Lukaski et al. and Chumlea et al. in both genders. The correlation was highest between the BF% measured by DXA and using Segal et al. equation in males (r = 0.94) and Van Loan and Mayclin equation in females (r = 0.84). High relationship was observed between BF% measured by DXA and sum of 15 SAT-layers (r = 0.88 in males and r = 0.91 in females). Stepwise multiple regression analysis indicated that two selected SAT-layers explained 85.9% and 86.7% (R2 x 100) of the total variance in BF% measured by DXA in males and females, respectively: [BF% = 1.308 neck + 0.638 hip + 6.971 (males; SEE = 2.59) and BF% = 1.152 hip + 1.797 calf + 12.347 (females; SEE = 3.46)]. In conclusion, lipometer and BIA give a similar mean estimation of BF% when compared with DXA. However, there is a wide range of variance for the upper and lower limits of agreement between the methods, and the methods are not interchangeable. Lipometer seems to be superior to BIA.

Anorexia athletica.

In many sports, athletes with low body weight have a distinct advantage over their opponents; however, this advantage can easily turn into a noticeable disadvantage because low body weight may also be associated with health problems. The present review focuses on the problem of anorexia athletica, with its emphasis on leanness and thinness in female and male sports athletes. Athletes often restrict calories and/or overexercise to achieve or maintain low body and fat masses. There is a growing body of evidence that several metabolic and endocrine disturbances are the result of prolonged energy restriction. However, the long-term outcome of such sport-related disordered eating has not been thoroughly studied. Effective methods of treatment are scarce and similar to treatment of eating disorders. Scientific studies are needed that help establish alternative regulations for sports in which a low body weight is a primary advantage for performance.

Relationships between plasma leptin levels and body composition parameters measured by different methods in postmenopausal women.

The aim of this study was to determine the effects of body composition measured by different methods with different measurement errors on fasting plasma leptin level in normal body mass and obese postmenopausal women. It was hypothesized that the relationship between plasma leptin concentration and body fat is higher using more sophisticated laboratory methods (dual energy X-ray absorptiometry, DXA) in comparison with field methods (bioelectrical impedance analysis, BIA, or skinfold thickness) for body fat measurement because of the greater precision of DXA measurements. Thirty-five postmenopausal (55-83 years of age) healthy Estonian women were divided into two groups: BMI < 27 kg/m(2) as non obese (n = 18) and BMI> 27 kg/m(2) as obese (n = 17). Body composition was determined using DXA (total body, arms, legs, and trunk fat percent, fat mass, and LBM) and BIA methods. Body fat percent was significantly higher using the DXA method. Subcutaneous adipose tissue distribution was determined by measuring nine skinfold thicknesses. Body fat distribution was defined as the ratio of waist-to-hip (WHR) and waist-to-thigh (WTR) circumferences. Leptin was determined by means of radioimmunoassays. Leptin concentration was not significantly different between groups (19.0 +/- 13.3 and 21.5 +/- 21.5 ng/ml in non obese and obese groups, respectively). Body fat percent and fat weight measured by DXA or BIA methods and all measured skinfold thickness values, except biceps and abdominal, were higher in obese women. Body height did not correlate significantly with leptin concentrations. The relationships between leptin concentration were highest with body weight (r = 0.67) and BMI (r = 0.73) values in the obese group. All measured body fat parameters using DXA or BIA methods correlated significantly with plasma leptin concentration in the obese group. LBM did not influence the leptin concentration in postmenopausal women. Stepwise multiple regression analysis indicated that the body fat percent measured using the DXA method was highly related to plasma leptin concentration in the obese group (63.2%; R(2) x 100). When absolute fat mass parameters were considered, leptin concentration was related to the mass of arms fat tissue in the obese group of women (62.3%). Body fat percent measured by BIA was highly related to plasma leptin concentration in the obese group (63.3%). Only biceps skinfold thickness was related to leptin concentration (22.5% and 58.9%, in the nonobese and obese groups, respectively) from the nine measured skinfold thicknesses. WHR and WTR did not reflect leptin concentration in different groups of postmenopausal women. It was concluded that different methods of body composition estimation generate different correlations with plasma leptin concentration. Body fat percent and especially fat mass measured by DXA are the main predictors relating to plasma leptin concentration in obese, but not in nonobese, postmenopausal women. In addition, fat mass in arms measured by DXA and biceps skinfold thickness were also highly related to leptin concentration.

Quantitative analysis of sinistrin in serum with high-performance liquid chromatography for renal function testing.

Sinistrin, as inulin, is widely used as a marker for renal function testing. A reliable and accurate method with a simple sample preparation for the quantitative determination of sinistrin would be of advantage. We developed a high-performance liquid chromatography (HPLC)-based method with electrochemical detection for the quantitative measurement of sinistrin in serum and plasma. Sample preparation is easy and includes enzymatic removal of glucose, deproteinization, acid hydrolysis of sinistrin, and HPLC separation of fructose. The recovery of sinistrin from serum is the same as that from water and is near 100%. The method presented has a linear range up to 500 mg/L. The results from our method are in agreement with a fully enzymatic quantification (regression coefficient 1.01, coefficient of variation 0.97). Sinistrin concentrations in aqueous solutions can be measured down to 2mg/L with a coefficient of variation of 5.7%. Quantification in serum is primarily limited by its physiological fructose content. The sensitivity of the described method is sufficient for its use in renal function testing. We describe a method for quantification of sinistrin which allows accurate measurements especially at low concentrations and low sample volumes. This laboratory method may be used for obtaining sinistrin pharmacokinetics in renal function testing.