Nutritional Status of Patients Starting on Peritoneal Dialysis: A Comparison Between Planned and Unplanned Dialysis Initiation.

OBJECTIVE: A suboptimal dialysis initiation with insufficient or no planning before urgent start of dialysis remains a common problem associated with increased morbimortality. Whether nutritional markers differ between patients starting peritoneal dialysis (PD) in unplanned and planned modes has not yet been explored. Therefore, we aimed to evaluate whether the nutritional status at the start of dialysis differed between patients with unplanned and planned PD initiation. METHODS: In this observational study comprising 47 adult patients starting PD (age 58 ± 15 years, 51% female), 29 patients had unplanned (starting dialysis up to 72 hours after peritoneal catheter implantation) and 18 planned (follow-up predialysis >90 days) dialysis initiation. Within 30 days of PD initiation, nutritional status was evaluated using anthropometric measurements, multifrequency bioelectrical impedance analysis, appetite assessment, handgrip strength, laboratory markers, and the malnutrition-inflammation score. Physical activity and performance were also evaluated. RESULTS: Patients with an unplanned PD initiation had a higher frequency of diabetes, higher blood glucose, urea, and glycated hemoglobin levels, and lower hemoglobin and albumin levels. Furthermore, they had a lower calf circumference, slower gait speed, higher protein intake, and greater malnutrition-inflammation score, while their physical activity level and appetite did not differ. CONCLUSION: Patients with an unplanned PD had unfavorable clinical and nutritional markers compared with those with planned PD. These findings indicate that a lack of follow-up prior to dialysis initiation can influence the clinical and nutritional statuses of patients, reinforcing the importance of conservative treatment prior to dialysis initiation.

Association between urinary sodium excretion and hard outcomes in non-dialysis chronic kidney disease patients.

BACKGROUND: Restriction of sodium intake is routinely recommended for patients with chronic kidney disease (CKD). Whether or not sodium intake is associated with the progression of CKD and mortality remains uncertain. We evaluated the association between urinary sodium excretion (as a surrogate for sodium intake) with the occurrence of renal failure and mortality in patients with non-dialytic CKD. METHODS: We conducted a retrospective study of patients followed at a CKD clinic care hospital from October 2006 to March 2017. Adult patients with non-dialytic CKD were included. Using a time-to-event analysis, we examined the association of urinary sodium excretion as a categorical variable (categorized as quintiles: 1st quintile: 0.54-2.51 g; 2nd quintile: 2.52-3.11 g, 3rd quintile: 3.12-3.97 g, 4th quintile: 3.98-5.24 g and 5th quintile: 5.26-13.80 g) and the outcomes of interest. The primary outcome was defined as progression to end-stage renal disease requiring any type of renal replacement therapy. The secondary outcome was mortality. RESULTS: Two hundred five patients were included in the study (mean follow up of 2.6 years) with a mean eGFR of 26 (19-41) ml/min/1.73m2. 37 patients (18%) required renal replacement therapy and 52 (25,3%) died. There was association between urinary sodium excretion and need for renal replacement therapy (adjusted HR 0.245; 95%CI 0.660-0.912). There was no association between urinary sodium excretion and mortality in adjusted models. CONCLUSION: Moderate sodium intake was associated with a lower risk of renal failure.

Handgrip Strength Thresholds are Associated With Malnutrition Inflammation Score (MIS) in Maintenance Hemodialysis Patients.

OBJECTIVE: The aim is to verify the association between nutritional status and muscle strength, considering handgrip strength (HGS) cutoffs associated with sarcopenia and mortality. METHODS: Cross-sectional analysis, including hemodialysis patients. Malnutrition Inflammation Score (MIS) was used to assess nutritional status. Muscle function was assessed by HGS, and the considered cutoffs were established by other studies. Cutoffs for sarcopenia diagnosis were 27 and 16 kg for males and females, respectively; cutoffs associated with mortality were 22 and 7 kg for males and females, respectively. Two binary logistic regression models were built, with HGS categorized according to the cutoff for sarcopenia and mortality as dependent variables. RESULTS: Of the 218 patients who were included, 56.9% were male, the mean age was 58.3 years, and 44.7% diabetic; 132 patients (60.6%) had HGS <27 or 16 kg. Age, prevalence of diabetes, and MIS were higher, creatinine and albumin were lower in patients with HGS below these values; 77 patients (35.2%) had HGS <22 or 7 kg. Age, male, and diabetes prevalence, CRP and MIS were higher, midarm muscle circumference (MAMC), creatinine, albumin, and urea were lower in patients with HGS below these values. In the logistic regression MIS (OR 1.202; 95% CI 1.073-1.347; P < .01), age, male, diabetes, and MAMC were associated with the risk of HGS below the cutoffs for sarcopenia. MIS (OR 1.322; 95% CI 1.192-1.467; P < .01), age, male, and diabetes were associated with the risk of HGS below the cutoffs associated with mortality. CONCLUSION: Worse nutritional status increases the risk of HGS below the cutoffs associated with sarcopenia and mortality in hemodialysis patients.

Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall.

OBJECTIVES: After dialysis initiation, a high protein diet is recommended due to significant nutrient losses through dialysate and increased risk of protein energy wasting. In peritoneal dialysis (PD) patients, protein intake can be assessed through different methods that have some advantages and limitations, which affect its use on routine care. The aim of this study is to evaluate the agreement between 2 different methods (24-hour dietary recall and PNA-protein equivalent of total nitrogen appearance) on estimating protein intake in PD patients. DESIGN AND METHODS: Patients on PD for at least 3 months, aged 18 years old or more, were enrolled. To estimate protein intake, 24-hour dietary recall and PNA was used. PNA was calculated from 24-hour urine on the same day of the 24-hour dietary recall. RESULTS: Fifty individuals on PD were included, mean age 55.7 ± 16.2 years, and body mass index 26.0 ± 4.5 kg/m2. The average energy consumption was 1788.79 ± 504.40 kcal/day, which corresponds to 26.81 ± 9.11 kcal/kg current body weight (BW)/day and 29.82 ± 8.39 kcal/kg ideal body weight (IBW)/day. The median of total daily and normalized protein intake estimated using dietary recall was 61.43 (45.28-87.40) g/day, 0.90 (0.58-1.22) g/kg current BW/day, and 1.04 (0.77-1.32) g/kg IBW/day, respectively. Daily protein intake estimated by PNA was 55.75 (48.27-67.74) g/day, protein intake normalized by current BW was 0.81 (0.72-0.99) g/kg and 0.92 (0.83-1.06) g/kg IBW/day. Bland-Altman analysis indicates no systematic bias for the assessment of total protein intake and normalized protein intake for current and ideal BW. Significant proportionality bias was observed for both evaluations, showing there is a dispersion of the values. CONCLUSIONS: Despite the absence of systematic bias in the Bland-Altman analysis, there is no agreement in the assessment of protein intake by dietary recall and PNA, due to the existence of proportionality bias. Thus, values can be influenced biased by the magnitude of the measures.

Association between vitamin D levels and mortality in hemodialysis patients: a cohort study.

Introduction: Low vitamin D levels are associated with mortality in hemodialysis (HD) patients; however, the serum vitamin D thresholds are unclear. This study aimed to identify the vitamin D level below which mortality increases in HD patients.Methods: A cohort of HD patients enrolled from January 2014 to January 2017 was evaluated. The variables were analyzed according to the season, namely, summer, winter, and annual average, mortality was the primary outcome. The patients were assigned to vitamin D quintiles, and multivariate Cox regression analysis adjusted for age, ethnicity, gender, body mass index (BMI), inhibitors of the renin-angiotensin system, statin, calcitriol, and antiplatelet drugs use, hemodialysis vintage, hypertension, diabetes mellitus, atherosclerotic disease, and C-reactive protein was performed.Results: There were studied 306 patients. Vitamin D levels of 18.0-23.6 ng/mL (hazard ratio [HR] = 4.30; 95% confidence interval [CI] 1.60-11.54, p = 0.004) and <18.0 ng/mL (HR = 3.83; 95% CI: 1.42-10.35, p = 0.008) in summer and vitamin D levels of 21.5-27.1 ng/mL (HR = 3.70; 95% CI: 1.50-9.11, p = 0.004) and ≤17.5 ng/mL (HR = 2.84; 95% CI: 1.13-7.13, p = 0.026) in winter were associated with mortality. The average annual values of vitamin D associated with all-cause mortality were <17.7 ng/dL (adjusted HR = 4.25, 95% CI: 1.57-11.48, p = 0.004), and between >17.7 ng/dL and ≤23.1 ng/dL (adjusted HR = 3.91, 95% CI: 1.47-10.42, p = 0.006).Conclusions: Annual average vitamin D levels <23.1 ng/mL were associated with higher all-cause mortality, regardless of the confounding variables evaluated.

Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH).

BACKGROUND: Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial. METHODS: This was a multicenter, open-label study with balanced randomization (1:1) and two parallel-groups. Inclusion criteria were non-diabetic adult patients on automated peritoneal dialysis (APD) for at least 3 months on therapy prior to randomization. Patients assigned to the intervention group were treated with 2L of icodextrin 7.5%, and the control group with glucose 2.5% during the long dwell and, at night in the cycler, with a prescription of standard glucose-based PD solution only in both groups. The primary end-point was the change in insulin resistance measured by homeostatic model assessment (HOMA) index at 90 days. RESULTS: Sixty patients were included in the intervention (n = 33) or the control (n = 27) groups. There was no difference between groups at baseline. After adjustment for pre-intervention HOMA index levels, the group treated with icodextrin had the lower post-intervention levels at 90 days in both intention to treat [1.49 (95% CI: 1.23-1.74) versus 1.89 (95% CI: 1.62-2.17)], (F = 4.643, P = 0.03, partial η(2) = 0.078); and the treated analysis [1.47 (95% CI: 1.01-1.84) versus 2.18 (95% CI: 1.81-2.55)], (F = 7.488, P = 0.01, partial η(2) = 0.195). CONCLUSIONS: The substitution of glucose for icodextrin for the long dwell improved insulin resistance measured by HOMA index in non-diabetic APD patients.

Safety of cinacalcet in children and adolescents with chronic kidney disease-mineral bone disorder: systematic review and proportional meta-analysis of case series.

BACKGROUND: Mineral and bone disease in children with chronic kidney disease can cause abnormalities in calcium, phosphorus, parathyroid hormone, and vitamin D and when left untreated can result in impaired growth, bone deformities, fractures, and vascular calcification. Cinacalcet is a calcimimetic widely used as a therapy to reduce parathyroid hormone levels in the adult population, with hypocalcemia among its side effects. The analysis of safety in the pediatric population is questioned due to the scarcity of randomized clinical trials in this group. OBJECTIVE: To assess the onset of symptomatic hypocalcemia or other adverse events (serious or non-serious) with the use of cinacalcet in children and adolescents with mineral and bone disorder in chronic kidney disease. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA: The bibliographic search identified 2699 references from 1927 to August/2023 (57 LILACS, 44 Web of Science, 686 PubMed, 131 Cochrane, 1246 Scopus, 535 Embase). Four references were added from the bibliography of articles found and 12 references from the gray literature (Clinical Trials). Of the 77 studies analyzed in full, 68 were excluded because they did not meet the following criteria: population, types of studies, medication, publication types and 1 article that did not present results (gray literature). PARTICIPANTS AND INTERVENTIONS: There were 149 patients aged 0-18 years old with Chronic Kidney Disease and mineral bone disorder who received cinacalcet. STUDY APPRAISAL AND SYNTHESIS METHODS: Nine eligible studies were examined for study type, size, intervention, and reported outcomes. RESULTS: There was an incidence of 0.2% of fatal adverse events and 16% of serious adverse events (p < 0.01 and I2 = 69%), in addition to 10.7% of hypocalcemia, totaling 45.7% of total adverse events. LIMITATIONS: There was a bias in demographic information and clinical characteristics of patients in about 50% of the studies and the majority of the studies were case series. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: If used in the pediatric population, the calcimimetic cinacalcet should be carefully monitored for serum calcium levels and attention to possible adverse events, especially in children under 50 months. SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO REGISTER): CRD42019132809.

Effect of dialysate sodium reduction on body water volume, blood pressure, and inflammatory markers in hemodialysis patients--a prospective randomized controlled study.

Accumulating evidence suggests an association between body volume overload and inflammation in chronic kidney diseases. The purpose of this study was to evaluate the effect of dialysate sodium concentration reduction on extracellular water volume, blood pressure (BP), and inflammatory state in hemodialysis (HD) patients. In this prospective controlled study, adult patients on HD for at least 90 days and those with C-reactive protein (CRP) levels ≥ 0.7 mg/dL were randomly allocated into two groups: group A, which included 29 patients treated with reduction of dialysate sodium concentration from 138 to 135 mEq/L; and group B, which included 23 HD patients not receiving dialysate sodium reduction (controls). Of these, 20 patients in group A and 18 in group B completed the protocol study. Inflammatory, biochemical, hematological, and nutritional markers were assessed at baseline and after 8 and 16 weeks. Baseline characteristics were not significantly different between the two groups. Group A showed a significant reduction in serum concentrations of tumor necrosis factor-α, and interleukin-6 over the study period, while the BP and extracellular water (ECW) did not change. In Group B, there were no changes in serum concentrations of inflammatory markers, BP, and ECW. Dialysate sodium reduction is associated with attenuation of the inflammatory state, without changes in the BP and ECW, suggesting inhibition of a salt-induced inflammatory response.

Serum myostatin levels are associated with physical function and hospitalization in peritoneal dialysis patients.

BACKGROUND: Myostatin functions as a negative regulator of skeletal muscle growth. The association of myostatin with muscle parameters in dialysis patients is inconsistent, and there are no studies associating myostatin with physical function and outcomes in peritoneal dialysis (PD) patients. Therefore, we assessed the association of serum myostatin with lean mass, physical function, and hospitalization in a prospective cohort of PD patients. METHODS: Lean mass, physical function, and serum myostatin were assessed at baseline. Patients were followed up for at least 24 months and hospitalization was recorded. RESULTS: Serum myostatin levels were positively correlated with handgrip strength and Appendicular Lean Mass Index among male patients. Binary logistic regression models were performed including myostatin levels and physical function parameters as independent variables. Serum myostatin, handgrip strength, gait speed, and Short Physical Performance Battery were associated with hospitalization. CONCLUSION: Lower serum myostatin and physical function were associated with hospitalization in PD patients.

Vitamin D and skeletal muscle: A narrative review focusing on chronic kidney disease and dialysis.

Morphological, molecular, and physiological effects of vitamin D on skeletal muscle have been analyzed both in animals and humans. Vitamin D may be a potential therapeutic for increasing muscle mass and function. The presence of vitamin D receptors in skeletal muscle cells is already established. However, there is still need for more evidence about the effect of vitamin D on muscle. Some studies have associated vitamin D and skeletal muscle in chronic kidney disease (CKD) patients; most of these studies enrolled hemodialysis patients. FGF-23 and Klotho were recently described in mineral and bone disorders in CKD, resulting in reductions in calcitriol levels. Therefore, both Klotho and FGF-23 may play a role in muscle loss in CKD, which is related to morbidity and mortality risk. Therefore, this article presents a narrative review, aiming to discuss the available information associating skeletal muscle and vitamin D, highlighting the results in CKD and dialysis patients.

Age, diabetes mellitus, and dialysis modality are associated with risk of poor muscle strength and physical function in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Due to the poor outcomes associated with the impairment of physical function and muscle strength in patients on maintenance dialysis, it is important to understand the factors that may influence physical function and muscle strength. The aim of this study was to explore the factors associated with physical function in hemodialysis and peritoneal dialysis patients. METHODS: Patients with chronic kidney disease on dialysis for at least 3 months, aged 18 years old or above, were enrolled. Physical function was assessed by handgrip strength, gait and sit-to-stand tests, and the Short Physical Performance Battery (SPPB). Clinical and laboratory data were collected to verify the association with physical function parameters through binary logistic regression. RESULTS: One-hundred ninety patients on maintenance dialysis were included; 140 patients (73.7%) on hemodialysis and 50 (26.3%) on peritoneal dialysis. The mean age was 57.3 ± 14.9 years, 109 (57.4%) were male, and 87 (45.8%) were older than 60 years. The median SPPB was 8.0 points (6.0-10.0 points) and the mean ± standard deviation of handgrip strength was 24.7 ± 12.2 kg. Binary logistic regression showed that age, type of renal replacement therapy, diabetes mellitus, and serum creatinine were significantly associated with both higher 4-meter gait test times and lower SPPB scores. Only age and diabetes mellitus were associated with higher sit-to-stand test times, while age and ferritin were associated with lower handgrip strength. CONCLUSION: Age, diabetes mellitus, serum creatinine, and hemodialysis modality are factors related to physical function in dialysis patients.

Association of Phase Angle, but Not Inflammation and Overhydration, With Physical Function in Peritoneal Dialysis Patients.

Introduction: Muscle mass depletion, overhydration, and inflammatory state have been related to impaired physical function in chronic kidney disease patients. The relationship between bioelectrical impedance analysis (BIA) parameters, such as hydration status and phase angle (PhA), with physical function in peritoneal dialysis (PD), is still not well-established. Therefore, the objective was to evaluate the association of BIA parameters (overhydration index and PhA) and inflammatory markers with physical function in patients on PD. Methods: The present cross-sectional study enrolled PD patients. Multifrequency BIA was performed to obtain overhydration index and PhA. The Short Physical Performance Battery (SPPB) test battery was applied to assess physical function. The time to complete the 4-m gait test and sit-to-stand test was also considered for physical function assessment. The inflammatory markers tumor necrosis factor-alpha and C-reactive protein levels were determined. Multiple linear regression models were performed, with the physical function variables as dependent variables, adjusted for age, diabetes, and sex. Results: Forty-nine PD patients were enrolled, 53.1% (n = 26) women; mean age, 55.5 ± 16.3 years. There were significant correlations between PhA and SPPB (r = 0.550, p < 0.001), time of 4-m gait test (r = -0.613, p < 0.001) and sit-to-stand test and (r = -0.547, p < 0.001). Overhydration index was significantly correlated with SPPB, 4-m gait test (r = 0.339, p = 0.017), and sit-to-stand test (r = 0.335, p = 0.019). Inflammatory markers were not significantly correlated with physical function parameters. In the multiple linear regression analysis, PhA was associated with physical function parameters, even after adjustments. Overhydration index was associated with all physical function tests only in the models with no adjustments. Conclusion: PhA was independently associated with physical function in PD patients. Inflammatory markers and overhydration index were not associated with physical function.

Incidence and characteristics of methicillin-resistant coagulase-negative Staphylococcus aureus in peritoneal dialysis-associated peritonitis in a single center using molecular methods.

PURPOSE: Peritonitis is a serious complication of peritoneal dialysis and coagulase-negative Staphylococcus (CNS) is the most frequent cause of peritoneal dialysis (PD)-infections in many centers. This study aimed to investigate the molecular epidemiology of CNS isolated from PD-peritonitis in a Brazilian single center, focusing on the genetic determinants conferring methicillin resistance. METHODS: Bacterial strains were isolated from peritoneal fluid of patients presenting PD-peritonitis, identified by phenotypic and molecular methods, and those identified as CNS were submitted to mecA detection, SCCmec, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). RESULTS: Over the 18-year period of this study (1995-2011), a total of 878 peritonitis episodes were diagnosed in this unit, 115 were caused by coagulase-negative staphylococci of which 72 by Staphylococcus epidermidis. mecA gene was detected in 55 CNS (47.8%), more frequently on the more recent years. SCCmec type III was the most frequent cassette, followed by SCCmec type IV and SCCmec type II. A diverstity of pulsotypes was observed among the S. epidermidis isolates, but five clusters (based on the 80% cutoff) were identified. Diversified sequence types (ST02, ST05, ST06, ST09, ST23, ST59 and ST371) were detected. CONCLUSIONS: Detection of SCCmec type III among coagulase-negative Staphylococcus underscores the role of hospital environments as potential source of methicillin-resistant Staphylococcus causing peritonitis in PD patients.

Influence of protein intake and muscle mass on survival in chronic dialysis patients.

INTRODUCTION: Some studies suggest that high body mass index (BMI) confers survival advantage in dialysis patients, but BMI does not differentiate muscle from fat mass, and the survival advantage conferred by its increase seems to be limited to patients with high muscle mass. Thus, discriminating body components when evaluating nutritional status and survival is highly important. This study evaluated the influence of nutritional parameters on survival in patients on chronic dialysis. SUBJECTS AND METHODS: Anthropometry, bioimpedance, biochemistry, and dietary recall were used to investigate the influence of nutritional parameters on survival in 79 prevalent patients on chronic dialysis. RESULTS: Protein intake <1.2 g/kg/day and creatinine <9.7 mg/dL were independent predictors of mortality in all patients. Regarding dialysis method, protein intake <1.2 g/kg/day was predictive of mortality among hemodialysis patients, and percent standard mid-arm muscle circumference <80% was identified as a risk factor among peritoneal dialysis patients. CONCLUSION: Higher muscle mass, possibly favored by a higher protein intake, conferred survival advantage in dialysis patients.

Correction: Update of the European consensus on sarcopenia: what has changed in diagnosis and prevalence in peritoneal dialysis?

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Inflammation and overweight in peritoneal dialysis: is there an association?

More than 30% of the patients on peritoneal dialysis show chronic systemic inflammatory activity with high levels of C-reactive protein. The purpose of this cross-sectional study was to investigate the influence of the inflammatory state on clinical and nutritional markers in patients on peritoneal dialysis. Twenty-seven patients were included: mean age was 57.6 +/- 19 years, 48% were male, and median time on peritoneal dialysis was 16.0 (8.3; 35.8) months. Clinical, dialytic, laboratory, anthropometric and electric bioimpedance data were collected with the sample stratified for C-reactive protein. In patients, the levels of Interleukin-6 and tumor necrosis factor-alpha were higher, while adiponectin levels were lower than in healthy individuals (p < or = 0.001), indicating the presence of inflammatory activity in the sample. When compared to patients with C-reactive protein <1 mg/dL, those with > or =1mg/dL showed higher body mass index (29.4 +/- 6.1 vs. 24.4 +/- 4.5 kg/m(2); p = 0.009), percent of standard body weight (124.5 +/- 25.4 vs. 106.8 +/- 17.9 %; p = 0.012), and percent of body fat as assessed by both anthropometry (31.3 +/- 9.9 vs. 23.9 +/- 9.1%; p = 0.056) and bioimpedance (38.9 +/- 6.3 vs. 26.2 +/- 12.6 %; p < 0.001). Patients with C-reactive protein > or =1mg/dL also exhibited higher levels of ferritin (701 +/- 568 vs. 532 +/- 356 ng/mL; p =0.054) and lower total lymphocyte count (median 1838 vs. 1638 mm3; p = 0.001). In conclusion, higher body mass index and body fat markers were associated with C-reactive protein > or = 1mg/dL, and higher C-reactive protein was associated with immunocompetence impairment evidenced by the lower total lymphocyte count. Our findings confirm the relationship between inflammation, body fat, and immunocompetence, which may be superimposed potentializing the inflammatory status.

Update of the European consensus on sarcopenia: what has changed in diagnosis and prevalence in peritoneal dialysis?

Patients on peritoneal dialysis (PD) may be affected by sarcopenia, which is a progressive and generalized skeletal muscle disorder characterized by muscle mass atrophy with decline of muscle strength and function. The aim was to evaluate differences in the diagnosis and prevalence of sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP). The screening for sarcopenia was performed in PD patients older than 18 years, with evaluation of appendicular skeletal muscle mass index (ASMMI), handgrip strength (HGS) and gait speed (GS). The diagnosis was according to the 2010 and 2019 versions of EWGSOP consensus on sarcopenia. Fifty subjects on PD were included, mean age 55.74 ± 16.22 years old, 52% female. The prevalence of sarcopenia ranged from 4 to 10% according to cut points and references used.

Role of parathyroid hormone in anorexia on maintenance hemodialysis patients.

BACKGROUND AND AIM: Anorexia, which is a common condition in patients on hemodialysis (HD), is characterized by impaired appetite, a subjective condition that hinders anorexia diagnosis. Anorexia is frequently associated with protein energy wasting and inflammation, increasing morbidity and mortality risk. The aim of the study was to evaluate the association between appetite and nutritional, inflammatory, hormonal, and dietary intake parameters in patients on maintenance HD. METHODS: Cross-sectional study with clinical, laboratory, and anthropometric parameters, body composition, muscle function, and dietary intake assessment. To evaluate appetite, a three simple questions questionnaire previously validated was used. After appetite classification, the sample was dichotomized in "normal appetite" and "impaired appetite" and compared. Multiple logistic regression was used to identify association between variables and outcome. RESULTS: 125 patients on HD were included, aged 60.6 ± 14.12 years old, median HD vintage 35.5 months. In dichotomized sample, 78.4% patients showed "normal appetite", and 21.6% "impaired appetite". "Impaired appetite" was independently associated with increased serum PTH (OR 1.001; 95% CI 1.000-1.002; p = 0.03), low zinc intake (OR 0.860; 95% CI 0.746-0.991; p = 0.03) and lower urea serum (OR 0.982; 95% CI 0.965-0.999; p = 0.04). Both groups showed insufficient dietary intake. CONCLUSIONS: Appetite was independently associated with increased serum of PTH, low serum concentration of urea, and low zinc intake which may infer association of appetite with mineral bone disease, protein intake and zinc deficiency.

Malnutrition Inflammation Score cut-off predicting mortality in maintenance hemodialysis patients.

BACKGROUND: Malnutrition is a strong predictor of mortality on hemodialysis patients, especially when it is associated with inflammation. Malnutrition Inflammation Score (MIS) is a simple and low cost tool which assesses the presence of malnutrition associated with inflammation. Therefore, the aim is to evaluate if MIS is associated with mortality in patients on maintenance hemodialysis and establish a cut-off to predict mortality at different follow-up periods. METHODS: Observational retrospective cohort study including 215 patients on hemodialysis between July 2012 and June 2014, censored until November 2015. MIS was used to assess patient's nutritional status at the moment they were enrolled in the study. They were followed for at least 18 months. RESULTS: At the end of 18 months, 38 (17.7%) deaths, 20 renal transplants (9.3%), four facilities transference (1.9%), three dialysis method change (1.4%) and one renal function recovery (0.5%) were observed. One hundred seventy one patients completed at least 24 months of follow-up, and during this additional period, there were five deaths and one renal transplant more. Score higher than 7 points was able to predict mortality for both follow-up periods using sensitivity and specificity analysis and ROC curves. Using this cut-off on Kaplan-Meier survival curve, it was possible to confirm the association of MIS with all-cause mortality at 18 months and 24 or more months of follow-up. Finally, Cox multivariate analysis adjusted for demographic, clinical and nutritional variables showed MIS as the only significant predictor of mortality. CONCLUSION: MIS is an independent predictor of mortality in hemodialysis patients.

Advanced glycation end-products (AGEs) accumulation in skin: relations with chronic kidney disease-mineral and bone disorder.

INTRODUCTION: Chronic kidney disease (CKD) is associated with high morbidity and mortality rates, main causes related with cardiovascular disease (CVD) and bone mineral disorder (CKD-BMD). Uremic toxins, as advanced glycation end products (AGEs), are non-traditional cardiovascular risk factor and play a role on development of CKD-BMD in CKD. The measurement of skin autofluorescence (sAF) is a noninvasive method to assess the level of AGEs in tissue, validated in CKD patients. OBJECTIVE: The aim of this study is analyze AGEs measured by sAF levels (AGEs-sAF) and its relations with CVD and BMD parameters in HD patients. METHODS: Twenty prevalent HD patients (HD group) and healthy subjects (Control group, n = 24), performed biochemical tests and measurements of anthropometric parameters and AGEs-sAF. In addition, HD group performed measurement of intact parathormone (iPTH), transthoracic echocardiogram and radiographies of pelvis and hands for vascular calcification score. RESULTS: AGEs-sAF levels are elevated both in HD and control subjects ranged according to the age, although higher at HD than control group. Single high-flux HD session does not affect AGEs-sAF levels. AGEs-sAF levels were not related to ventricular mass, interventricular septum or vascular calcification in HD group. AGEs-sAF levels were negatively associated with serum iPTH levels. CONCLUSION: Our study detected a negative correlation of AGEs-sAF with serum iPTH, suggesting a role of AGEs on the pathophysiology of bone disease in HD prevalent patients. The nature of this relation and the clinical application of this non-invasive methodology for evaluation AGEs deposition must be confirmed and clarified in future studies.