Medication Prescription, Common Side-effects, and Nutritional Status are Associated in Patients With Chronic Kidney Disease.

OBJECTIVE: Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and nutritional status in patients with CKD. METHODS: Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history and the number and type of currently prescribed medications were collected from patients' records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia. RESULTS: Two hundred seventeen patients with CKD were included in this cross-sectional study (n = 112 with pre-dialysis CKD stages 3-5, n = 33 with hemodialysis, and n = 72 with kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, whereas prescription of medications with xerostomia as a side-effect was associated with lower handgrip strength. CONCLUSION: Medication prescription was associated with poor nutritional status in patients with CKD, and monitoring of nutritional status in patients with CKD with long medication lists is warranted to identify and treat patients with poor nutritional status.

Correction to: High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study.

Following publication of the original article [1], the authors reported an error in the presentation of Table 3 and Table 4.

High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study.

BACKGROUND: Poor nutritional status of patients with renal disease has been associated with worsening of renal function and poor health outcomes. Simply measuring weight and height for calculation of the body mass index does however not capture the true picture of nutritional status in these patients. Therefore, we measured nutritional status by BMI, body composition, waist circumference, dietary intake and nutritional screening in three groups of renal patients. METHODS: Patients with chronic kidney disease not on renal replacement therapy (CKD stages 3-5, n = 112), after renal transplantation (n = 72) and patients treated with hemodialysis (n = 24) were recruited in a tertiary hospital in Bergen, Norway in a cross-sectional observational study. Dietary intake was assessed by a single 24 h recall. All patients underwent nutritional screening, anthropometric measurements, body composition measurement andfunctional measurements (hand grip strength). The prevalence of overweight and obesity, central obesity, sarcopenia, sarcopenic obesity and nutritional risk was calculated. RESULTS: Central obesity and sarcopenia were present in 49% and 35% of patients, respectively. 49% of patients with central obesity were normal weight or overweight according to their BMI. Factors associated with central obesity were a diagnosis of diabetes and increased fat mass, while factors associated with sarcopenia were age, female gender, number of medications. An increase in the BMI was associated with lower risk for sarcopenia. CONCLUSION: Central obesity and sarcopenia were present in renal patients at all disease stages. More attention to these unfavorable nutritional states is warranted in these patients.

[Nephrogenic systemic fibrosis and use of MR contrast media]. / Nefrogen systemisk fibrose ved bruk av MR-kontrastmiddel.

BACKGROUND: Nephrogenic systemic fibrosis (NSF) is a new and probably iatrogenic disorder. It was first described time in 2000 and associated with the use of gadolinium containing MR contrast media in patients with impaired renal function in 2006. MATERIAL AND METHOD: We describe a case of NSF identified at Haukeland University Hospital and give a brief overview of the disease, based on literature retrieved from a non-systematic search. RESULTS AND INTERPRETATION: NSF is a serious systemic disorder with active inflammation and fibrosis, particularly in skin, but also in other tissue such as skeletal muscle, heart and oesophagus. The condition is very difficult to treat. Awareness of the illness has led to changes in guidelines and clinical practice regarding use of gadolinium-containing contrast media in patients with renal impairment.