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1.
J Clin Med ; 13(11)2024 May 30.
Article in English | MEDLINE | ID: mdl-38892922

ABSTRACT

The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90-120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.

2.
Cancers (Basel) ; 15(4)2023 Feb 06.
Article in English | MEDLINE | ID: mdl-36831365

ABSTRACT

(1) Purpose: Recent studies indicate that advanced imaging parameters such as prostate PSMA tumor volume may have a value in predicting response to treatment of castration-resistant prostate cancer patients. In this study, we examine whether a relationship can be found between advanced imaging parameters such as prostate PSMA-TV and the presence of metastatic disease in newly diagnosed prostate cancer patients undergoing PSMA-PET/CT for staging purposes; (2) Methods: We retrospectively analyzed PET/CT studies of 91 patients with newly diagnosed prostate cancer. Prostate PSMA-TV was measured using the MIRADA-XD software. PET/CT results were recorded, as well as additional clinical parameters such as the Gleason score, etc.; (3) Results: Prostate PSMA-TV measurements were found to be able to significantly differentiate metastatic from the non-metastatic patient groups (13.7 vs. 5.5, p-value < 0.05). Overall, 54% percent of patients with levels of over 8.1 PSMA-TV had metastatic lesions found on their PSMA-PET/CT. A model based on this cutoff attained a sensitivity of 80%, a specificity of 68.3%, and a negative predictive value of 93.5% for identifying metastatic disease. Another bin model was found statistically capable of assessing the likelihood of the presence of metastatic disease with a p-value of 0.001; (4) Conclusions: Prostate PSMA-TV measurement has the potential to predict the presence of metastatic disease at staging and thus may impact further treatment decision and patient management.

3.
Biology (Basel) ; 12(2)2023 Jan 29.
Article in English | MEDLINE | ID: mdl-36829493

ABSTRACT

BACKGROUND AND OBJECTIVES: In ice hockey, the major physical workload comes from acceleration in all planes of motion and transitions between skating trajectories. Hockey players' anthropometric characteristics correlate with performance. In team sports, the use of ergogenic drugs for recovery is relevant to avoid athletes' overtraining. It is very important to protect athletes' health and allow them to maintain high-performance levels. Cytoflavin is an ergogenic drug whose action is based on the combined effects of its active ingredients (succinic acid, inosine, nicotinamide and riboflavin), which are naturally occurring metabolites that stimulate tissue respiration. The study aimed to assess the 6-week Cytoflavin consumption effects on body composition (body weight, body mass index, body fat percentage and bioimpedance phase angle) and aerobic performance. METHODS: This study included 60 male professional hockey players (aged 19 to 36 years) divided into two groups of 30 subjects: group I (body weight 87.90 ± 7.44 kg, BMI 25.86 ± 2.04 kg/m2) and group II (body weight 87.04 ± 6.22 kg, BMI 25.52 ± 2.38 kg/m2). Athletes in group I received Cytoflavin, whereas athletes in group II did not. RESULTS: In group I, statistically significant reductions in body weight and body mass index were not observed until 14 and 35 days, respectively. In contrast, in group II, both body weight and BMI significantly decreased both times. Aerobic performance significantly increased in both groups, with significantly greater increases in group I. CONCLUSIONS: Cytoflavin can be considered an ergogenic drug that improves body composition parameters, especially in the control of weight reduction and improvement in aerobic performance.

4.
Med Gas Res ; 13(3): 128-132, 2023.
Article in English | MEDLINE | ID: mdl-36571378

ABSTRACT

Nitric oxide can activate neutrophils and macrophages, facilitate the synthesis of collagen, which allows significantly accelerating the regeneration of traumatized tissues. We studied the effects of nitric oxide-containing gas flow generated by plasma-chemical device "Plason" in a rat model of full-thickness wounds. Histological and morphometric analyses revealed that Plason treated wounds expressed significantly fewer signs of inflammation and contained a more mature granulation tissue on day 4 after the operation. Considering the results of the experimental study, we applied the Plason device in sports medicine for the treatment of lower limb bruises of 34 professional soccer players. Athletes were asked to assess the intensity of pain with the Visual Analogue Scale. Girths of their lower limbs were measured over the course of rehabilitation. Nitric oxide therapy of full-thickness wounds inhibited inflammation and accelerated the regeneration of skin and muscle tissues. Compared with the control, we observed a significant reduction in pain syndrome on days 2-7 after injuries, edema, and hematoma, and shortened treatment duration. This pilot study indicates that the use of nitric oxide is a promising treatment method for sports injuries.


Subject(s)
Soccer , Wound Healing , Humans , Rats , Animals , Nitric Oxide , Pilot Projects , Inflammation/drug therapy , Pain/drug therapy
5.
Am J Mens Health ; 16(6): 15579883221136983, 2022.
Article in English | MEDLINE | ID: mdl-36458594

ABSTRACT

Heart diseases are the most common non-communicable diseases worldwide. We examined the prevalence of risk factors for heart disease among a sub-population of working men. In total, 11,059 railway crew workers of the Russian Railways Company were included in the study. We also asked participants to answer several questions based on the WHO STEPwise approach to surveillance (STEPS) translated into Russian. Only 30% of drivers had normal body mass index (BMI), whereas 70% were overweight or obese. In 12% of subjects, total cholesterol was higher than 5 mmol/L. In 15% of participants, glucose level was higher than 5.5 mmol/L. 38% of drivers reported smoking. Physical inactivity was registered in 54% of persons. Only 29% ate according to the key principles of good diet quality. 24% of respondents had a family history of heart disease. MANOVA demonstrated that BMI was determined by age, profession, smoking, physical inactivity, and diet quality. As age increased, the number of people with normal cholesterol levels decreased. It was demonstrated that a correlation existed between glucose levels and BMI. In the total group, the correlation was 0.46 (p < .05). The correlation between those parameters increased due to age, from 0.33 in the <30 years of age group up to 0.52 in the >50 years of age group. This study demonstrated that there is a high prevalence of risk factors for heart disease in train drivers in the Russian Federation.


Subject(s)
Heart Diseases , Male , Humans , Adult , Middle Aged , Risk Factors , Heart Diseases/epidemiology , Heart Disease Risk Factors , Cholesterol , Glucose
6.
Front Endocrinol (Lausanne) ; 13: 985297, 2022.
Article in English | MEDLINE | ID: mdl-36034451

ABSTRACT

While participating in an intensive training process, the athlete's body requires not only energy, but also specific macro- and microelements. The purpose of this study was to show the meaning of monitoring the level of mineral trace elements in athletes-wrestlers during physical activity. As an experimental group, 66 male wrestlers aged 18-20 years with at least 3 years of intensive wrestling experience were examined. The control group consisted of 92 young cadets of military school aged 18-20 years, who had previous sports training, but were not engaged in wrestling. To determine the quantitative content of trace elements, the hair was cut from the back of the head for the entire length in an amount of at least 0.1 g. an examined using the mass spectrometer ICP-MS Agilent 7900. Strong positive correlations were found for sodium with potassium and rubidium, magnesium with calcium, potassium with rubidium, and rubidium with caesium among wrestlers. Wrestlers were found to have higher levels of a number of macro- and microelements, including toxic ones.


Subject(s)
Trace Elements , Wrestling , Child , Hair , Humans , Male , Potassium , Rubidium
7.
Article in English | MEDLINE | ID: mdl-35742665

ABSTRACT

PURPOSE: The purpose of this study is to examine the prevalence of workplace exposure, behavior, and individual health conditions, along with resulting medical activity among locomotive crew members depending on their place of work. PATIENTS AND METHODS: Participants included 5585 train drivers and 3723 train drivers' assistants (7% of the total train operators in the Russian Federation). Measured height and weight were used to calculate body mass index (BMI), and waist circumference, pulse rate, and blood pressure were also measured. The risk assessment was conducted using the STEPS tool. The level of commitment to a Healthy Lifestyle was assessed based on World Health Organization recommendations. Occupational risk factors were surveyed. Morbidity was analyzed over the past year. RESULTS: The lowest frequency of work exposure risk factors was found for employees of the Trans-Baikal railway; the highest was among Krasnoyarsk, North, and South-East. The participants from the Far East and October Railways had the lowest self-reported frequency of behavioral risk factors. The participants from the Eastern Siberian, October, and Southern Urals railways had the lowest occurrence of individual health conditions. The participants from the East Siberian, Far East, Kuibyshev, and Sverdlovsk railways were the least likely to visit their doctor, take temporary disability leave, or be hospitalized. The total assessed Healthy Lifestyle commitment index was higher for participants from the Far Eastern and Southern Urals railways. The participants from the Moscow and October railways were the least committed to a Healthy Lifestyle. CONCLUSIONS: Significant differences exist between risk factors and Healthy Lifestyle commitment between railways. Future research should examine changes due to a new corporate health program introduced in 2020.


Subject(s)
Railroads , Body Mass Index , Employment , Humans , Risk Factors , Workplace
8.
Biomed Res Int ; 2022: 4769560, 2022.
Article in English | MEDLINE | ID: mdl-35722458

ABSTRACT

The purpose of this investigation was to assess the acute effects of partial range of motion (pROM) exercises, on the accuracy of soccer penalty kicks on goal. This method limits the joint from moving through the complete length of a motion, creates an occlusion effect, and thus causes the type 1 muscle fibers to work anaerobically. Thirty-six soccer players, with 5-8 years of soccer playing experience, were pretested for accuracy then retested (rtt = 0.92) and divided into random groups from the Associação Banco do Brasil Futebol Clube-Group A, Paraná Futebol Clube-Group P, and Coritiba Futebol Clube-Group C. Groups were composed of 12 people performing full range of motion (fROM) exercises or pROM exercises. Both groups performed 5 sets of back squats at 50% of body weight in sets of 40 seconds with metronome tempo of 56 bpm for an average of 10-12 repetitions per 40-second set. Blood samples were collected post-warm-up, after the 3rd set, and following the 5th set for both groups, within 3-5 minutes of cessation of exercise. Athletes performing fROM exercises showed increased blood lactate from 2.69 ± 0.2 to 4.0 ± 1.2 mmol/L (p < 0.05), and in pROM, blood lactate increased from 2.48 ± 0.42 to 10.29 ± 1.3 mmol/L (p < 0.001). In fROM, accuracy decreased from 42.96 ± 13.39% to 41.37 ± 17.25% (p > 0.1), a slight decrease, while in the pROM groups, accuracy decreased from 45.42 ± 14.93% to 24.53 ± 10.2% (p < 0.001). The calculations demonstrating average percentages of accuracy are presented in the tables. These findings support that pROM exercises significantly increase blood lactate resulting in a reduction in soccer kick accuracy. This decrease in accuracy directly correlates to the accumulation of lactic acid and hydrogen ions (H+) and demonstrates that pROM strength training should not be utilized prior to a sport-specific session in order to avoid interference with the development of special skills.


Subject(s)
Athletic Performance , Resistance Training , Soccer , Athletes , Athletic Performance/physiology , Humans , Lactic Acid , Range of Motion, Articular , Resistance Training/methods , Soccer/physiology
9.
Drug Des Devel Ther ; 16: 349-362, 2022.
Article in English | MEDLINE | ID: mdl-35210752

ABSTRACT

BACKGROUND: Ditrosyl iron complexes (DNIC) are endogenous donors of nitric oxide. The possibility of their application to stimulate regeneration has been studied for more than 15 years. However, the most effective dose and form of delivery have not yet been determined. PURPOSE: The aim of this research was to develop a spray form of DNIC that accelerates wound healing. METHODS: We prepared a series of DNIC sprays with spray dosages of 10, 50 and 100 µg. We modelled full-thickness skin wounds in 24 Wistar rats and treated them with distilled water (n = 6), 10 (n = 6), 50 (n = 6) and 100 µg (n = 6) for three post-operative days. On the fourth day, the excised wound tissues were studied by morphological, immunohistochemical and morphometric methods. RESULTS: We demonstrated that 50 µg of DNIC spray had the most beneficial effect on wound healing: the thickness of the granulation tissue layer was 140% higher, vimentin positive fibroblasts predominated and the intensity of inflammation was significantly lower than in the control. There was a dose-dependent decrease in the functional activity of mast cells in the experimental groups compared to the control. CONCLUSION: DNIC spray is a potential effective dosage form for the treatment of large-area skin lesions.


Subject(s)
Nitric Oxide Donors , Wound Healing , Animals , Iron , Nitric Oxide/chemistry , Nitric Oxide Donors/pharmacology , Rats , Rats, Wistar , Skin
10.
Rev Cardiovasc Med ; 23(1): 21, 2022 01 17.
Article in English | MEDLINE | ID: mdl-35092213

ABSTRACT

After reading with great interest the article entitled: "Exploring the impact of the COVID-19 pandemic on provision of cardiology services: a scoping review" redacted by Farah Yasmin et al., published by Reviews in Cardiovascular Medicine, we would like to add the following thoughts. Acute respiratory distress syndrome (ARDS) in Coronavirus disease 2019 (COVID-19) and pulmonary insufficiency reduces blood oxygen saturation and results in hypoxia. Therefore, the determining factor in the survival of patients with COVID-19 is their resistance to hypoxia. At the same time, it is the cardiovascular system that is an important and very sensitive link in the human adaptation to hypoxia. That is why it is necessary to carefully study the relationship between diseases of the heart, blood vessels, the reactivity of the cardiovascular system to hypoxia, and mortality in patients who develop ARDS with COVID-19.


Subject(s)
COVID-19 , Cardiology , Cardiovascular System , Respiratory Insufficiency , Humans , Hypoxia/diagnosis , Hypoxia/epidemiology , Hypoxia/therapy , Pandemics , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/therapy , SARS-CoV-2
11.
Eur J Transl Myol ; 31(4)2021 Oct 01.
Article in English | MEDLINE | ID: mdl-34595898

ABSTRACT

Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.

13.
BMC Nephrol ; 21(1): 530, 2020 12 07.
Article in English | MEDLINE | ID: mdl-33287733

ABSTRACT

BACKGROUND: The iron-based phosphate binder (PB), sucroferric oxyhydroxide (SFOH), demonstrated its effectiveness for lowering serum phosphate levels, with low daily pill burden, in clinical trials of dialysis patients with hyperphosphatemia. This retrospective database analysis evaluated the real-world effectiveness of SFOH for controlling serum phosphate in European hemodialysis patients. METHODS: De-identified patient data were extracted from a clinical database (EuCliD®) for adult hemodialysis patients from France, Italy, Portugal, Russia and Spain who were newly prescribed SFOH for up to 1 year as part of routine clinical care. Serum phosphate and pill burden were compared between baseline (3-month period before starting SFOH) and four consecutive quarterly periods of SFOH therapy (Q1-Q4; 12 months) in the overall cohort and three subgroups: PB-naïve patients treated with SFOH monotherapy (mSFOH), and PB-pretreated patients who were either switched to SFOH monotherapy (PB → mSFOH), or received SFOH in addition to another PB (PB + SFOH). RESULTS: 1096 hemodialysis patients (mean age: 60.6 years; 65.8% male) were analyzed, including 796, 188 and 53 patients in, respectively, the PB + SFOH, mSFOH, and PB → mSFOH groups. In the overall cohort, serum phosphate decreased significantly from 1.88 mmol/L at baseline to 1.77-1.69 mmol/L during Q1-Q4, and the proportion of patients achieving serum phosphate ≤1.78 mmol/L increased from 41.3% at baseline to 56.2-62.7% during SFOH treatment. Mean PB pill burden decreased from 6.3 pills/day at baseline to 5.0-5.3 pills/day during Q1-Q4. The subgroup analysis found the proportion of patients achieving serum phosphate ≤1.78 mmol/L increased significantly from baseline during SFOH treatment in the PB + SFOH group (from 38.1% up to 60.9% [Q2]) and the mSFOH group (from 49.5% up to 75.2% [Q2]), but there were no significant changes in the PB → mSFOH group. For the PB + SFOH group, serum phosphate reductions were achieved with a similar number of PB pills prescribed at baseline prior to SFOH treatment (6.5 vs 6.2 pills/day at Q4). SFOH daily pill burden was low across all 3 subgroups (2.1-2.8 pills/day). CONCLUSION: In this real-world study of European hemodialysis patients, prescription of SFOH as monotherapy to PB-naïve patients, or in addition to existing PB therapy, was associated with significant improvements in serum phosphate control and a low daily pill burden.


Subject(s)
Chelating Agents/therapeutic use , Ferric Compounds/therapeutic use , Hyperphosphatemia/drug therapy , Kidney Failure, Chronic/therapy , Renal Dialysis , Sucrose/therapeutic use , Aged , Databases, Factual , Drug Combinations , Europe , Female , Humans , Hyperphosphatemia/blood , Hyperphosphatemia/etiology , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/complications , Male , Middle Aged
14.
Article in English | MEDLINE | ID: mdl-32188073

ABSTRACT

In some countries, obesity rates among police officers are higher than the general public, despite physically demanding jobs. Obesity rates based on body mass index (BMI) may lack accuracy as BMI does not directly address body composition. Since data are lacking for obesity rates among Russian police officers, this study documented and compared officer obesity rates to the adult Russian population and compared the accuracy of body mass index (BMI) for obesity classification to two direct measures of body composition. Moscow region police officers (N = 182, 84% men) underwent height, weight, waist circumference (WC), and body fat percentage (BF%) bioelectrical impedance measurements during annual medical examinations. BMI-defined obesity rates were 4.6% for men and 17.2% for women, which were >3 and >1.8 times lower than Russian adults, respectively. WC-defined obesity rates were similar to BMI (3.3% for men and 10.3% for women), but BF%-defined obesity rates were much higher (22.2% for men and 55.2% for women). Although obesity rates were lower than those found among police officers in other countries, BMI alone was not a particularly accurate method for classifying weight status among Russian police officers.


Subject(s)
Body Composition , Body Mass Index , Obesity , Police , Adipose Tissue , Adult , Cross-Sectional Studies , Female , Humans , Male , Moscow , Russia , Waist Circumference
15.
Int Q Community Health Educ ; 37(2): 93-98, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28103767

ABSTRACT

Purpose To analyze the prevalence of risk factors among Russian students. Methods In this study, 834 students were included from five Federal universities which were localized in four Federal regions of Russian Federation. Future doctors, school teachers, and wellness trainers were included in this study. Students were specifically asked about smoking, physical activity International Physical Activity Questionnaire (IPAQ), and food preference. Waist, hip, weight, and height were measured. Results The region of study and ethnic group were not influenced with respect to age and body mass index ( p > .1), while all other factors had a significant influence ( p < .05). High levels of smoking, hypodynamia, and motivation to intake of unhealthy food were found in medical students in comparison with those in future teachers and wellness instructors ( p < .05). The indicators of central obesity (due to levels of body mass index and waist-hip ratio) were found in medical students. Perspective Special programs to prevent the most common behavior risk factors in future medical doctors have to be designed.


Subject(s)
Exercise , Food Preferences , Health Behavior , Smoking/epidemiology , Students/statistics & numerical data , Adolescent , Body Mass Index , Body Weights and Measures , Ethnicity , Female , Humans , Male , Motivation , Obesity/epidemiology , Residence Characteristics , Risk Factors , Russia , Sedentary Behavior , Universities , Young Adult
16.
Int Q Community Health Educ ; 36(4): 219-225, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27628684

ABSTRACT

Purpose To analyze the prevalence of select behavioral risk factors among Russian university students majoring in medicine, education, and exercise science. Methods A total of 834 students from five Federal universities located in four federal regions of Russia were included in the study. The purposive sample included future doctors, school teachers, and fitness trainers. Students were asked specifically about smoking, level of physical activity, and food preferences. To calculate body mass indices (BMIs), waist, hip, weight, and height were also measured. Results Smoking rates, level of activity, and nutritional habits were significantly different by age, but BMI was not. Smoking rates and BMI were significantly different by gender, but level of activity and nutritional habits were not. Like the differences found by age, smoking rates, level of activity, and nutritional habits were significantly different by ethnicity, but BMI was not. There were significant difference across all behavioral health risk factors by region. The results show significantly higher levels of physical inactivity, consumption of unhealthy foods, and high BMIs among medical students compared with future teachers and wellness instructors ( p < .05). In the same time, the smoking levels are the highest among future teachers. The highest prevalence of smoking was found to be associated with gender (for females living Moscow and for males in rural regions), and Russian ethnic group. Conclusion Tailored programs to prevent common health behavior risk factors among future medical doctors are urgently needed in the Russian Federation.

17.
J Am Soc Nephrol ; 27(4): 1225-33, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26494833

ABSTRACT

Safety concerns with erythropoietin analogues and intravenous (IV) iron for treatment of anemia in CKD necessitate development of safer therapies. Roxadustat (FG-4592) is an orally bioavailable hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor that promotes coordinated erythropoiesis through HIF-mediated transcription. We performed an open-label, randomized hemoglobin (Hb) correction study in anemic (Hb≤10.0 g/dl) patients incident to hemodialysis (HD) or peritoneal dialysis (PD). Sixty patients received no iron, oral iron, or IV iron while treated with roxadustat for 12 weeks. Mean±SD baseline Hb was 8.3±1.0 g/dl in enrolled patients. Roxadustat at titrated doses increased mean Hb by ≥2.0 g/dl within 7 weeks regardless of baseline iron repletion status, C-reactive protein level, iron regimen, or dialysis modality. Mean±SEM maximal change in Hb from baseline (ΔHb(max)), the primary endpoint, was 3.1±0.2 g/dl over 12 weeks in efficacy-evaluable patients (n=55). In groups receiving oral or IV iron, ΔHb(max) was similar and larger than in the no-iron group. Hb response (increase in Hb of ≥1.0 g/dl from baseline) was achieved in 96% of efficacy-evaluable patients. Mean serum hepcidin decreased significantly 4 weeks into study: by 80% in HD patients receiving no iron (n=22), 52% in HD and PD patients receiving oral iron (n=21), and 41% in HD patients receiving IV iron (n=9). In summary, roxadustat was well tolerated and corrected anemia in incident HD and PD patients, regardless of baseline iron repletion status or C-reactive protein level and with oral or IV iron supplementation; it also reduced serum hepcidin levels.


Subject(s)
Anemia/drug therapy , Glycine/analogs & derivatives , Isoquinolines/therapeutic use , Renal Dialysis , Anemia/blood , Female , Glycine/therapeutic use , Hepcidins/blood , Humans , Male , Middle Aged , Peritoneal Dialysis
18.
J Ren Nutr ; 26(2): 72-80, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26627050

ABSTRACT

OBJECTIVE: In patients with advanced kidney disease, metabolic and nutritional derangements induced by uremia interact and reinforce each other in a deleterious vicious circle. Literature addressing the effect of dialysis initiation on changes in body composition (BC) is limited and contradictory. The aim of this study was to evaluate changes in BC in a large international cohort of incident hemodialysis patients. METHODS: A total of 8,227 incident adult end-stage renal disease patients with BC evaluation within the initial first 6 months of baseline, defined as 6 months after renal replacement therapy initiation, were considered. BC, including fat tissue index (FTI) and lean tissue index (LTI), were evaluated by Body Composition Monitor (BCM, Fresenius Medical Care, Bad Homburg, Germany). Exclusion criteria at baseline were lack of a BCM measurement before or after baseline, body mass index (BMI) < 18.5 kg/m(2), presence of metastatic solid tumors, treatment with a catheter, and prescription of less or more than 3 treatments per week. Maximum follow-up was 2 years. Descriptive analysis was performed comparing current values with the baseline in each interval (delta analysis). Linear mixed models considering the correlation structure of the repeated measurements were used to evaluate factors associated with different trends in FTI and LTI. RESULTS: BMI increased about 0.6 kg/m(2) over 24 months from baseline. This was associated with increase in FTI of about 0.95 kg/m(2) and a decrease in LTI of about 0.4 kg/m(2). Female gender, diabetic status, and low baseline FTI were associated with a significant greater increase of FTI. Age > 67 years, diabetes, male gender, high baseline LTI, and low baseline FTI were associated with a significant greater decrease of LTI. CONCLUSIONS: With the transition to hemodialysis, end-stage renal disease patients presented with distinctive changes in BC. These were mainly associated with gender, older age, presence of diabetes, low baseline FTI, and high baseline LTI. BMI increases did not fully represent the changes in BC.


Subject(s)
Body Composition , Renal Dialysis , Adiposity , Adolescent , Adult , Aged , Body Mass Index , Electric Impedance , Europe , Female , Follow-Up Studies , Humans , Kidney Failure, Chronic/therapy , Latin America , Longitudinal Studies , Middle Aged , South Africa , Young Adult
19.
Clin J Am Soc Nephrol ; 10(6): 1031-40, 2015 Jun 05.
Article in English | MEDLINE | ID: mdl-25904755

ABSTRACT

BACKGROUND AND OBJECTIVES: Direct comparison of cinacalcet and vitamin D analogs as monotherapies to lower parathyroid hormone (PTH) levels has not been undertaken. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a prospective, multicenter, phase 4, randomized, open-label study that enrolled participants from 2010 to 2012. Adult participants (n=312) on hemodialysis with PTH >450 pg/ml were randomized 1:1 to 12 months of treatment with either cinacalcet (n=155) or vitamin D analogs (n=157) to evaluate the mean percentage change in plasma PTH level (primary end point) and the proportion of participants achieving plasma PTH <300 pg/ml or a ≥30% decrease in PTH (secondary end points). A preplanned analysis to determine whether there were important region-by-treatment interactions was also undertaken. RESULTS: Baseline mean PTH was 846 pg/ml (n=155) for cinacalcet and 816 pg/ml (n=157) for vitamin D analog therapy. The mean (95% confidence interval) percentage change from baseline in PTH was -12.1% (-20.0% to -4.1%) in the cinacalcet arm and -7.0% (-14.9% to 0.8%) in the vitamin D analog arm, a difference of -5.0% (-15.4% to 5.4%) (P=0.35). Similarly, there was no difference in achievement of secondary efficacy end points between arms (19.4% and 15.3% of participants with PTH≤300 pg/ml and 42.6% and 33.8% of participants had a PTH reduction >30% in the cinacalcet and vitamin D analog arms, respectively). A prespecified analysis revealed a large treatment-by-region interaction, with nominally greater response to cinacalcet compared with vitamin D analogs in non-United States participants (US versus non-US participants, P<0.001). Hypocalcemia was more common in the cinacalcet arm, whereas hypercalcemia and hyperphosphatemia occurred more often in the vitamin D analog arm. CONCLUSIONS: Participants had similar modest reductions in PTH with either cinacalcet or vitamin D analog monotherapy over 52 weeks of treatment, but effects varied by region. Treatments differed with regard to effect on calcium and phosphorus levels.


Subject(s)
Calcimimetic Agents/therapeutic use , Cinacalcet/therapeutic use , Hyperparathyroidism, Secondary/drug therapy , Kidney Failure, Chronic/therapy , Renal Dialysis , Vitamin D/therapeutic use , Aged , Aged, 80 and over , Australia , Biomarkers/blood , Calcimimetic Agents/adverse effects , Canada , Cinacalcet/adverse effects , Female , Humans , Hyperparathyroidism, Secondary/blood , Hyperparathyroidism, Secondary/diagnosis , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/diagnosis , Male , Parathyroid Hormone/blood , Prospective Studies , Renal Dialysis/adverse effects , Russia , Time Factors , Treatment Outcome , United States , Vitamin D/adverse effects , Vitamin D/analogs & derivatives
20.
Clin J Am Soc Nephrol ; 10(6): 1021-30, 2015 Jun 05.
Article in English | MEDLINE | ID: mdl-25873267

ABSTRACT

BACKGROUND AND OBJECTIVES: Cinacalcet and vitamin D are often combined to treat secondary hyperparathyroidism (SHPT) in patients on dialysis. Independent effects on fibroblast growth factor-23 (FGF-23) concentrations in patients on hemodialysis administered cinacalcet or vitamin D analogs as monotherapies during treatment of SHPT are evaluated. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A multicenter, randomized, open-label study to compare the efficacy of cinacalcet versus traditional vitamin D therapy for management of secondary hyperparathyroidism among subjects undergoing hemodialysis (PARADIGM) was a prospective, phase 4, multicenter, randomized, open-label study conducted globally. Participants (n=312) were randomized 1:1 to cinacalcet (n=155) or vitamin D analog (n=157) for 52 weeks. Levels of FGF-23 were measured at baseline and weeks 20 and 52. The absolute and percentage changes from baseline in plasma FGF-23, parathyroid hormone (PTH), calcium (Ca), phosphorus (P), and calcium-phosphorus product (Ca×P) were assessed. Correlations and logistic regression were used to explore relationships between changes in FGF-23 and changes in PTH, Ca, P, and Ca×P from baseline to week 52 by treatment arm. RESULTS: Median (quartiles 1, 3) decrease in FGF-23 concentrations was observed in the cinacalcet arm (-40%; -63%, 16%) compared with median increase in the vitamin D analog arm (47%; 0%, 132%) at week 52 (P<0.001). Changes in FGF-23 in both arms were unrelated to changes in PTH (cinacalcet: r=0.17, P=0.11; vitamin D analog: r=-0.04, P=0.70). Changes in FGF-23 in the vitamin D analog but not the cinacalcet arm were correlated with changes in Ca (cinacalcet: r=0.11, P=0.30; vitamin D analog: r=0.32, P<0.01) and P (cinacalcet: r=0.19, P=0.07; vitamin D analog: r=0.49, P<0.001). Changes in FGF-23 were correlated with changes in Ca×P in both arms (cinacalcet: r=0.26, P=0.01; vitamin D analog: r=0.57, P<0.001). Independent of treatment arm, participants with reductions in P or Ca×P were significantly more likely to show reductions in FGF-23. CONCLUSIONS: During treatment of SHPT, cinacalcet use was associated with a decrease in FGF-23 concentrations, whereas vitamin D analogs were associated with an increase. The divergent effects of these treatments on FGF-23 seem to be independent of modification of PTH. It is possible that effects of cinacalcet and vitamin D analogs on FGF-23 may be mediated indirectly by other effects on bone and mineral metabolism.


Subject(s)
Calcimimetic Agents/therapeutic use , Cinacalcet/therapeutic use , Fibroblast Growth Factors/blood , Hyperparathyroidism, Secondary/drug therapy , Kidney Failure, Chronic/therapy , Renal Dialysis , Vitamin D/therapeutic use , Aged , Australia , Biomarkers/blood , Calcimimetic Agents/adverse effects , Calcium/blood , Canada , Chi-Square Distribution , Cinacalcet/adverse effects , Female , Fibroblast Growth Factor-23 , Humans , Hyperparathyroidism, Secondary/blood , Hyperparathyroidism, Secondary/diagnosis , Kidney Failure, Chronic/blood , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/diagnosis , Logistic Models , Male , Middle Aged , Parathyroid Hormone/blood , Phosphorus/blood , Prospective Studies , Renal Dialysis/adverse effects , Risk Factors , Russia , Time Factors , Treatment Outcome , United States , Vitamin D/adverse effects , Vitamin D/analogs & derivatives
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