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1.
J Ren Nutr ; 2024 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-38897365

RESUMEN

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.

3.
Eur J Clin Nutr ; 77(2): 292-294, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36329200

RESUMEN

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.


Asunto(s)
Músculo Esquelético , Diálisis Peritoneal , Humanos , Masculino , Fuerza de la Mano , Estudios Prospectivos , Miostatina , Hospitalización
4.
J Ren Nutr ; 32(6): 739-743, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-35131413

RESUMEN

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.


Asunto(s)
Diabetes Mellitus , Desnutrición , Sarcopenia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza de la Mano/fisiología , Sarcopenia/epidemiología , Estudios Transversales , Creatinina , Desnutrición/epidemiología , Diálisis Renal , Estado Nutricional , Inflamación , Albúminas
5.
J Ren Nutr ; 32(4): 469-475, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-34426053

RESUMEN

OBJECTIVE: The aim of this study is to assess the association of nutritional status and quality of life with low physical function, according to the revised European Working Group on Sarcopenia in Older People (EWGSOP) - sarcopenia consensus cut-offs in maintenance hemodialysis patients. DESIGN AND METHODS: This is a cross-sectional study including patients on maintenance hemodialysis. Participants were submitted to a single evaluation of physical function, nutritional status, and quality of life. Handgrip strength, Short Physical Performance Battery (SPPB), sit-to-stand test, and gait speed were performed to evaluate physical function. Cut-offs proposed by the revised EWGSOP consensus were considered. Malnutrition Inflammation Score was used to assess nutritional status. Quality of life was assessed by the 36-Item Short Form Health Survey. RESULTS: Seventy-seven patients were enrolled, 64.9% male, mean age 55 ± 14 years. According to the cut-offs proposed by the most recent EWGSOP consensus, 55.8% of patients presented SPPB <8, 48.1% gait speed test ≤0.8 m/seconds, sit-to-stand test >15 seconds, and 39.0% handgrip strength <27 kg and <16 kg for men and women, respectively. Malnutrition Inflammation Score was significantly associated with all physical function parameters, except gait speed, in receiver operating characteristic curve and logistic regression. The 36-Item Short Form Health Survey domains or component summary were associated with SSPB, gait speed, and handgrip strength in logistic regression. CONCLUSION: Poor nutritional status and quality of life are associated with low physical function (according to the cut-offs proposed by EWGSOP) in hemodialysis patients.


Asunto(s)
Desnutrición , Sarcopenia , Adulto , Anciano , Consenso , Estudios Transversales , Femenino , Evaluación Geriátrica , Fuerza de la Mano , Humanos , Inflamación , Masculino , Desnutrición/epidemiología , Persona de Mediana Edad , Estado Nutricional , Calidad de Vida , Diálisis Renal
6.
Nutr Clin Pract ; 37(6): 1348-1355, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34970778

RESUMEN

BACKGROUND: There are many consensuses to diagnose sarcopenia, and their agreement in patients receiving hemodialysis (HD) is not clear. We described the sarcopenia prevalence in patients receiving HD using different consensuses and analyzed their level of agreement. METHODS: Sixty-seven patients (43 men, 55 ± 14.6 years) were evaluated for appendicular skeletal muscle mass using dual-energy x-ray absorptiometry and muscle strength using handgrip strength. Patients were classified according to different sarcopenia consensuses (European Working Group on Sarcopenia in Older People [EWGSOP], Revised EWGSOP [EWGSOP2], Foundation for the National Institutes of Health Project [FNIH], and Asian Working Group for Sarcopenia 2019 [AWGS2]). Kappa analysis identified the level of agreement. RESULTS: The prevalence of sarcopenia ranged from 1.5% to 11.9% depending on the sarcopenia consensus. The agreement between the different consensuses ranged from poor to almost perfect. FNIH and EWGSOP showed the lowest agreement (κ = 0.20; 95% CI, -0.14 to 0.54; P < 0.05), whereas EWGSOP2 and AWGS2 had the largest κ = 0.90 (95% CI, 0.71 to 1.00; P < 0.001). When stratified by age (≥60 years), the sarcopenia prevalence was higher in the older group (27% vs 2%; P = 0.004). In addition, male participants seemed to be more prone to sarcopenia compared with female counterparts, but this difference was not statistically confirmed (16% vs 4%; P = 0.242). CONCLUSION: The sarcopenia consensuses showed from poor to almost perfect agreement, which varied the sarcopenia prevalence rates in patients receiving HD. EWGSOP2 and AWGS2 showed the largest agreement.


Asunto(s)
Sarcopenia , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Sarcopenia/etiología , Fuerza de la Mano/fisiología , Consenso , Absorciometría de Fotón , Diálisis Renal/efectos adversos , Prevalencia
7.
Kidney Res Clin Pract ; 40(2): 294-303, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-34078025

RESUMEN

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.

8.
Front Nutr ; 8: 686245, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34136523

RESUMEN

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.

9.
Hemodial Int ; 2021 Mar 10.
Artículo en Inglés | MEDLINE | ID: mdl-33694274

RESUMEN

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.

10.
J Ren Nutr ; 31(3): 320-326, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-32958375

RESUMEN

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.


Asunto(s)
Nitrógeno , Diálisis Peritoneal , Adolescente , Adulto , Anciano , Soluciones para Diálisis , Proteínas en la Dieta , Humanos , Persona de Mediana Edad , Diálisis Renal
11.
Eur J Clin Nutr ; 74(2): 357-358, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31831841

RESUMEN

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

12.
Clin Nutr ESPEN ; 34: 137-141, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31677704

RESUMEN

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.


Asunto(s)
Anorexia/metabolismo , Hormona Paratiroidea/metabolismo , Diálisis Renal/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Anorexia/diagnóstico , Apetito , Composición Corporal , Estudios Transversales , Ingestión de Alimentos , Femenino , Humanos , Inflamación/complicaciones , Masculino , Persona de Mediana Edad , Evaluación Nutricional , Estado Nutricional , Encuestas y Cuestionarios , Síndrome Debilitante/complicaciones , Síndrome Debilitante/diagnóstico , Zinc
13.
Eur J Clin Nutr ; 73(8): 1209-1211, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31300725

RESUMEN

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.


Asunto(s)
Músculo Esquelético/fisiopatología , Diálisis Peritoneal/estadística & datos numéricos , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia , Sarcopenia/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Consenso , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Marcha , Fuerza de la Mano , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular , Prevalencia , Sarcopenia/fisiopatología , Adulto Joven
14.
Am J Physiol Renal Physiol ; 314(6): F1188-F1196, 2018 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29412705

RESUMEN

There is a growing consensus that patients with chronic kidney disease (CKD) should engage in regular exercise, but there is a lack of formal guidelines. In this report, we determined whether combined aerobic and resistance exercise would elicit superior physiological gains, in particular muscular strength, compared with aerobic training alone in nondialysis CKD. Nondialysis patients with CKD stages 3b-5 were randomly allocated to aerobic exercise {AE, n = 21; 9 men; median age 63 [interquartile range (IQR) 58-71] yr; median estimated glomerular filtration rate (eGFR) 24 (IQR 20-30) ml·min-1·1.73 m-2} or combined exercise [CE, n = 20, 9 men, median age 63 (IQR 51-69) yr, median eGFR 27 (IQR 22-32) ml·min-1·1.73 m-2], preceded by a 6-wk run-in control period. Patients then underwent 12 wk of supervised AE (treadmill, rowing, or cycling exercise) or CE training (as AE plus leg extension and leg press exercise) performed three times per week. Outcome assessments of knee extensor muscle strength, quadriceps muscle volume, exercise capacity, and central hemodynamics were performed at baseline, following the 6-wk control period, and at the end of the intervention. AE and CE resulted in significant increases in knee extensor strength of 16 ± 19% (mean ± SD; P = 0.001) and 48 ± 37% ( P < 0.001), respectively, which were greater after CE ( P = 0.02). AE and CE resulted in 5 ± 7% ( P = 0.04) and 9 ± 7% ( P < 0.001) increases in quadriceps volume, respectively ( P < 0.001), which were greater after CE ( P = 0.01). Both AE and CE increased distance walked in the incremental shuttle walk test [28 ± 44 m ( P = 0.01) and 32 ± 45 m ( P = 0.01), respectively]. In nondialysis CKD, the addition of resistance exercise to aerobic exercise confers greater increases in muscle mass and strength than aerobic exercise alone.


Asunto(s)
Terapia por Ejercicio/métodos , Fuerza Muscular , Músculo Cuádriceps/fisiopatología , Insuficiencia Renal Crónica/terapia , Entrenamiento de Fuerza , Anciano , Capacidad Cardiovascular , Inglaterra , Prueba de Esfuerzo , Tolerancia al Ejercicio , Femenino , Tasa de Filtración Glomerular , Estado de Salud , Humanos , Riñón/fisiopatología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Músculo Cuádriceps/diagnóstico por imagen , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/fisiopatología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
15.
Nutrire Rev. Soc. Bras. Aliment. Nutr ; 42: 1-7, Dec. 2017. tab, ilus
Artículo en Inglés | LILACS | ID: biblio-881050

RESUMEN

Evaluation of body fat and its distribution are important because they can predict several risk factors, mainly cardiovascular risk. Imaging techniques have high precision and accuracy for body fat measurement. However, trained personnel are required and the cost is high. Anthropometric indices might be used to evaluate body fat and its distribution in general population. In chronic kidney disease patients, studies have been indicating that overweight status improves survival rates. On the other hand, visceral fat accumulation is associated with inflammatory responses and insulin resistance. This narrative review discusses particularities of fat distribution in metabolic context and the relevance of available methods for abdominal adiposity evaluation in chronic kidney disease and end-stage renal disease patients.


Asunto(s)
Humanos , Masculino , Femenino , Obesidad Abdominal , Insuficiencia Renal Crónica/complicaciones , Factores de Riesgo , Pesos y Medidas Corporales/estadística & datos numéricos
16.
Clin Nutr ESPEN ; 17: 63-67, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28361749

RESUMEN

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.


Asunto(s)
Técnicas de Apoyo para la Decisión , Inflamación/diagnóstico , Fallo Renal Crónico/terapia , Desnutrición/diagnóstico , Evaluación Nutricional , Estado Nutricional , Diálisis Renal/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Brasil/epidemiología , Distribución de Chi-Cuadrado , Femenino , Humanos , Inflamación/mortalidad , Inflamación/fisiopatología , Estimación de Kaplan-Meier , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Fallo Renal Crónico/fisiopatología , Masculino , Desnutrición/mortalidad , Desnutrición/fisiopatología , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Prevalencia , Modelos de Riesgos Proporcionales , Curva ROC , Diálisis Renal/efectos adversos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
17.
Clin Nutr ; 36(4): 1170-1174, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-27595381

RESUMEN

BACKGROUND: Currently, the execution of indirect calorimetry, which is considered the gold standard for measuring energy expenditure, is not indicate during dialysis, and it may interfere on nutritional therapy of these patients. This study aimed to evaluate the resting energy expenditure (REE) in patients with severe acute kidney injury treated by different modalities of dialysis and to identify whether dialysis influences on REE. METHODS: This was a prospective cohort study that evaluated patients admitted in intensive care units with diagnosis of acute kidney injury AKIN-3, mechanically ventilated, and submitted to conventional hemodialysis (CHD), extended hemodialysis (EHD) or high volume peritoneal dialysis (HVPD). Indirect calorimetry was performed at pre dialysis time and during the dialysis procedure. Parameters that could change REE were also evaluated. RESULTS: One-hundred patients undergoing 290 dialysis sessions were evaluated, with mean age 60.3 ± 17 years, 69% were male and 74% have died. There was no significant difference between REE of predialysis time and during dialysis time (2156 ± 659 kcal vs. 2100 ± 634 kcal, respectively, p = 0.15). No difference was observed in the REE before and during dialysis of different modalities. There were no differences between parameters pre and during dialysis of each modality. There was only a difference in norepinephrine dose, which was higher in pre dialysis time in HVPD and EHD modalities, compared with CHD modality. Moreover, during dialysis time, EHD modality had significantly higher VAD compared to other dialysis modalities. CONCLUSION: The three evaluated modalities did not change REE. Indirect calorimetry can be performed during dialysis procedures and there was no difference between ventilation parameters, sedatives use, body temperature and VAD in both moments.


Asunto(s)
Lesión Renal Aguda/terapia , Metabolismo Basal , Diálisis Peritoneal , Diálisis Renal , Lesión Renal Aguda/complicaciones , Lesión Renal Aguda/metabolismo , Lesión Renal Aguda/fisiopatología , Anciano , Metabolismo Basal/efectos de los fármacos , Temperatura Corporal , Brasil , Calorimetría Indirecta , Estudios de Cohortes , Enfermedad Crítica/terapia , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Norepinefrina/uso terapéutico , Diálisis Peritoneal/efectos adversos , Estudios Prospectivos , Diálisis Renal/efectos adversos , Respiración Artificial , Índice de Severidad de la Enfermedad , Factores de Tiempo , Vasoconstrictores/uso terapéutico
19.
Clin Nutr ; 35(6): 1429-1433, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27083497

RESUMEN

BACKGROUND & AIMS: Muscle wasting is associated with mortality in dialysis patients. The measurement of muscle mass has some limitations, while muscle strength assessment is simple, safe and allows the recognition of patients at risk of progressing to poor outcomes related to malnutrition. The aim of this study is verify if handgrip strength (HGS) is associated with all-cause mortality in patients in maintenance haemodialysis (HD) and peritoneal dialysis (PD). METHODS: This was an observational retrospective cohort study which included all patients in maintenance HD and PD from July 2012 to October 2014. Patients were followed-up until June 2015. RESULTS: Two-hundred sixty five patients were enrolled (218 HD and 47 PD) and they were followed for 13.4 ± 7.9 months. During the follow-up period, 53 patients (20%) have died, 36 patients (13.6%) have undergone renal transplantation, 13 patients (4.9%) have switched off dialysis method and 5 patients (1.9%) have transferred to another facility. The cut-off of HGS able to predict mortality was 22.5 kg for men and 7 kg for women. Using this cut-off to fit the Kaplan-Meier survival curve, the association of HGS with all-cause mortality for both genders was confirmed. Finally, in the multivariate analysis adjusted for demographic, clinical and nutritional variables, HGS remained significant predictor of mortality, independent of dialysis modality. CONCLUSIONS: HGS cut-offs that predict mortality were 22.5 kg for men and 7 kg for women. HGS was associated with mortality independent of dialysis modality.


Asunto(s)
Fuerza de la Mano , Fallo Renal Crónico/terapia , Mortalidad , Diálisis Peritoneal , Diálisis Renal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Análisis Multivariante , Evaluación Nutricional , Estado Nutricional , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Adulto Joven
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