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1.
Int Urol Nephrol ; 51(7): 1271-1278, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31119516

RESUMO

PURPOSE: Protein-energy wasting (PEW) is highly prevalent in end-stage renal disease (ESRD) patients with inflammation who are on haemodialysis treatment. Interleukin-18 (IL-18) is an important pro-inflammatory cytokine that is significantly elevated in ESRD patients. However, the relationship between PEW and IL-18 is unclear. We therefore performed a cross-sectional study on 100 ESRD patients undergoing haemodialysis to clarify this. METHODS: PEW was defined according to the diagnostic criteria of the International Society of Renal Nutrition and Metabolism. Inflammation was assessed based on the serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and IL-18. We analysed the association between PEW and IL-18 by using logistic analysis and linear regression after adjustment for basic characteristics, comorbidities and laboratory findings. RESULTS: Among the 100 haemodialysis patients who were recruited, 56 had PEW. Even though there was no difference between the PEW group and non-PEW group with regard to disease causes, age, gender, cholesterol, ferritin, and haemoglobin, the levels of inflammation indicators such as CRP, IL-6, TNF-α and IL-1ß were significantly higher in the PEW group. Moreover, IL-18 was found to contribute to PEW, but was negatively correlated with pre-albumin after adjustment for possible confounding factors. CONCLUSIONS: Thus, the findings indicate that IL-18 is associated with PEW in ESRD patients on haemodialysis, which suggests that IL-18 may be involved in the pathogenesis of PEW in this setting.


Assuntos
Interleucina-18/sangue , Falência Renal Crônica , Desnutrição Proteico-Calórica , Diálise Renal , Albumina Sérica/análise , Biomarcadores/sangue , China/epidemiologia , Correlação de Dados , Estudos Transversais , Feminino , Humanos , Inflamação/sangue , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/etiologia , Diálise Renal/efeitos adversos , Diálise Renal/métodos
2.
Nutrients ; 11(5)2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31137583

RESUMO

BACKGROUND: Since haemodialysis is a lifesaving therapy, adequate control measures are necessary to evaluate its adequacy and to constantly adjust the dose to reduce hospitalisation and prolong patient survival. Malnutrition is common in haemodialysis patients and closely related to morbidity and mortality. Patients undergoing haemodialysis have a high prevalence of protein-energy malnutrition and inflammation, along with abnormal iron status. The haemodialysis dose delivered is an important predictor of patient outcome. AIM: To evaluate through haemodialysis adequacy, which parameter(s), if any, better predict Kt/V, among those used to assess nutritional status, inflammation response, and iron status. METHODS: We retrospectively studied 78 patients undergoing haemodialysis due to end-stage renal disease. As parameters of nutritional status, geriatric nutritional risk index (GNRI), transferrin levels, lymphocyte count, and albumin concentration were analysed. As signs of inflammation, C reactive protein (CRP) levels and ferritin concentrations were studied as well. Iron status was evaluated by both transferrin and ferritin levels, as well as by haemoglobin (Hb) concentration. RESULTS: The core finding of our retrospective study is that transferrin levels predict the adequacy of haemodialysis expressed as Kt/V; the latter is the only predictor (P = 0.001) when adjusting for CRP concentrations, a solid marker of inflammation, and for ferritin levels considered an iron-storage protein, but also a parameter of inflammatory response. DISCUSSION AND CONCLUSION: In keeping with the results of this study, we underline that the use of transferrin levels to assess haemodialysis quality combine into a single test the evaluation of the three most important factors of protein-energy wasting.


Assuntos
Inflamação/sangue , Distúrbios do Metabolismo do Ferro/sangue , Falência Renal Crônica/terapia , Desnutrição Proteico-Calórica/sangue , Diálise Renal , Transferrina/metabolismo , Idoso , Biomarcadores/sangue , Feminino , Avaliação Geriátrica , Humanos , Inflamação/diagnóstico , Inflamação/etiologia , Mediadores da Inflamação/sangue , Ferro/sangue , Ferro/deficiência , Distúrbios do Metabolismo do Ferro/diagnóstico , Distúrbios do Metabolismo do Ferro/etiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Valor Preditivo dos Testes , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/etiologia , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Iran J Kidney Dis ; 13(1): 48-55, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30851719

RESUMO

INTRODUCTION: Protein-energy wasting (PEW) is prevalent in dialysis patients, and cardiovascular disease (CVD) is the leading cause of mortality in these patients. This study aimed to determine the prevalence of PEW and its relationship with CVD risk factors in peritoneal dialysis (PD) patients in Tehran, Iran. MATERIALS AND METHODS: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. The diagnosis of PEW was done based on the criteria of the International Society of Renal Nutrition and Metabolism. Serum high-sensitivity C-reactive protein, soluble intercellular adhesion molecule type 1, malondialdehyde, and lipid profile were measured. RESULTS: The prevalence of PEW was 29% in the PD patients. Significant associations were found between the prevalence of PEW in PD patients and sex (P = .01), age (P = .03), type of PD dialysis solution (P = .04), and microinflammation (P = .03). Serum C-reactive protein (P = .02), soluble intercellular adhesion molecule type 1 (P = .001), and triglyceride (P = .03) were significantly higher in the PD patients without PEW as compared to those with PEW, whereas high-density lipoprotein cholesterol level was significantly lower in the PD patients without PEW as compared to those with PEW (P = .003). CONCLUSIONS: Our study shows that PEW is prevalent in Iranian PD patients. In addition, serum concentrations of CVD risk factors are dependent on the amount of glucose absorbed from PD solutions and are more impaired in PD patients without PEW as compared to those with PEW.


Assuntos
Doenças Cardiovasculares/complicações , Falência Renal Crônica/complicações , Diálise Peritoneal/efeitos adversos , Desnutrição Proteico-Calórica/epidemiologia , Proteína C-Reativa/metabolismo , Estudos Transversais , Feminino , Humanos , Molécula 1 de Adesão Intercelular/sangue , Irã (Geográfico)/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Prevalência , Desnutrição Proteico-Calórica/sangue , Fatores de Risco , Triglicerídeos/sangue
5.
Nephrology (Carlton) ; 24(1): 81-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29064128

RESUMO

AIM: Correction of metabolic acidosis in patients with chronic kidney disease has been associated with improvement in thyroid function. We examined whether changes in bicarbonate were associated with changes in thyroid function in patients with end-stage renal disease receiving conventional or more frequent haemodialysis. METHODS: In the Frequent Hemodialysis Network Trials, the relationship between changes in serum bicarbonate, free triiodothyronine (FT3) and free thyroxine (FT4) was examined among 147 and 48 patients with endogenous thyroid function who received conventional (3×/week) or more frequent (6×/week) haemodialysis (Daily Trial) or who received conventional or more frequent nocturnal haemodialysis (Nocturnal Trial). Equilibrated normalized protein catabolic rate (enPCR) was examined to account for nutritional factors affecting both acid load and thyroid function. RESULTS: Increasing dialysis frequency was associated with increased bicarbonate level. Baseline bicarbonate level was not associated with baseline FT3 and FT4. Change in bicarbonate level was not associated with changes in FT3 and FT4 in the Daily Trial nor for FT4 in the Nocturnal Trial (r ≤ 0.14, P > 0.21). While, a significant correlation between change in serum bicarbonate and change in FT3 (r = 0.44, P = 0.02) was observed in the Nocturnal Trial; findings were no longer significant after adjusting for change in enPCR (r = 0.37, P = 0.08). For participants with baseline bicarbonate <23 mmol/L, no association between change in bicarbonate and change in thyroid indices were seen in the Daily Trial; for the Nocturnal Trial, findings were also not significant for change in FT3 and the association between change in bicarbonate and change in FT4 (r = 0.54, P = 0.03) was no longer significant after adjusting for enPCR (r = 0.45, P = 0.11). CONCLUSION: Changes in bicarbonate were not associated with changes in thyroid hormone levels after adjusting for enPCR, as a marker of nutritional status. Future studies should examine whether improvement in acid base status improves thyroid function in haemodialysis patients with evidence of thyroid hypofunction.


Assuntos
Equilíbrio Ácido-Base , Bicarbonatos/sangue , Hemodiálise no Domicílio/métodos , Falência Renal Crônica/terapia , Diálise Renal/métodos , Glândula Tireoide/metabolismo , Tiroxina/sangue , Tri-Iodotironina/sangue , Acidose/sangue , Acidose/fisiopatologia , Adulto , Idoso , Biomarcadores/sangue , Feminino , Hemodiálise no Domicílio/efeitos adversos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Estudos Prospectivos , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/fisiopatologia , Diálise Renal/efeitos adversos , Glândula Tireoide/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
6.
Nutrients ; 10(9)2018 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-30235860

RESUMO

BACKGROUND: Fluid overload and protein-energy wasting (PEW) are common in patients with end-stage renal disease (ESRD) and lead to a poor prognosis. We aimed to evaluate the volume and nutritional status of ESRD patients and to determine the clinical significance of phase angle (PhA). METHODS: This study was a cross-sectional comparison of bioimpedance spectroscopy (BIS) findings in patients with non-dialysis chronic kidney disease (CKD) stage 5 (CKD5-ND, N = 80) and age/sex-matched peritoneal dialysis patients (PD, N = 80). PEW was defined as a PhA less than 4.5°. RESULTS: The PhA was found to be positively associated with a geriatric nutritional risk index (GNRI, r = 0.561, p < 0.001), lean tissue index (LTI, r = 0.473, p < 0.001), and albumin (r = 0.565, p < 0.001) while OH/ECW (r = -0.824, p < 0.001) showed an inverse correlation. The CKD5-ND group had more overhydration (p = 0.027). The PD group had significantly higher PhA (p = 0.023), GNRI (p = 0.005), hemoglobin (p < 0.001), and albumin (p = 0.003) than the CKD5-ND group. The cut-off values predicting PEW were found to be 3.55 g/dL for albumin, 94.9 for GNRI, and 12.95 kg/m² for LTI in PD patients. CONCLUSIONS: This study demonstrated that PhA could be used as a marker to reflect nutritional status in patients with ESRD. Since BIS can inform both volume and nutritional status, regular monitoring will provide the basis for active correction of fluid overload and nutritional supplementation, which may improve outcomes in patients with ESRD.


Assuntos
Composição Corporal , Falência Renal Crônica/terapia , Avaliação Nutricional , Estado Nutricional , Diálise Peritoneal , Desnutrição Proteico-Calórica/diagnóstico , Equilíbrio Hidroeletrolítico , Desequilíbrio Hidroeletrolítico/diagnóstico , Idoso , Biomarcadores/sangue , Estudos Transversais , Impedância Elétrica , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos , Valor Preditivo dos Testes , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/fisiopatologia , Fatores de Risco , Albumina Sérica Humana/análise , Análise Espectral/métodos , Desequilíbrio Hidroeletrolítico/sangue , Desequilíbrio Hidroeletrolítico/fisiopatologia
7.
Pediatr Nephrol ; 33(11): 2113-2122, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29980850

RESUMO

BACKGROUND: This study aimed to evaluate plasma concentrations of leptin and total ghrelin in children with chronic kidney disease (CKD) and assess their roles in protein-energy wasting (PEW). METHODS: This study consisted of three different CKD populations [CKD group (20 patients with non-dialysis CKD), dialysis group (39 patients on dialysis), and kidney transplant (KTx) group (35 KTx recipients)] and control group (18 healthy children). Plasma leptin and total ghrelin levels were measured. Multi-frequency bioimpedance analysis was used for the assessment of fat and lean mass. PEW was defined using criteria including body mass, muscle mass, growth, serum albumin level, and protein intake. RESULTS: While plasma leptin levels did not differ among the study groups, total ghrelin levels were significantly higher in the dialysis group (P < 0.001). Seven dialysis patients (18%) and one CKD patient (5%) but none of the KTx recipients met the criteria of PEW. Dialysis patients with PEW had lower plasma leptin levels compared to their counterparts (P = 0.018); however, total ghrelin levels did not differ between the two groups (P = 0.10). Low leptin level in dialysis patients was independently associated with lower fat mass index (P < 0.001) and lower height-specific SD scores of BMI (P = 0.019). CONCLUSIONS: PEW is prevalent in dialysis patients. Low levels of leptin seem to be associated with PEW. Our result suggests that low leptin levels may be a consequence rather than a cause of PEW. Longitudinal studies are required to investigate this complex relationship between leptin and PEW in pediatric dialysis patients.


Assuntos
Grelina/sangue , Leptina/sangue , Desnutrição Proteico-Calórica/epidemiologia , Insuficiência Renal Crônica/complicações , Adolescente , Distribuição da Gordura Corporal , Índice de Massa Corporal , Criança , Feminino , Humanos , Transplante de Rim/efeitos adversos , Masculino , Prevalência , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/etiologia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/terapia
8.
BMC Nephrol ; 19(1): 139, 2018 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-29902980

RESUMO

BACKGROUND: Chronic kidney disease (CKD) is global health concern and priority. It is the 12th leading cause of death worldwide. Protein Energy Wasting occurs in 20-25% of patients with chronic kidney disease and can lead to a high morbidity and mortality rate. We determined the prevalence of protein energy wasting and factors associated among patients with chronic kidney disease at Mulago National Referral Hospital, Kampala, Uganda. METHODS: We conducted a cross-sectional study recruiting 182 (89 non-CKD patients and 93 CKD patients) consecutively from the outpatient clinic and wards on New Mulago Hospital complex. We took anthropometric measurements including heights, weights, Triceps skin fold (TSF), Mid- Upper Arm circumference (MUAC), Body Mass Index (BMI) and Mid-arm muscle circumference (MAMC). Serum albumin levels and lipid profile levels were also obtained. Following consent of study participants, Data was collected using questionnaires and analyzed using STATA 14.1. Percentages, frequencies, means, medians, standard deviation and interquartile range were used to summarise data. Crude and adjusted binary logistic regression was performed to assess unadjusted and adjusted effect measures of protein energy wasting due to several factors. Stratification by CKD status was performed during the analysis to minimize confounding. RESULTS: The median age for CKD patients was 39 years compared to 27 years for non-CKD participants (p < 0.001). The prevalence of protein energy wasting (PEW) was 68.6% in this study with 47.3 and 21.3% among CKD and non-CKD participants respectively. Factors which were associated with PEW included CKD age between 18 and 24, being single, catholic religion, CKD stage 4, Hb < 11.5 g/dl and LDL > 160 mg/dl. CONCLUSION: Protein energy Wasting is prevalent among patients with chronic kidney disease and clinicians should routinely screen for it during patient care.


Assuntos
Hospitais de Ensino , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/epidemiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Adulto , Estudos Transversais , Feminino , Hospitais de Ensino/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Desnutrição Proteico-Calórica/sangue , Insuficiência Renal Crônica/sangue , Fatores de Risco , Uganda/epidemiologia , Adulto Jovem
9.
Nutr Clin Pract ; 33(3): 419-425, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29665145

RESUMO

BACKGROUND: Serum albumin and prealbumin levels, may be more strongly associated with inflammation than with nutrient delivery. Their predictive value has not been extensively described in surgical intensive care unit (ICU) patients. METHODS: We analyzed a registry of adult surgical ICU patients receiving enteral nutrition. Subjects with at least 1 serum albumin, prealbumin, or C-reactive protein (CRP) level were included. Demographic, nutrition, and clinical outcome data were collected. RESULTS: A total 252 subjects were included. A subset had serial measurements: albumin (n = 194), prealbumin (n = 13), CRP (n = 9), white blood cell (WBC) (n = 131), and neutrophil-lymphocyte ratio (NLR) (n = 86). Serum albumin level was inversely correlated with all 3 inflammatory biomarkers (CRP, ρ = -0.24, P <0.02; WBC, ρ = -0.15, P <0.001; and NLR, ρ = -0.26, P < 0.001). Change in serum albumin level was inversely correlated with change in NLR (ρ = -0.22, P = 0.044) but not with CRP or WBC. Admission serum albumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (3.2 [2.7-3.7] vs. 2.7 [2.3-3.0], P = 0.004). Admission serum prealbumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (9 [7-12] vs. 4 [3-5], P = 0.001). Serum albumin level was inversely correlated with Charlson Comorbidity Index (ρ = 0.20, P = 0.001). Calorie and/or protein delivery in the ICU was not correlated with changes in serum albumin or prealbumin levels. CONCLUSIONS: In the ICU, initial serum albumin levels and serial trends are inversely correlated with inflammation. Although initial serum albumin levels are reflective of baseline nutrition status, neither serum albumin level nor serum prealbumin level trends correlate with calorie or protein deficits and should not be used to assess adequacy of nutrition delivery.


Assuntos
Cuidados Críticos , Unidades de Terapia Intensiva , Pré-Albumina/metabolismo , Albumina Sérica/metabolismo , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Proteínas na Dieta/administração & dosagem , Nutrição Enteral , Feminino , Humanos , Inflamação/sangue , Leucócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Estado Nutricional , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/terapia , Estudos Retrospectivos , Fatores de Risco
10.
J Nutr Sci Vitaminol (Tokyo) ; 64(1): 34-40, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29491270

RESUMO

In Japan, parenteral nutrition (PN) solutions are frequently administered to patients in the postoperative short-term period. In these cases, amino acid-containing peripheral parenteral nutrition (PPN) solutions, amino acid-free maintenance solutions or combinations of the two are used. However, consensus regarding the most beneficial solution for these patients is lacking. Here, we examined the nutritional status and wound healing outcomes in protein-malnourished rats receiving postoperative administrations of PPN solution, maintenance solution or combinations of the two solutions. Protein malnutrition was induced in Sprague-Dawley rats by feeding an AIN-93G-based low-protein diet (5% casein) for 2 wk. After laparotomy, dorsal skin incision, and placement of a jugular vein catheter, the rats were divided into 3 groups. Each group was administered 113 kcal/kg/d, with group A receiving maintenance solutions without amino acid, group B receiving PPN with 1.5% amino acid, and group C receiving PPN with 3% amino acid. After 5 d post-operative administration, we measured the tensile strength of the wound area, skeletal muscle weights, and nutritional parameters. Significantly higher plasma nutritional parameters and gastrocnemius and extensor digitorum longus (EDL) muscle weights were observed in groups B and C than in group A. Group C exhibited significantly elevated tensile strength of the wound area along with up-regulation of type I collagen mRNA expression compared to group A. These findings demonstrate the nutritional status and wound healing benefits of short-term postoperative administration of PPN solutions containing amino acids in protein-malnourished rats.


Assuntos
Aminoácidos/administração & dosagem , Estado Nutricional , Nutrição Parenteral , Desnutrição Proteico-Calórica/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Aminoácidos/sangue , Animais , Nitrogênio da Ureia Sanguínea , Masculino , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Tamanho do Órgão/efeitos dos fármacos , Soluções de Nutrição Parenteral/química , Período Pós-Operatório , Pré-Albumina/metabolismo , Desnutrição Proteico-Calórica/sangue , Ratos , Ratos Sprague-Dawley , Albumina Sérica/metabolismo , Transferrina/metabolismo
11.
J Cell Physiol ; 233(1): 486-496, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28370189

RESUMO

In the present study, we investigated the relationship between early life protein malnutrition-induced redox imbalance, and reduced glucose-stimulated insulin secretion. After weaning, male Wistar rats were submitted to a normal-protein-diet (17%-protein, NP) or to a low-protein-diet (6%-protein, LP) for 60 days. Pancreatic islets were isolated and hydrogen peroxide (H2 O2 ), oxidized (GSSG) and reduced (GSH) glutathione content, CuZn-superoxide dismutase (SOD1), glutathione peroxidase (GPx1) and catalase (CAT) gene expression, as well as enzymatic antioxidant activities were quantified. Islets that were pre-incubated with H2 O2 and/or N-acetylcysteine, were subsequently incubated with glucose for insulin secretion measurement. Protein malnutrition increased CAT mRNA content by 100%. LP group SOD1 and CAT activities were 50% increased and reduced, respectively. H2 O2 production was more than 50% increased whereas GSH/GSSG ratio was near 60% lower in LP group. Insulin secretion was, in most conditions, approximately 50% lower in LP rat islets. When islets were pre-incubated with H2 O2 (100 µM), and incubated with glucose (33 mM), LP rats showed significant decrease of insulin secretion. This effect was attenuated when LP islets were exposed to N-acetylcysteine.


Assuntos
Glicemia/metabolismo , Dieta com Restrição de Proteínas , Insulina/sangue , Ilhotas Pancreáticas/metabolismo , Estresse Oxidativo , Desnutrição Proteico-Calórica/metabolismo , Fenômenos Fisiológicos da Nutrição Animal , Animais , Antioxidantes/farmacologia , Catalase/genética , Catalase/metabolismo , Modelos Animais de Doenças , Regulação Enzimológica da Expressão Gênica , Glutationa/metabolismo , Glutationa Peroxidase/genética , Glutationa Peroxidase/metabolismo , Peróxido de Hidrogênio/metabolismo , Insulina/metabolismo , Secreção de Insulina , Ilhotas Pancreáticas/efeitos dos fármacos , Masculino , Estado Nutricional , Oxirredução , Estresse Oxidativo/efeitos dos fármacos , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/genética , Desnutrição Proteico-Calórica/fisiopatologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Ratos Wistar , Superóxido Dismutase-1/genética , Superóxido Dismutase-1/metabolismo , Fatores de Tempo
12.
Nefrologia ; 38(2): 141-151, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28755901

RESUMO

INTRODUCTION: Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. OBJECTIVE: To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). PATIENTS AND METHODS: Cross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. RESULTS: The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084-1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893-0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998-0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992-0.998). CONCLUSION: Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.


Assuntos
Desnutrição Proteico-Calórica/etiologia , Insuficiência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Antropometria , Composição Corporal , Estudos Transversais , Registros de Dieta , Impedância Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atrofia Muscular/etiologia , Estado Nutricional , Prevalência , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/epidemiologia , Proteinúria/etiologia , Insuficiência Renal Crônica/sangue , Albumina Sérica/análise
13.
Nefrologia ; 38(1): 57-63, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29102271

RESUMO

INTRODUCTION: Low levels of thyroid hormones, total triiodothyronine (T3) and free triiodothyronine (FT3) in haemodialysis patients is a marker of malnutrition and inflammation and are predictors of mortality. The aim of this study was to determine the prevalence of malnutrition-inflammation complex syndrome in haemodialysis and its relationship with the thyroid hormones thyrotropin, T3, FT3 and free thyroxine (FT4), as well as to evaluate the prevalence of low FT3 syndrome and its correlation with nutritional and inflammatory markers. MATERIALS AND METHODS: Cross-sectional, analytical and comparative study that enrolled 128 haemodialysis patients: 50.8% females; mean age 45.05±17.01 years; mean time on haemodialysis 45.4±38.8 months; 29.7% diabetics; 79.7% with hypertension. Serum thyroid hormones thyrotropin, T3, FT3 and FT4 concentrations were measured and Malnutritition-Inflammation Score (MIS) was applie to diagnostic. RESULTS: Mean thyroid hormone values were: thyroid hormones thyrotropin 2.48±1.8 mIU/ml (range: 0.015-9.5), T3 1.18±0.39 ng/ml (range 0.67-2.64), FT3 5.21±0.96pmol/l (range: 3.47-9.75); FT4 1.35±0.4 ng/ml (range: 0.52-2.57). Malnutrition-inflammation complex syndrome prevalence was 53.9%; 11.7% presented low FT3 levels. Serum T3 and FT3 concentrations inversely correlated with Malnutritition-Inflammation Score (MIS), while FT4 correlated positively with Malnutrition-Inflammation Score. In the linear regression analysis, low FT3 was associated with IL-6 (ß= 0.265, p=.031), C-reactive protein (CRP) (ß= -0.313, p=.018) and albumin (ß= 0.276, p=.002). CONCLUSION: Low T3 and FT3 levels are correlated with malnutrition and inflammation parameters. Malnutrition-inflammation complex syndrome can affect serum concentrations of thyroid hormones.


Assuntos
Inflamação/epidemiologia , Desnutrição Proteico-Calórica/epidemiologia , Diálise Renal , Hormônios Tireóideos/deficiência , Adolescente , Adulto , Idoso , Biomarcadores , Proteínas Sanguíneas/análise , Estudos Transversais , Feminino , Humanos , Inflamação/sangue , Inflamação/etiologia , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Prevalência , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/etiologia , Índice de Gravidade de Doença , Síndrome , Hormônios Tireóideos/sangue , Tireotropina/sangue , Adulto Jovem
14.
J Trop Pediatr ; 64(5): 364-372, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29092084

RESUMO

Background: Malnourished children show variable growth responses to nutritional rehabilitation. We aimed to investigate whether these differences could be explained by variations in growth and energy-regulating hormones. Methods: Quasi-experimental study: Children aged 6-24 months in rural Gambia were recruited to controls if weight-for-height z-score (WHZ) > -2 (n = 22), moderate acute malnutrition if WHZ < -2 and > -3 (n = 18) or severe acute malnutrition if WHZ < -3 (n = 20). Plasma hormone and salivary CRP levels were determined by ELISA. Results: In univariable analyses, increases in weight-for-age z-score (WAZ) in malnourished children were positively correlated with insulin (F-ratio 7.8, p = 0.006), C-peptide (F-ratio 12.2, p < 0.001) and cortisol (F-ratio 5.0, p = 0.03). In multivariable analysis, only baseline C-peptide (F-ratio 7.6, p = 0.009) predicted the changes in WAZ over 28 days of interventions. Conclusion: In rural Gambian, malnourished children, although it cannot be used in isolation, baseline C-peptide was a predictor of future response to rehabilitation.


Assuntos
Braço/anatomia & histologia , Biomarcadores/sangue , Desnutrição/dietoterapia , Terapia Nutricional/métodos , População Rural , Antropometria , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Transtornos da Nutrição Infantil , Pré-Escolar , Ensaio de Imunoadsorção Enzimática , Feminino , Gâmbia/epidemiologia , Hormônios/sangue , Humanos , Lactente , Masculino , Desnutrição/sangue , Desnutrição/epidemiologia , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/dietoterapia , Saliva/metabolismo , Resultado do Tratamento
15.
Kidney Blood Press Res ; 42(6): 1216-1224, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29248911

RESUMO

BACKGROUND/AIMS: Protein energy wasting (PEW) is a common medical phenomenon that is observed in maintenance dialysis patients. PEW also increases morbidity and mortality of these patients. Its pathogenesis is unclear. We hypothesize that serum irisin levels and volume overload may induce PEW in peritoneal dialysis (PD) patients. The aim of this study is to measure serum irisin levels, evaluate volume status of PD patients, and study their correlations with PEW in PD patients. METHODS: This study is a cross-sectional study with 160 PD patients from the PD center of Peking University Third Hospital and 35 healthy control subjects. PD patients were divided into PEW group and non-PEW group according to PEW diagnosis criteria. Serum irisin concentrations were measured by ELISA. Volume overload status (volume overload is defined as overhydration value ≥2 liters) of PD patients was analyzed by bioelectrical impedance. RESULTS: The serum irisin levels were significantly lower in PD patients compared with those of the controls (113.2±11.8 ng/ml vs. 464.2±37.4 ng/ml, P<0.01). The serum irisin levels were lower in PD patients with PEW than those of the patients without PEW (106.5±15.2 ng/ml vs. 117.4±17.6 ng/ml, P<0.01). PEW is more prevalent in patients with volume overload than patients without volume overload (62.5% vs. 43.1%, x2=5.756, P=0.016); however, no direct relationship was found between irisin levels and volume overload status. The independent influencing factors of PEW were serum irisin, serum albumin, and volume overload. CONCLUSION: Our results are the first to provide clinical evidence of the association between serum irisin, volume overload, and PEW in PD patients. PEW may inhibit the release or synthesis of irisin from skeletal muscles, and volume overload may aggravate PEW in PD patients.


Assuntos
Fibronectinas/sangue , Diálise Peritoneal/efeitos adversos , Desnutrição Proteico-Calórica/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Soluções para Diálise/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/etiologia , Albumina Sérica/análise
16.
Eur J Clin Invest ; 47(8): 545-554, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28621798

RESUMO

BACKGROUND: Protein-energy wasting is a prevalent disorder in haemodialysis. Zinc-α2-glycoprotein (ZAG) and adipose triglyceride lipase (ATGL) are novel adipokines with recognized lipolytic effects and proposed role in metabolic homoeostasis. This study was conducted to investigate the association of ZAG and ATGL concentrations with malnutrition-inflammation score (MIS) and metabolic profile of patients with haemodialysis. MATERIALS AND METHODS: Eighty-eight patients under regular haemodialysis were divided based on MIS to normal to mild wasting (NMW; n = 35) or moderate wasting (MW; n = 53) group. Anthropometric measurements along with fasting serum concentrations of ZAG, ATGL, free fatty acids (FFAs), albumin, transferrin, total iron-binding capacity (TIBC), hs-CRP, lipid profile and glucose metabolism were assessed. RESULTS: Adipose triglyceride lipase concentration was significantly higher in MW than NMW group (10·89 ± 5·7 vs. 8·02 ± 3·37 mIU/mL; P = 0·008). The ZAG and FFAs were not significantly different between two groups. ATGL was directly correlated with FFAs in all of the patients (r = 0·284, P = 0·007) and MW (r = 0·32, P = 0·021), and marginally in NMW (r = 0·31, P = 0·057) groups. ATGL and odds of having mild or moderate wasting were significantly correlated (OR = 1·21, P = 0·033). A positive association was observed between ATGL with TG (r = 0·31, P = 0·049) and also with transferrin and TIBC (r = 0·44, P = 0·001) only in MW group. An inverse relationship was observed between ATGL and HDL in all of the participants (r=-0·222, P = 0·04). No significant correlation was observed between ZAG and other parameters. CONCLUSIONS: The serum concentrations of ATGL, but not ZAG, were significantly higher in MW compared to NMW group. Each unit increase in ATGL concentrations was correlated with 21% increase in the odds of wasting severity. ATGL might play a role in wasting pathogenesis and metabolic profile in haemodialysis.


Assuntos
Adipocinas/metabolismo , Lipase/metabolismo , Desnutrição Proteico-Calórica/sangue , Diálise Renal , Proteínas de Plasma Seminal/metabolismo , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Paniculite/sangue , Desnutrição Proteico-Calórica/etiologia
17.
Arq Gastroenterol ; 54(3): 211-216, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28538943

RESUMO

BACKGROUND: Patients that underwent Percutaneous Endoscopic Gastrostomy (PEG) present with protein-energy malnutrition. Trace elements are required in small quantities and Chromium (Cr) displays a major role in the metabolism. OBJECTIVE: This study aims to evaluate Cr levels and its relationship with serum proteins, BMI and underlying diseases during the first 3 months of PEG feeding. METHODS: Prospective observational study during 3-months, when PEG was performed (T0), after 4 (T1), and 12 weeks (T3). Initial evaluation included: age, gender, underlying disease, NRS-2002, BMI, serum albumin, transferrin and Cr concentration. At T1 and T3 a blood sample was collected for Cr, albumin and transferrin. A Graphite Furnace Atomic Absorption Spectroscopy was used to assess Cr. According with the underlying disease, patients were divided into two groups: head and neck cancer (HNC) and neurological dysphagia (ND). All patients were fed with homemade meals. RESULTS: A one hundred and twenty-nine patients (80 males), 26-95 years old were studied: HNC-52; ND-77. The observed data included low mean values of BMI from 71 patients; low Cr-8, low albumin-70, low transferrin-85 and 57 with both proteins low. Albumin was associated with survival time ( P =0.024) and there was a significant correlation between albumin and Cr (r=0.217, P =0.012). A good evolution of Cr and proteins values was observed, with no low Cr levels at T3. CONCLUSION: Low serum Cr is rare in PEG-patients, with no relationship to other studied parameters. For the minority of patients displaying low Cr before gastrostomy, homemade PEG meals seem to be effective.


Assuntos
Cromo/sangue , Nutrição Enteral , Gastrostomia/efeitos adversos , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
J Nutr Health Aging ; 21(5): 567-572, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28448088

RESUMO

OBJECTIVE: To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older. DESIGN: Non-randomised controlled study. SETTING AND PARTICIPANTS: The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L). INTERVENTION: Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months. MEASUREMENTS: The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention. RESULTS: The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group. CONCLUSIONS: Individually tailored dietary counseling may improve nutritional status among older home care clients.


Assuntos
Aconselhamento , Proteínas na Dieta/administração & dosagem , Ingestão de Energia , Comportamento Alimentar , Serviços de Assistência Domiciliar , Estado Nutricional , Desnutrição Proteico-Calórica/dietoterapia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Dieta , Ingestão de Alimentos , Feminino , Avaliação Geriátrica , Humanos , Masculino , Refeições , Avaliação Nutricional , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/prevenção & controle , Albumina Sérica/metabolismo , Lanches
19.
J Ren Nutr ; 27(4): 267-274, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28431808

RESUMO

OBJECTIVE: Rapid screening and monitoring of nutritional status is mandatory in hemodialysis population because of the increasingly encountered nutritional problems. Considering the limitations of previous composite nutrition scores applied in this population, we tried to develop a standardized composite nutrition score (SCNS) using low lean tissue index as a marker of protein wasting to facilitate clinical screening and monitoring and to predict outcome. DESIGN AND METHODS: This retrospective cohort used 2 databases of dialysis populations from Taiwan between 2011 and 2014. First database consisting of data from 629 maintenance hemodialysis patients was used to develop the SCNS and the second database containing data from 297 maintenance hemodialysis patients was used to validate this developed score. RESULTS: SCNS containing albumin, creatinine, potassium, and body mass index was developed from the first database using low lean tissue index as a marker of protein wasting. When applying this score in the original database, significantly higher risk of developing protein wasting was found for patients with lower SCNS (odds ratio 1.38 [middle tertile vs highest tertile, P < .0001] and 2.40 [lowest tertile vs middle tertile, P < .0001]). The risk of death was also shown to be higher for patients with lower SCNS (hazard ratio 4.45 [below median level vs above median level, P < .0001]). These results were validated in the second database. CONCLUSION: We developed an SCNS consisting of 4 easily available biochemical parameters. This kind of scoring system can be easily applied in different dialysis facilities for screening and monitoring of protein wasting. The wide application of body composition monitor in dialysis population will also facilitate the development of specific nutrition scoring model for individual facility.


Assuntos
Falência Renal Crônica/epidemiologia , Desnutrição Proteico-Calórica/epidemiologia , Diálise Renal/efeitos adversos , Idoso , Biomarcadores/sangue , Nitrogênio da Ureia Sanguínea , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Creatinina/sangue , Feminino , Seguimentos , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/terapia , Modelos Logísticos , Masculino , Avaliação Nutricional , Estado Nutricional , Potássio/sangue , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/diagnóstico , Desnutrição Proteico-Calórica/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Albumina Sérica/metabolismo , Taiwan/epidemiologia , Triglicerídeos/sangue
20.
Nephrol Dial Transplant ; 32(11): 1780-1789, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28371919

RESUMO

The chronic kidney disease (CKD) population is aging. Currently a high percentage of patients treated on dialysis are older than 65 years. As patients get older, several conditions contribute to the development of malnutrition, namely protein energy wasting (PEW), which may be compounded by nutritional disturbances associated with CKD and from the dialysis procedure. Therefore, elderly patients on dialysis are vulnerable to the development of PEW and awareness of the identification and subsequent management of nutritional status is of importance. In clinical practice, the nutritional assessment of patients on dialysis usually includes methods to assess PEW, such as the subjective global assessment, the malnutrition inflammation score, and anthropometric and laboratory parameters. Studies investigating measures of nutritional status specifically tailored to the elderly on dialysis are scarce. Therefore, the same methods and cutoffs used for the general adult population on dialysis are applied to the elderly. Considering this scenario, the aim of this review is to discuss specific considerations for nutritional assessment of elderly patients on dialysis addressing specific shortcomings on the interpretation of markers, in addition to providing clinical practice guidance to assess the nutritional status of elderly patients on dialysis.


Assuntos
Avaliação Nutricional , Desnutrição Proteico-Calórica/diagnóstico , Insuficiência Renal Crônica/terapia , Biomarcadores/sangue , Proteínas Sanguíneas/metabolismo , Composição Corporal , Índice de Massa Corporal , Feminino , Humanos , Estado Nutricional , Desnutrição Proteico-Calórica/sangue , Diálise Renal , Insuficiência Renal Crônica/sangue
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