This study sought to better characterize the relationships between body mass index (BMI) and lean body mass (LBM) as assessed by serum creatinine (SCr) and mortality.
The data were collected from a ...prospective prevalent cohort in maintenance hemodialysis patients.
The study was carried out in 25 dialysis units in Rhônes Alpes area (France and Switzerland).
A total of 1,205 patients were followed up for 1-year, starting July 1, 2005.
Mortality as well as clinical and biological routine parameters were recorded. Kaplan-Meier, Cox model, Log rank test were used for the statistical analysis.
We found that SCr was a strong predictor of mortality (P < .001), whereas BMI was not. Additionally, higher BMI lost its protective effect when it was associated with low SCr. Survival was strongly reduced in patients having a predialysis SCr <717 μmol/L in patients with a BMI >23 (P < .001).
BMI should not be used by itself but in conjunction with SCr as a surrogate of LBM to improve its morbid-mortality predictive power. LBM should also be taken into account in further survival studies carried out in hemodialysis patients.
Bone damage because of chronic kidney disease (CKD) represents a daily challenge for nephrologists. The impact of CKD on bone health may be immediate (serum phosphocalcic disturbances) or delayed ...(bone fractures and vascular calcifications). Histomorphometry remains the gold standard to evaluate bone, but it is rarely performed in clinical practice. Areal measurement of bone mineral density by dual x-ray absorptiometry is routinely performed to evaluate bone mass. However, this technique presents some limitations. In 2000, the United States National Institutes of Health defined new "quality" criteria for the diagnosis of osteoporosis in addition to decreased bone mass. Bone strength actually integrates two concepts: bone quantity and bone quality (i.e., microarchitectural organization, bone turnover, bone material properties such as mineralization, collagen traits, and microdamage) that cannot be evaluated by dual x-ray absorptiometry. New three-dimensional, noninvasive bone-imaging techniques have thus been developed, e.g., high-resolution peripheral quantitative computed tomography. High-resolution peripheral quantitative computed tomography allows evaluation of both volumetric density and microarchitecture in different compartments of bone, at the distal radius and tibia. High-resolution peripheral quantitative computed tomography may be useful in predicting fractures and assessing bone preventive or therapeutic strategies in CKD patients. It should be evaluated in long-term, longitudinal follow-ups.
The protein requirements recommended by international guidelines are uncommonly met in many dialysis patients. Recent large scale epidemiological studies have shown that survival impairs only when ...protein intake decreases below 0.9 g/kg body weight/day, and patients survival is highest for a protein intake comprised between 1.0 and 1.4 g/kg body weight/day. In case of inflammation, protein intake is frequently decreased by anorexia, however artificial nutritional support (either orally or intravenously) is able to improve nutritional status. Concerning phosphate intake, whereas increasing protein intake will slightly augment serum phosphate, the strongly observed beneficial survival benefit largely overcomes the serum phosphate increase risk. Finally, new dialysis techniques and/or membranes should be adequately assessed for their consequences on patients' nutritional status since there is a theoretical risk of increased nutrient losses.
Patients with chronic kidney disease have been advised for many years to reduce their protein intake. This review addresses the biochemical, pathophysiologic, and nutritional background that ...underlies this recommendation. The clinical and therapeutic evidence for prescribing such diets is addressed, as well as the potential caveats. A proposed method for managing and monitoring patients also is provided.
The stomach may play an important role in central feeding regulation because it produces two peptides, ghrelin and the recently identified obestatin. These peptide hormones exert opposite actions on ...weight regulation. Whereas ghrelin is orexigenic, obestatin seems to be anorexigenic. Studies on feeding regulation are of particular importance for patients with chronic kidney disease (CKD), because anorexia and weight loss are associated with wasting and increased morbidity and mortality. This review discusses recent information about ghrelin and obestatin and their potential role in CKD. In addition, it seems important to consider not only single values but also their ratios, because both compounds could be affected disharmoniously by CKD.
Adiponectin and chronic kidney disease Guebre-Egziabher, Fitsum; Drai, Jocelyne; Fouque, Denis
Journal of renal nutrition
17, Številka:
1
Journal Article
Recenzirano
Enhanced chronic inflammation and reduced insulin sensitivity are often present in chronic kidney disease (CKD). Cardiovascular disease remains a major cause of morbidity and mortality in end-stage ...renal patients. Adiponectin (ADP) is a hormone exclusively produced by adipocytes and possesses anti-inflammatory and cardioprotective properties. Despite the high prevalence of insulin resistance and cardiovascular disease, levels of ADP are increased among end-stage renal disease patients on hemo or peritoneal dialysis but also among patients with moderate renal failure or with the nephrotic syndrome. Furthermore, lower ADP levels are associated with poor cardiovascular outcome. In this review, we examine ADP modifications in CKD and discuss the different factors that may have an impact on this adipokine metabolism in renal failure.
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