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Kovesdy CP. Obesity and Metabolic Health in CKD. Clin J Am Soc Nephrol 2025; 20:742-754. [PMID: 40085173 PMCID: PMC12097191 DOI: 10.2215/cjn.0000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 03/04/2025] [Indexed: 03/16/2025]
Abstract
Obesity is a worldwide epidemic with a future projected growth of 40% over 10 years. Obesity increases the risk of diabetes, hypertension, and cardiovascular disease, and it also leads to higher risk of CKD, through both direct and indirect mechanisms. Although obesity is a feature of overnutrition and is associated with poor outcomes in the general population, obese individuals with CKD often display complex metabolic patterns such as sarcopenic obesity, and obesity can be associated with better survival in individuals with advanced CKD. Weight loss interventions are proven to improve glycemic control and cardiovascular risk factors, and successful weight loss is associated with improved albuminuria in patients with preexisting CKD. The long-term effects of weight loss interventions on kidney function and on survival in patients with CKD are less well studied, and hence, such interventions should be individualized.
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Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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Oliveira D, de Souza VA, Souza GC, Suassuna LF, Bastos MG, Reboredo MM, da Silva Fernandes NM. Sarcopenic obesity in predialysis chronic kidney disease: Muscle strength is a predictor of mortlity and disease progression in a six-year prospective cohort. PLoS One 2025; 20:e0318773. [PMID: 40100802 PMCID: PMC11918380 DOI: 10.1371/journal.pone.0318773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 01/21/2025] [Indexed: 03/20/2025] Open
Abstract
INTRODUCTION Sarcopenic obesity (SO) is a poorly defined physiological condition that is associated with increased morbimortality in the general population. The prevalence of SO has increased, making it an important public health issue; however, its effects when associated with other chronic conditions are still unclear. Therefore, it is necessary to comprehend the potential outcomes in chronic kidney disease (CKD) patients. OBJECTIVE To assess the associations of predialysis CKD patients with SO and its components with death and disease progression to renal replacement therapy (RRT). METHODS Prospective six-year cohort with 100 patients with predialysis CKD (stages one through five). Participants were older than 18 years and signed an informed consent form. The data were collected in an outpatient clinic specializing in predialysis care, and demographic, clinical, laboratory and inflammatory variable data were collected. A descriptive analysis was performed, and the SO and non-SO groups were compared with Student's t test, Mann‒Whitney U test and Cox regression, taking into consideration all relevant confounding variables. Body composition variables utilized to diagnose SO were separately analyzed along with the outcomes. RESULTS Sixteen percent of our sample were diagnosed with SO, but this was not associated with death or RRT, while lower BMI values were negatively associated with these outcomes. However, in an isolated analysis, handgrip strength was correlated with both RRT (p = 0.029) and death (p = 0.003). We recommend that health professionals pay greater attention to muscle strength, striving for earlier assessment, in an effort to better counsel patients and implement actions to increase or preserve strength through nonpharmacological treatment, such as resistance training.
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Affiliation(s)
- Dílmerson Oliveira
- Department of Clinical Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
- Department of physiology, School of Physical Education, FAMINAS, Muriaé, Brazil
| | - Viviane Angelina de Souza
- Department of Clinical Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Lucas Fernandes Suassuna
- Department of Clinical Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Marcus Gomes Bastos
- Department of Clinical Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Maycon Moura Reboredo
- Department of Clinical Medicine, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Liu Q, Welsh P, Celis-Morales C, Ho FK, Lees JS, Mark PB. Discordance between cystatin C-based and creatinine-based estimated glomerular filtration rate and health outcomes in adults: a systematic review and meta-analysis. Clin Kidney J 2025; 18:sfaf003. [PMID: 40235956 PMCID: PMC11997436 DOI: 10.1093/ckj/sfaf003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Indexed: 04/17/2025] Open
Abstract
Background The intra-individual difference in cystatin C-based and creatinine-based estimated glomerular filtration rate (eGFRcys and eGFRcr, respectively), i.e. eGFR discordance, has recently been demonstrated to have prognostic implications. eGFR discordance was associated with mortality, cardiovascular and renal outcomes. We present a systematic review and meta-analysis to summarize the existing literature. Methods We searched PubMed, Embase and MEDLINE up to 28 April 2024 for cohort and cross-sectional studies in English reporting the association of eGFR discordance with mortality, cardiovascular and renal outcomes. The quality of studies was evaluated by Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) form. Data from studies were extracted to a pre-defined table and pooled using a random-effects model. Stratified and sensitivity analyses were performed. Results A total of 1489 studies were initially identified, of which 18 studies with longitudinal or cross-sectional designs were included, with a sample size between 373 and 363 494 people. In general, the risk of bias was graded as "low" or "some concerns". eGFR was mainly calculated using Chronic Kidney Disease Epidemiology Collaboration equations, while a few studies applied other equations. An eGFR discordance featuring lower eGFRcys, e.g. eGFRcys ≤60% of eGFRcr, or eGFRcys-eGFRcr ≤-15 mL/min/1.73 m2, was consistently associated with higher mortality and elevated risk of cardiovascular and renal outcomes. People with lower eGFRcys have a 58% greater risk of mortality [hazard ratio (HR) = 1.58, 95% confidence interval (CI) 1.42, 1.76] and 32% greater risk of cardiovascular events (HR = 1.32, 95% CI 1.25, 1.39). People with higher eGFRcys have a 39% lower risk of mortality (HR = 0.61, 95% CI 0.52, 0.70) and 29% lower risk of cardiovascular events (HR = 0.71, 95% CI 0.62, 0.81). No meta-analysis for renal outcomes was conducted due to data availability. Conclusions The eGFR discordance serves as a meaningful indicator of adverse health outcomes. The lack of a consensus on the cut-off value of eGFR discordance and the mixture use of eGFR equations warrants attention.
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Affiliation(s)
- Qiaoling Liu
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Paul Welsh
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Human Performance Lab, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Maule, Chile
- High-Altitude Medicine Research Centre (CEIMA), Universidad Arturo Prat, Iquique, Chile
| | - Frederick K Ho
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jennifer S Lees
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Patrick B Mark
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Kim HJ. Insulin Sensitivity and Muscle Loss in the Absence of Diabetes Mellitus: Findings from a Longitudinal Community-Based Cohort Study. J Clin Med 2025; 14:1270. [PMID: 40004800 PMCID: PMC11856990 DOI: 10.3390/jcm14041270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2025] [Revised: 01/26/2025] [Accepted: 02/12/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Muscle loss is a serious complication in chronic disease patients, yet studies on long-term changes in muscle mass based on insulin sensitivity in the absence of diabetes mellitus are scarce. This community-based cohort study analyzed the longitudinal association between insulin sensitivity and muscle loss in middle-aged South Korean adults. Methods: This study included 6016 subjects (aged 40-65 years) from the Korean Genome and Epidemiology Study, conducted between 2001 and 2016. Fat-free mass, fat mass, body weight, and kidney function were assessed biennially. Subjects were categorized into four groups based on the composite (Matsuda) insulin sensitivity index (ISI) quartiles. The primary outcome was muscle loss, defined as a decline in fat-free mass of 10% or more from baseline. The secondary outcome was the occurrence of all-cause mortality. Results: During 69,480 person-years of follow-up, muscle loss occurred in 311 (5.2%) subjects. Multivariable Cox regression revealed a reverse-graded association between insulin sensitivity and muscle loss risk. Hazard ratios (95% confidence intervals) for the second, third, and highest ISI quartiles were 0.70 (0.51-0.94), 0.69 (0.50-0.95), and 0.65 (0.46-0.92), respectively, compared with the lowest quartile. Insulin sensitivity, however, was not significantly associated with all-cause mortality, though the mortality risk was higher in individuals with muscle loss. Conclusions: A reverse-graded relationship between insulin sensitivity and muscle loss risk was identified in middle-aged South Korean adults, with the lowest risk in the highest ISI quartile. These findings suggest that higher insulin sensitivity may reduce the risk of muscle loss.
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Affiliation(s)
- Hyun Jung Kim
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon-si 14584, Gyeonggi-do, Republic of Korea
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Bongetti EK, Wilkinson AL, Wetmore JB, Murray AM, Woods RL, Espinoza S, Ernst ME, Fravel MA, Orchard SG, Phuong Thao LT, Ryan J, Wolfe R, Polkinghorne KR. Association Between Albuminuria and Glomerular Filtration Rate With Incident Frailty. Kidney Int Rep 2025; 10:489-502. [PMID: 39990877 PMCID: PMC11843128 DOI: 10.1016/j.ekir.2024.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/16/2024] [Accepted: 11/12/2024] [Indexed: 02/25/2025] Open
Abstract
Introduction The association between estimated glomerular filtration rate (eGFR) and albuminuria with incident frailty in generally healthy older individuals is unclear. We investigated whether baseline eGFR or urine albumin-to-creatinine ratio (UACR) are associated with incident frailty and assessed them using 2 separate methods: a modified Fried frailty phenotype (FP), and a deficit accumulation frailty index (FI). Methods This was a secondary analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) randomized trial cohort, which enrolled independent, healthy, older adults aged ≥65 years in Australia and the USA. Time to incident frailty was analyzed using discrete time survival analysis. Results In total, 16,965 participants were included using the FP, mean age was 75.0 ± 4.5 years, median baseline eGFR was 78.6 ml/min per 1.73 m2 (interquartile range [IQR]: 67.6-89.5), and the median UACR was 0.80 mg/mmol (0.50-1.50). Data to generate the FI outcomes were available for 12,272 participants. The relationships between eGFR and both incident FP and FI were nonlinear, such that an eGFR < 30 or ≥ 95 ml/min per 1.73 m2 was significantly associated with an increased risk of incident frailty. For every doubling of baseline UACR, risk of incident frailty increased by 4% using the FP (hazard ratio [HR]: 1.04, 95% CI: 1.02, 1.07) and the FI (HR: 1.04, 95% confidence interval [CI]: 1.01-1.07). Conclusion In older, generally healthy adults, both low and high eGFRs were associated with increased risk of incident frailty. Doubling of UACR, even at low levels, was independently associated with incident frailty.
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Affiliation(s)
- Elisa K. Bongetti
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna L. Wilkinson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Disease Elimination, Burnet Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - James B. Wetmore
- Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research and Department of Medicine, Hennepin Healthcare Research Institute, and Department of Medicine, Geriatrics Division, Hennepin Healthcare Minneapolis, Minnesota, USA
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sara Espinoza
- Center for Translational Geroscience, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa, USA
| | - Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kevan R. Polkinghorne
- Department of Nephrology, Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Wang J, Zhao J, Li L, Lin X, Guo X, Peng F, Zuo X, Liu X, Ying C. Association Between Peritoneal Glucose Absorption, Lipid Metabolism, and Cardiovascular Disease Risk in Nondiabetic Patients on Peritoneal Dialysis. J Ren Nutr 2025; 35:196-206. [PMID: 38851308 DOI: 10.1053/j.jrn.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/26/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Excessive sugar intake increases the energy metabolic burden and the risk of cardiovascular disease (CVD). Patients on peritoneal dialysis absorb much more glucose than the World Health Organization recommends, but the link to CVD is unclear. OBJECTIVE To identify the association between peritoneal glucose absorption, lipid metabolism, and CVD. METHODS We applied generalized additive mixed effects and mixed effects Cox proportional hazard models to evaluate the impact of peritoneal glucose absorption on lipid profiles and CVD risk. We performed subgroup analyses by using protein intake (normalized protein nitrogen appearance [nPNA] and normalized protein catabolic rate [nPCR] were used to assess protein intake) and high-sensitivity C-reactive protein (hs-CRP). RESULTS After multivariable adjustment, peritoneal glucose absorption per 10 g/d increase was associated with an increase in cholesterol of 0.145 (95% confidence interval [CI]: 0.086-0.204) mmol/L. No link with the total risk of CVD was observed; however, protein intake and hs-CRP levels affected the relationship between glucose absorption and CVD risk. Patients with values for nPNA and nPCR <1.0 g/(kg·d) were associated with a lower risk of CVD (hazard ratio [HR] 95% CI: 0.68 (0.46-0.98)) with glucose absorption per 10 g/d increase. While patients with hs-CRP levels ≥3 mg/d or values for nPNA or nPCR ≥1.0 g/(kg·d) were associated with a higher risk of CVD (HR 95% CI: 1.32 (1.07-1.63); 1.31 (1.02-1.68)) for glucose absorption per 10 g/d increase. CONCLUSIONS Our study found a positive correlation between peritoneal glucose absorption and lipid profiles. Increased glucose absorption was associated with a lower risk of CVD in lower protein intake patients and a higher risk of CVD in higher hs-CRP or protein intake levels in patients on peritoneal dialysis.
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Affiliation(s)
- Jinxue Wang
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Peng
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaoqin Liu
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Narasaki Y, Rhee CM, Kalantar-Zadeh K, Rastegar M. Why protein-energy wasting leads to faster progression of chronic kidney disease. Curr Opin Nephrol Hypertens 2025; 34:55-66. [PMID: 39611279 DOI: 10.1097/mnh.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
PURPOSE OF REVIEW Protein-energy wasting (PEW) is increasingly more prevalent as chronic kidney disease (CKD) progresses to more advanced stages. There is a global recognition of the importance of preventing and mitigating PEW in the CKD population not on dialysis given the goal of extending dialysis-free time and delaying dialysis initiation and growing evidence of the clinical consequences of PEW which include the risk of death, hospitalization and clinical conditions such as infections. We reviewed the association of PEW and the malnutrition characteristics indicative of PEW on CKD progression. RECENT FINDINGS Studies show the association between low serum albumin levels, low BMI, and diets with inadequate dietary energy and protein intake and CKD progression. Limited studies suggest low muscle mass impacts CKD progression. Optimizing nutrition by dietary management, including a moderately low protein (0.6-0.8 g/kg/day) and plant-based (>50% of protein source, known as PLADO) diet and as needed with supplementation [e.g. during acute kidney injury (AKI) event] administrated orally, enterally, or parenterally are the basis for the prevention and treatment of PEW in CKD and delaying CKD progression. Furthermore, other therapeutic methods such as treating or avoiding comorbidities and AKI, ensuring appropriate exercise and incremental transition to dialysis treatment may help ameliorate and prevent PEW development in CKD patients. SUMMARY Using tailored precision nutrition approaches and nutritional supplementation with or without other beneficial strategies may help prevent and treat PEW and its consequent occurrence of CKD progression.
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Affiliation(s)
- Yoko Narasaki
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach
| | - Connie M Rhee
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
- Nephrology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange
| | - Kamyar Kalantar-Zadeh
- Tibor Rubin Veterans Affairs Long Beach Healthcare System, Long Beach
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Mandana Rastegar
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
- Nephrology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
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Huang Y, Liu S, Muo C, Lai C, Chang C. Male Sex and Ageing are Independent Risk Factors for Sarcopenia Stage in Patients With Chronic Kidney Disease Not Yet on Dialysis. J Cachexia Sarcopenia Muscle 2024; 15:2684-2692. [PMID: 39351998 PMCID: PMC11634482 DOI: 10.1002/jcsm.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 09/05/2024] [Accepted: 09/11/2024] [Indexed: 12/13/2024] Open
Abstract
BACKGROUND The risk of sarcopenia in older adults with chronic kidney disease (CKD) not yet on dialysis is controversial. The aims of this study were to investigate the association among sarcopenia, diabetes and predialysis CKD and evaluate the impact of gender and ageing on the risk of sarcopenia statuses in older patients with predialysis CKD. METHODS The participants aged ≥60 years old were recruited from the community of New Taipei City, Taiwan. Handgrip strength, appendicular skeletal muscle mass and the 6-m walk were measured. The diagnosis of sarcopenia was established based on the consensus of Asian Sarcopenia Working Group 2019. These older adults were categorised into G1, G2 and G3-5 according to the guidelines of Kidney Disease Improving Global Outcomes (KDIGO) after calculating the estimated glomerular filtration rate by the Modification of Diet in Renal Disease equation. The Chi-square test and ANOVA were used to estimate the difference of categorical and continuous variables, respectively. Polytomous logistic regression was employed to assess the odds ratio (OR) and 95% confidence intervals (CIs) of the sarcopenia status and sarcopenia-associated risk factors in the predialysis CKD patients. All tests were two-sided, and p < 0.05 was defined as statistical significance. RESULTS Among the 3648 older adults (mean age: 71.9 ± 6.07 years), including 1701 males and 1947 females, 870 (23.9%), 94 (2.58%) and 48 (1.32%) had possible sarcopenia, sarcopenia and severe sarcopenia, respectively. After adjustment, the risk for possible sarcopenia, sarcopenia and severe sarcopenia significantly increased with ageing (OR = 1.11, 1.10 and 1.23; 95% CI = 1.10-1.13, 1.07-1.15 and 1.18-1.30, respectively) and male gender (OR = 2.26, 20.3 and 25.4; 95% CI = 1.87-2.73, 11.5-36.0 and 11.3-57.2, respectively). Compared with KDIGO G1, no significant association between KDIGO G3-5 and the statuses of sarcopenia was observed (OR = 0.97, 0.88 and 0.91; 95% CI = 0.75-1.26, 0.43-1.78 and 0.37-2.27, p = 0.821, 0.718, 0.838, for possible sarcopenia, sarcopenia and severe sarcopenia, respectively). Ageing and male gender indicated a significant risk for higher sarcopenia status in older patients with predialysis CKD (0.027-fold/year and 0.284-fold, respectively) (p < 0.0001). CONCLUSIONS This study illuminated the importance of the male sex and the ageing process on the risk of sarcopenia progression in patients with predialysis CKD. Early clinical screening and aggressive treatment for the prevention of higher sarcopenia status in advanced older male adults with predialysis CKD are recommended.
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Affiliation(s)
- Yi‐Fang Huang
- Department of General DentistryChang Gung Memorial HospitalLinkouTaiwan
- Graduate Institute of Dental and Craniofacial Science, College of MedicineChang Gung UniversityTaoyuanTaiwan
- School of Dentistry, College of Oral MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Shih‐Ping Liu
- Translational Medicine Research CenterChina Medical University HospitalTaichungTaiwan
- Program for Aging, College of MedicineChina Medical UniversityTaichungTaiwan
| | - Chih‐Hsin Muo
- Management Office for Health DataChina Medical University HospitalTaichungTaiwan
| | - Chen‐Yi Lai
- Internal Audit DepartmentFar Eastern Memorial HospitalNew TaipeiTaiwan
- Graduate Institute of MedicineYuan Ze UniversityTaoyuanTaiwan
| | - Chung‐Ta Chang
- School of Dentistry, College of Oral MedicineTaipei Medical UniversityTaipeiTaiwan
- Graduate Institute of MedicineYuan Ze UniversityTaoyuanTaiwan
- Department of Emergency MedicineFar Eastern Memorial HospitalNew TaipeiTaiwan
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Abbas Torki S, Roumi Z, Tahavorgar A, Salimi Z, Mohammadi S, Shekari S, Saeedirad Z, Amjadi A, Mirzaee P, Shafaei H, Bahar B, Mofidi F, Khosravi M, Doaei S, Gholamalizadeh M. Effect of omega-3 fatty acids supplementation on muscle mass, fat mass, and visceral fat of hemodialysis patients; A randomized clinical trial. J Basic Clin Physiol Pharmacol 2024; 35:347-352. [PMID: 39533425 DOI: 10.1515/jbcpp-2024-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Several studies demonstrated the benefits of omega-3 fatty acids supplementation in chronic kidney disease (CKD) patients. The objective of this study was to investigate the effect of omega-3 fatty acids supplementation in body composition, specifically on the lean body mass and fat mass in hemodialysis patients. METHODS In this randomized, double-blind, placebo-controlled clinical trial, a total of 120 end-stage renal disease (ESRD) patients were randomly allocated into two groups. The intervention group has taken three grams of omega-3 fatty acids daily while the placebo group received three grams of medium chain triglycerides (MCT) as a placebo for a total of 2 months. The changes in the body mass index (BMI) and body composition (fat mass, muscle, and visceral fat) were assessed at baseline and following the intervention. RESULTS No significant difference was found in the mean of BMI, FAT, muscle, and visceral fat in the intervention group compared to the control group after the intervention. After two months of omega-3 fatty acid supplementation, the study found no statistically significant impact of omega-3 fatty acids supplementation on various indices of body composition. The effect of ω-3 supplementation in reducing visceral fat was close to significant (p=0.08). CONCLUSIONS This study suggests that there is currently inadequate evidence to support the effect of omega-3 fatty acid supplementation in improving anthropometric measurements in patients with CKD, except a partial effect on visceral fat. Further large-scale and long-term clinical trials are needed to confirm the present results.
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Affiliation(s)
- Saheb Abbas Torki
- Department of Nutrition, Faculty of Nutrition Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Roumi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Atefeh Tahavorgar
- School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Salimi
- 556492 Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | | | - Soheila Shekari
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Zahra Saeedirad
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Amjadi
- Department of Nutrition, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pouya Mirzaee
- Department of Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Hanieh Shafaei
- Shahid Beheshti College of Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Bojlul Bahar
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
| | - Fatemeh Mofidi
- Department of Clinical Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Khosravi
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Doaei
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, 556492 Shahid Beheshti University of Medical Sciences , Tehran, Iran
- Reproductive Health Research Center, Department of Obstetrics and Gynecology, School of Medicine, Al-Zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Maryam Gholamalizadeh
- Cancer Research Center, 556492 Shahid Beheshti University of Medical Sciences , Tehran, Iran
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10
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Sahi G, Reid J, Moist L, Chiu M, Vinson A, Stranges S, Naylor K, Zhu Y, Clemens KK. Prevalence, Characteristics, and Outcomes of People With A High Body Mass Index Across the Kidney Disease Spectrum: A Population-Based Cohort Study. Can J Kidney Health Dis 2024; 11:20543581241293199. [PMID: 39529654 PMCID: PMC11552050 DOI: 10.1177/20543581241293199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/19/2024] [Indexed: 11/16/2024] Open
Abstract
Background Obesity has a major impact on health and health care, particularly in those with chronic kidney disease (CKD). Objective The objective was to describe the prevalence, characteristics, and outcomes of people living with CKD and obesity (defined by a body mass index [BMI] ≥30 kg/m2) in Canada. Design Population-based cohort study using linked administrative health data (ICES). Patients Adults aged 18 year and older with CKD G1-5D who had a height and weight recorded during a visit to an academic hospital in London Ontario Canada, between January 2010 and December 2019. Measures CKD as defined by CKD 3A or higher. BMI as defined by weight kg/m2. Methods As a primary interest, we described the percentage of patients with CKD across different BMI categories (<25 kg/m2, BMI 25-29.9 kg/m2, and BMI ≥30 kg/m2), as well as their demographic and clinical profiles. As secondary interests, we followed patients until January 1, 2022 to summarize: (1) the percentage with CKD G3 who had kidney disease progression (50% decline from baseline estimated glomerular filtration rate [eGFR]) by BMI category, (2) the percentage with CKD G3-4 who developed kidney failure (initiation of maintenance dialysis or an eGFR of <15 mL/min/1.73 m2) by BMI category, (3) the percentage with CKD G4-G5D who received a kidney transplant by BMI category, and (4) post-transplant outcomes in those transplanted over the study period, by BMI category. We performed similar analyses across CKD risk categories. Results Of the 198 151 patients included, the percentage with obesity defined by a BMI ≥30 kg/m2 increased from CKD G1 to CKD G4 (ie, 37% of those with CKD G1 had a BMI ≥30 kg/m2 vs 40.9% of CKD G4). In CKD G5D and CKD T, the prevalence of high BMI appeared to drop (only ~38% had a BMI ≥30 kg/m2 across groups). Across CKD categories, those with a BMI ≥30 kg/m2 appeared to have more comorbidities, use more health care resources, and have more socioeconomic disparities than those with lower BMIs. Although secondary outcome events were limited, those with G3-4 with a BMI ≥30 kg/m2 appeared to have a higher risk of CKD progression and those with CKD G5D with BMI ≥30 kg/m2 were less likely to receive transplant over the study period. Interestingly those transplanted with a BMI ≥30 kg/m2 appeared to have fewer post-transplant complications. We also observed an "obesity-paradox" in the risk of mortality, with high BMI appearing protective, particularly in the end stages of kidney disease. Limitations We used BMI to capture obesity in this study but recognize its limitations as a measure of body composition. Secondary outcomes were descriptive and unadjusted due to small sample size and may have been subject to selection bias and confounding. Conclusions Obesity defined by high BMI is highly prevalent in people with CKD, and patients have health, health care, and social disparity. Future studies to understand the impact of BMI on patients with CKD and how to individualize and manage BMI and obesity across the spectrum of CKD remain important.
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Affiliation(s)
- Gurleen Sahi
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Louise Moist
- Lawson Health Research Institute, London, ON, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Michael Chiu
- Division of Nephrology, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, ON, Canada
| | - Amanda Vinson
- Division of Nephrology, Department of Medicine, Nova Scotia Health, Halifax, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | | | - Yunxu Zhu
- Centre for Diabetes, Endocrinology and Metabolism, St. Joseph’s Health Care London, ON, Canada
| | - Kristin K. Clemens
- ICES, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St. Joseph’s Health Care London, ON, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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11
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Ozbek L, Abdel-Rahman SM, Unlu S, Guldan M, Copur S, Burlacu A, Covic A, Kanbay M. Exploring Adiposity and Chronic Kidney Disease: Clinical Implications, Management Strategies, Prognostic Considerations. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1668. [PMID: 39459455 PMCID: PMC11509396 DOI: 10.3390/medicina60101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 10/04/2024] [Accepted: 10/09/2024] [Indexed: 10/28/2024]
Abstract
Obesity poses a significant and growing risk factor for chronic kidney disease (CKD), requiring comprehensive evaluation and management strategies. This review explores the intricate relationship between obesity and CKD, emphasizing the diverse phenotypes of obesity, including sarcopenic obesity and metabolically healthy versus unhealthy obesity, and their differential impact on kidney function. We discuss the epidemiological evidence linking elevated body mass index (BMI) with CKD risk while also addressing the paradoxical survival benefits observed in obese CKD patients. Various measures of obesity, such as BMI, waist circumference, and visceral fat assessment, are evaluated in the context of CKD progression and outcomes. Mechanistic insights into how obesity promotes renal dysfunction through lipid metabolism, inflammation, and altered renal hemodynamics are elucidated, underscoring the role of adipokines and the renin-angiotensin-aldosterone system. Furthermore, the review examines current strategies for assessing kidney function in obese individuals, including the strengths and limitations of filtration markers and predictive equations. The management of obesity and associated comorbidities like arterial hypertension, type 2 diabetes mellitus, and non-alcoholic fatty liver disease in CKD patients is discussed. Finally, gaps in the current literature and future research directions aimed at optimizing the management of obesity-related CKD are highlighted, emphasizing the need for personalized therapeutic approaches to mitigate the growing burden of this intertwined epidemic.
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Affiliation(s)
- Lasin Ozbek
- Department of Medicine, Koç University School of Medicine, Istanbul 34450, Turkey; (L.O.); (S.M.A.-R.); (S.U.); (M.G.)
| | - Sama Mahmoud Abdel-Rahman
- Department of Medicine, Koç University School of Medicine, Istanbul 34450, Turkey; (L.O.); (S.M.A.-R.); (S.U.); (M.G.)
| | - Selen Unlu
- Department of Medicine, Koç University School of Medicine, Istanbul 34450, Turkey; (L.O.); (S.M.A.-R.); (S.U.); (M.G.)
| | - Mustafa Guldan
- Department of Medicine, Koç University School of Medicine, Istanbul 34450, Turkey; (L.O.); (S.M.A.-R.); (S.U.); (M.G.)
| | - Sidar Copur
- Department of Internal Medicine, Koç University School of Medicine, Istanbul 34450, Turkey;
| | - Alexandru Burlacu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
| | - Adrian Covic
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T Popa”, 700115 Iasi, Romania;
- Nephrology Clinic, Dialysis, and Renal Transplant Center “C.I. Parhon” University Hospital, 700503 Iasi, Romania
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koç University School of Medicine, Istanbul 34450, Turkey
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12
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Kujawowicz K, Mirończuk-Chodakowska I, Cyuńczyk M, Witkowska AM. Identifying Malnutrition Risk in the Elderly: A Single- and Multi-Parameter Approach. Nutrients 2024; 16:2537. [PMID: 39125416 PMCID: PMC11314023 DOI: 10.3390/nu16152537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/23/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Malnutrition is a significant concern affecting the elderly, necessitating a complex assessment. This study aims to deepen the understanding of factors associated with the assessment of malnutrition in the elderly by comparing single- and multi-parameter approaches. In this cross-sectional study, 154 individuals underwent a comprehensive geriatric assessment (CGA). Malnutrition risk was determined using the mini nutritional assessment (MNA). Additional factors assessed included sarcopenia, polypharmacy, depression, appetite, handgrip strength, and gait speed. Phase angle (PA) and body composition were measured using bioelectrical impedance analysis (BIA). The MNA identified a malnutrition risk in 36.8% of individuals. The geriatric depression scale (GDS) and PA demonstrated moderate effectiveness in assessing malnutrition risk, with AUC values of 0.69 (95% CI: 0.60-0.78) and 0.62 (95% CI: 0.54-0.72), respectively. A logistic regression model incorporating handgrip strength, skeletal muscle mass, sarcopenia, osteoporosis, depression, specific antidepressant use, mobility, appetite, and smoking achieved superior performance in predicting malnutrition risk, with an AUC of 0.84 (95% CI: 0.77-0.91). In conclusion, this study demonstrates that integrating multiple parameters into a composite model provides a more accurate and comprehensive assessment of malnutrition risk in elderly adults.
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Affiliation(s)
- Karolina Kujawowicz
- Department of Food Biotechnology, Medical University of Białystok, 15-089 Białystok, Poland; (I.M.-C.); (M.C.); (A.M.W.)
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13
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Levy S, Attia A, Omar M, Langford N, Vijay A, Jeon H, Galvani C, Killackey MT, Paramesh AS. Collaborative Approach Toward Transplant Candidacy for Obese Patients with End-Stage Renal Disease. J Am Coll Surg 2024; 238:561-572. [PMID: 38470035 DOI: 10.1097/xcs.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND An elevated BMI is a major cause of transplant preclusion for patients with end-stage renal disease (ESRD). This phenomenon exacerbates existing socioeconomic and racial disparities and increases the economic burden of maintaining patients on dialysis. Metabolic bariatric surgery (MBS) in such patients is not widely available. Our center created a collaborative program to undergo weight loss surgery before obtaining a kidney transplant. STUDY DESIGN We studied the outcomes of these patients after MBS and transplant surgery. One hundred eighty-three patients with ESRD were referred to the bariatric team by the transplant team between January 2019 and June 2023. Of these, 36 patients underwent MBS (20 underwent Roux-en-Y gastric bypass and 16 underwent sleeve gastrectomy), and 10 underwent subsequent transplantation, with another 15 currently waitlisted. Both surgical teams shared resources, including dieticians, social workers, and a common database, for easy transition between teams. RESULTS The mean starting BMI for all referrals was 46.4 kg/m 2 and was 33.9 kg/m 2 at the time of transplant. The average number of hypertension medications decreased from 2 (range 2 to 4) presurgery to 1 (range 1 to 3) postsurgery. Similarly, hemoglobin A1C levels improved, with preoperative averages at 6.2 (range 5.4 to 7.6) and postoperative levels at 5.2 (range 4.6 to 5.8) All transplants are currently functioning, with a median creatinine of 1.5 (1.2 to 1.6) mg/dL (glomerular filtration rate 46 [36.3 to 71]). CONCLUSIONS A collaborative approach between bariatric and transplant surgery teams offers a pathway toward transplant for obese ESRD patients and potentially alleviates existing healthcare disparities. ESRD patients who undergo MBS have unique complications to be aware of. The improvement in comorbidities may lead to superior posttransplant outcomes.
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Affiliation(s)
- Shauna Levy
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Abdallah Attia
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mahmoud Omar
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Nicole Langford
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Adarsh Vijay
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Hoonbae Jeon
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Carlos Galvani
- From the Divisions of Bariatric and Minimally Invasive Surgery (Levy, Attia, Galvani)
| | - Mary T Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA (Omar, Killackey)
| | - Anil S Paramesh
- Transplant Surgery (Langford, Vijay, Jeon, Paramesh), Department of Surgery, Tulane University School of Medicine, New Orleans, LA
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14
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Sabatino A, Sola KH, Brismar TB, Lindholm B, Stenvinkel P, Avesani CM. Making the invisible visible: imaging techniques for assessing muscle mass and muscle quality in chronic kidney disease. Clin Kidney J 2024; 17:sfae028. [PMID: 38444750 PMCID: PMC10913944 DOI: 10.1093/ckj/sfae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 03/07/2024] Open
Abstract
Muscle wasting and low muscle mass are prominent features of protein energy wasting (PEW), sarcopenia and sarcopenic obesity in patients with chronic kidney disease (CKD). In addition, muscle wasting is associated with low muscle strength, impaired muscle function and adverse clinical outcomes such as low quality of life, hospitalizations and increased mortality. While assessment of muscle mass is well justified, the assessment of skeletal muscle should go beyond quantity. Imaging techniques provide the means for non-invasive, comprehensive, in-depth assessment of the quality of the muscle such as the infiltration of ectopic fat. These techniques include computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Dual energy X-ray absorptiometry is also an imaging technique, but one that only provides quantitative and not qualitative data on muscle. The main advantage of imaging techniques compared with other methods such as bioelectrical impedance analysis and anthropometry is that they offer higher precision and accuracy. On the other hand, the higher cost for acquiring and maintaining the imaging equipment, especially CT and MRI, makes these less-used options and available mostly for research purposes. In the field of CKD and end-stage kidney disease (ESKD), imaging techniques are gaining attention for evaluating muscle quantity and more recently muscle fat infiltration. This review describes the potential of these techniques in CKD and ESKD settings for muscle assessment beyond that of muscle quantity.
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Affiliation(s)
- Alice Sabatino
- Department of Nephrology, Parma University Hospital, Parma, Italy
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Kristoffer Huitfeldt Sola
- Unit of Radiology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, and Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Torkel B Brismar
- Unit of Radiology, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, and Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
| | - Carla Maria Avesani
- Division of Renal Medicine, Baxter Novum. Department of Clinical Science, Intervention and Technology. Karolinska Institute, Stockholm, Sweden
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15
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Kawasaki Y, Nishiki K, Nojiri M, Kato R, Shinomiya S, Oikawa T, Ishizaki T, Toga H, Mizuno S. Prognostic value of the serum creatinine/cystatin C ratio in patients with chronic obstructive pulmonary disease. Respir Investig 2024; 62:143-149. [PMID: 38134662 DOI: 10.1016/j.resinv.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/29/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Sarcopenia, characterized by skeletal muscle atrophy and physical inactivity, is a manifestation of chronic obstructive pulmonary disease (COPD) and is associated with a poor prognosis. The serum creatinine (Cr)/cystatin C (CysC) ratio has been proposed as a marker of sarcopenia, given its correlation with total skeletal muscle mass, and as a prognostic indicator in COPD. This study aimed to evaluate the usefulness of the serum Cr/CysC ratio as a prognostic determinant in these patients. METHODS A total of 124 outpatients with COPD were enrolled in this study. Their serum Cr and CysC levels were measured. Survival time analyses were conducted to compare mortality rates between the low and high serum Cr/CysC ratio groups. Multivariate analysis was performed to investigate the association between various factors. RESULTS Using a serum Cr/CysC cut-off value of 0.885, the mortality rate (per 1000 person-years) for overall mortality was significantly higher in the low serum Cr/CysC ratio group (69.2 versus 28.6; hazard ratio, 2.47; 95% confidence interval, 1.06-5.79; p < 0.05). Similarly, the mortality rate due to respiratory disease was also higher (37.8 versus 8.2; hazard ratio, 4.68; 95% confidence interval, 1.05-20.9; p < 0.05). Multivariate Cox proportional hazards analysis revealed that serum Cr/CysC was an independent risk factor for respiratory disease mortality, regardless of age and airflow limitations. CONCLUSIONS The serum Cr/CysC ratio could be a valuable clinical parameter for identifying sarcopenia and severe airflow obstruction. The study findings highlight the utility of this ratio as a prognostic predictor in patients with COPD.
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Affiliation(s)
- Yasutaka Kawasaki
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Kazuaki Nishiki
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Masafumi Nojiri
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ryo Kato
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Shohei Shinomiya
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Taku Oikawa
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Takeshi Ishizaki
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hirohisa Toga
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Shiro Mizuno
- Department of Respiratory Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-gun, Ishikawa, 920-0293, Japan
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16
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Tian M, Lan Q, Yu F, He P, Hu S, Zha Y. Sex Differences in the Association of Weight-Adjusted-Waist Index with Sarcopenic Obesity: A Cross-Sectional Study of Hemodialysis Patients. Metab Syndr Relat Disord 2023; 21:596-602. [PMID: 37843817 DOI: 10.1089/met.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Objective: To explore the association between weight-adjusted-waist index (WWI) and sarcopenic obesity (SO) in patients with maintenance hemodialysis (MHD). Methods: A multicenter, cross-sectional study that included 3311 adult MHD patients was conducted in 20 hemodialysis (HD) centers from June 1, 2021, to August 30, 2021. Body composition was evaluated by body composition monitor based on bioimpedance spectroscopy. Hand grip strength was measured by CAMRY® dynamometer. WWI was calculated as waist circumference (cm) divided by the square root of body weight (kg). Multiple logistic regression models, spearman correlation analysis, and receiver-operating characteristic (ROC) analyses were conducted. Results: The median age of the study was 55 years, and 39.4% of patients were female. The prevalence of SO was 22.7% in the total population, and patients with SO had higher WWI. Higher WWI quartiles were independently associated with a higher risk of SO in men after adjusting for potential confounders, including age, dialysis vintage, body mass index, biochemical indicators, and various medical histories; the odds ratio (OR) of SO was highest in the fourth quartile of the WWI (OR: 4.08, 95% confidence interval: 2.65-6.27, P for trend <0.001). Age-adjusted WWI provided a better diagnostic power than WWI only for SO in men (area under the ROC curve: 0.72 vs. 0.68, P < 0.001). WWI was not associated with SO in female HD patients. Conclusion: WWI is independently associated with SO in male but not female MHD patients. This anthropometric index is simple to calculate, making it applicable in clinical practice.
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Affiliation(s)
- Maolu Tian
- School of Medicine, Guizhou University, Guiyang, China
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qin Lan
- Clinical Medical College, Zunyi Medical University, Zunyi, China
| | - Fangfang Yu
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pinghong He
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Shanshan Hu
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
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17
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Inoshita H, Asaoka D, Matsuno K, Yanagisawa N, Suzuki Y, Miyauchi K. Cross-Sectional Study on the Association between Dietary Patterns and Sarcopenia in Elderly Patients with Chronic Kidney Disease Receiving Conservative Treatment. Nutrients 2023; 15:4994. [PMID: 38068851 PMCID: PMC10708199 DOI: 10.3390/nu15234994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
Sarcopenia is a poor prognostic factor in patients with chronic kidney disease (CKD). Adequate dietary patterns are important for preventing sarcopenia; however, evidence regarding the underlying association between sarcopenia and diet is insufficient. Therefore, in this study, we aimed to investigate the association between sarcopenia and dietary patterns in CKD patients receiving conservative treatment. In this cross-sectional study, 441 patients with conservative CKD were examined using the Asian Working Group for Sarcopenia diagnostic criteria. CKD was defined as an eGFR of <60 mL/min/1.73 m2 present for >3 months. The participants were divided into sarcopenia and non-sarcopenia groups, and dietary patterns were compared between the two groups using the dietary variety score, a simple dietary survey method that investigates the weekly frequency of consumption of 10 food groups. Logistic regression analysis for CKD G3 showed that female sex (odds ratio (OR): 0.166, 95% confidence interval (CI): 0.086-0.320), increased body mass index (OR: 0.663, 95% CI: 0.590-0.745), and almost daily consumption of green/yellow vegetables (OR: 0.350, 95% CI: 0.176-0.695) were positively associated with non-sarcopenia. Although further prospective studies are required, the results suggest that low frequent consumption of vegetables is associated with sarcopenia in patients with CKD.
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Affiliation(s)
- Hiroyuki Inoshita
- Department of Nephrology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Daisuke Asaoka
- Department of Gastroenterology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo 113-8421, Japan;
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo 136-0075, Japan
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18
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Lee DY, Shin S. Association between Chronic Kidney Disease and Dynapenia in Elderly Koreans. Healthcare (Basel) 2023; 11:2976. [PMID: 37998468 PMCID: PMC10671638 DOI: 10.3390/healthcare11222976] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Chronic kidney disease (CKD) is caused by various factors such as chronic inflammation, oxidative stress, and obesity. Loss of muscle strength and mass is a negative prognostic factor for CKD. Therefore, in this study, we aimed to investigate the association between CKD and dynapenia in the Korean elderly. To this end, we analyzed 7029 participants from the 2014-2019 Korean National Health and Nutrition Examination Survey (KNHANES) aged ≥65 years. After adjusting for all of the covariates that could affect the results, such as physical examinations, lifestyle factors, and exercise, the association between CKD and dynapenia was found to be significant, at 1.207 (95% CI: 1.056-1.379) in CKD stage 2 and 1.790 (95% CI: 1.427-2.246) in CKD stage 3a-5. However, when sexes were analyzed separately, women were significant in both CKD stage 2 and stage 3-5 compared to normal, but only in stage 3-5 for men. Additionally, the prevalence of dynapenia increased significantly as the stage of CKD increased (normal, stage 2, and stage 3-5: 18.5%, 20.8%, and 32.3% in men and 27.5%, 34.4%, and 46.1% in women, respectively). Thus, CKD is significantly related to dynapenia, especially in women, when stratified by sex.
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Affiliation(s)
- Do-Youn Lee
- College of General Education, Kookmin University, Seoul 02707, Republic of Korea;
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan 38541, Republic of Korea
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan 38541, Republic of Korea
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Tian M, Yuan J, Yu F, He P, Zhang Q, Zha Y. Decreased intracellular water is associated with sarcopenic obesity in chronic haemodialysis patients. BMC Geriatr 2023; 23:630. [PMID: 37803331 PMCID: PMC10559522 DOI: 10.1186/s12877-023-04357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE To explore the association between intracellular water (ICW) and sarcopenic obesity in patients undergoing chronic haemodialysis (HD). METHODS A multicentre, cross-sectional study of 3354 adult chronic HD patients was conducted in 20 haemodialysis centres from June 1, 2021, to August 30, 2021. The diagnosis of sarcopenic obesity was made according to the revised Asian Working Group's definition of sarcopenia combined with obesity per the body fat percentage definition. Body composition was evaluated by a body composition monitor using bioimpedance spectroscopy. Multiple logistic regression models, stratified analyses, interactive analyses, and receiver-operating characteristic analyses were conducted. RESULTS A total of 752 patients were diagnosed with sarcopenic obesity among 3354 participants. The patients were grouped by sex-specific ICW median levels, and the prevalence of sarcopenic obesity was significantly higher in the low ICW group than in the high ICW group (41.3%vs 3.0%). Decreased ICW was significantly associated with sarcopenic obesity. The association remained statistically significant even after adjusting for dialysis vintage, age, body mass index, biochemical indicators, and various medical histories. The odds ratios of the low ICW group were much higher than those of the high ICW group in both males and females (P for trend < 0.001). The association was stable across subgroups, and the interaction analysis showed that age, body mass index and history of diabetes had interactive roles in the association between ICW and sarcopenic obesity (P for interaction < 0.05). Furthermore, the ICW cut-off values for identifying sarcopenic obesity were 19.1 kg and 14.5 kg for males and females, respectively. CONCLUSION Decreased ICW was an independent risk factor for sarcopenic obesity in chronic HD patients. The measurement of ICW by bioimpedance spectroscopy might be a non-invasive and valid means for identifying the risk of future sarcopenic obesity in HD patients.
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Affiliation(s)
- Maolu Tian
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, #83, Zhongshan Road, Nanming District, Guiyang, Guizhou, 550002, China
- Medical College, Guizhou University, Guiyang, China
| | - Jing Yuan
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, #83, Zhongshan Road, Nanming District, Guiyang, Guizhou, 550002, China
| | - Fangfang Yu
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Pinghong He
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qian Zhang
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yan Zha
- Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
- NHC Key Laboratory of Pulmonary Immunological Disease, Guizhou Provincial People's Hospital, #83, Zhongshan Road, Nanming District, Guiyang, Guizhou, 550002, China.
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20
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Sabatino A, Avesani CM, Regolisti G, Adinolfi M, Benigno G, Delsante M, Fiaccadori E, Gandolfini I. Sarcopenic obesity and its relation with muscle quality and mortality in patients on chronic hemodialysis. Clin Nutr 2023; 42:1359-1368. [PMID: 37418843 DOI: 10.1016/j.clnu.2023.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND & AIMS Sarcopenia is prevalent in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), and is associated with poor outcomes, while obesity may be protective. Sarcopenic obesity is associated with increased frailty, morbidity and mortality in the general population. Myosteatosis, i.e., muscle fat infiltration, has major effects on muscle strength and physical performance, but is poorly investigated in the nephrology setting. In the present study we aimed to assess the association between sarcopenic obesity, as diagnosed by abdominal CT, and mortality. Moreover, the relationship between myosteatosis, sarcopenic obesity and mortality was also investigated. METHODS This is a retrospective study in which ESKD patients on HD submitted to unenhanced abdominal CT for clinical reasons at least 6 months after dialysis initiation were evaluated for sarcopenic obesity and myosteatosis, defined as intermuscular fat area and low attenuation muscle area. Sarcopenic obesity was diagnosed in cases of low abdominal skeletal muscle area and high total fat area. Receiver-operating characteristics (ROC) analysis with Youden index was used to determine the cut-off for high total fat area. Intermuscular fat area and low attenuation muscle area were evaluated by applying the Hounsfield unit of interest (-190; -30, and -29; +29 respectively). Cox regression analysis was used to evaluate the association between predictors and mortality risk. RESULTS We enrolled 212 patients, aged 68.8 (±14.7) years, 65.5% (139/212) male. Median follow-up was 19.7 (interquartile range [IQR] 2.7-35) months. Sarcopenic obesity was diagnosed in 19.8% of patients and was associated with increased mortality (HR: 3.29 (1.72; 6.27), P < 0.001), and with the presence of myosteatosis. Both intermuscular fat area and low attenuation muscle area were associated with increased mortality in adjusted analyses. CONCLUSIONS Patients with sarcopenic obesity have increased myosteatosis. Sarcopenic obesity and myosteatosis are associated with increased mortality in patients on HD.
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Affiliation(s)
- Alice Sabatino
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Carla Maria Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Medical Unit Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Regolisti
- UO Clinica e Immunologia Medica, Parma University Hospital, Parma, Italy
| | - Marianna Adinolfi
- Dipartimento di Scienze degli Alimenti e del Farmaco, Parma University, Parma, Italy
| | - Giuseppe Benigno
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Delsante
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Enrico Fiaccadori
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ilaria Gandolfini
- Nephrology Unit, Parma University Hospital, and Department of Medicine and Surgery, University of Parma, Parma, Italy
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21
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Kogon AJ, Roem J, Schneider MF, Mitsnefes MM, Zemel BS, Warady BA, Furth SL, Rodig NM. Associations of body mass index (BMI) and BMI change with progression of chronic kidney disease in children. Pediatr Nephrol 2023; 38:1257-1266. [PMID: 36018433 PMCID: PMC10044533 DOI: 10.1007/s00467-022-05655-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Obesity is prevalent among children with chronic kidney disease (CKD) and is associated with cardiovascular disease and reduced quality of life. Its relationship with pediatric CKD progression has not been described. METHODS We evaluated relationships between both body mass index (BMI) category (normal, overweight, obese) and BMI z-score (BMIz) change on CKD progression among participants of the Chronic Kidney Disease in Children study. Kaplan-Meier survival curves and multivariable parametric failure time models depict the association of baseline BMI category on time to kidney replacement therapy (KRT). Additionally, the annualized percentage change in estimated glomerular filtration rate (eGFR) was modeled against concurrent change in BMIz using multivariable linear regression with generalized estimating equations which allowed for quantification of the effect of BMIz change on annualized eGFR change. RESULTS Participants had median age of 10.9 years [IQR: 6.5, 14.6], median eGFR of 50 ml/1.73 m2 [IQR: 37, 64] and 63% were male. 160 (27%) of 600 children with non-glomerular and 77 (31%) of 247 children with glomerular CKD progressed to KRT over a median of 5 years [IQR: 2, 8]. Times to KRT were not significantly associated with baseline BMI category. Children with non-glomerular CKD who were obese experienced significant improvement in eGFR (+ 0.62%; 95% CI: + 0.17%, + 1.08%) for every 0.1 standard deviation concurrent decrease in BMI. In participants with glomerular CKD who were obese, BMIz change was not significantly associated with annualized eGFR change. CONCLUSION Obesity may represent a target of intervention to improve kidney function in children with non-glomerular CKD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Amy J Kogon
- Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA.
| | - Jennifer Roem
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael F Schneider
- Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark M Mitsnefes
- Pediatrics, Division of Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Babette S Zemel
- Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Bradley A Warady
- Pediatrics, Division of Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Susan L Furth
- Pediatrics, Division of Nephrology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, PA, USA
| | - Nancy M Rodig
- Pediatrics, Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
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22
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Kinoshita-Katahashi N, Shibata Y, Yasuda H, Ishikawa S, Gotoh T, Nakamura Y, Kayaba K, Ojima T. Association between physical activity and mortality in the Japanese general population with mild to moderate impaired renal function: the Jichi Medical School (JMS) cohort study. Clin Exp Nephrol 2023; 27:243-250. [PMID: 36471189 DOI: 10.1007/s10157-022-02301-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The association between physical activity volume or intensity and mortality in general population with impaired renal function is unclear. We assessed these relationships among Japanese residents with impaired renal function. METHODS We analyzed 638 individuals with estimated creatinine clearance below 60 ml/min in the Jichi Medical School cohort study. Exposures included the daily amount of physical activity converted to the physical activity index (PAI) used in the Framingham study and the activity time for each intensity. Physical activity intensity was classified into sedentary and nonsedentary. Nonsedentary activity was further divided into light-intensity and moderate-to-vigorous physical activity (MVPA). The outcome was all-cause mortality. Quartiles of the exposures were created, and hazard ratios (HRs) were calculated using the Cox proportional hazards model. RESULTS The mean age of the subjects was 63.3 years, and 72.4% were female. In total, 172 deaths were registered during 11,567 person-years. No significant association was found between PAI and mortality. A significant association was found between long sedentary time and increased mortality (p = 0.042). Regarding nonsedentary activity, the HRs [95% confidence intervals (CIs)] for Q2, Q3, and Q4 versus Q1 were 0.85 (0.55-1.31), 0.67 (0.41-1.08), and 0.90 (0.54-1.45), respectively. In the subdivided analysis for light-intensity activity, the HRs (95% CIs) of Q2, Q3, and Q4 versus Q1 were 0.53 (0.33-0.84), 0.51 (0.34-0.82), and 0.57 (0.34-0.96), respectively. No significant association was found between MVPA and mortality. CONCLUSIONS Nonsedentary activity, especially light-intensity activity, significantly reduced mortality among residents with impaired renal function.
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Affiliation(s)
- Naoko Kinoshita-Katahashi
- Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yosuke Shibata
- Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Shizukiyo Ishikawa
- Medical Education Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Tadao Gotoh
- National Health Insurance Shirotori Hospital, 1205-1 Tamezane, Shirotori, Gujo, Gifu, 501-5122, Japan
| | - Yosizkazu Nakamura
- Public Health Department of Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Kazunori Kayaba
- Saitama Prefectural University, 820 Sannomiya, Koshigaya, Saitama, 343-8540, Japan
| | - Toshiyuki Ojima
- Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan
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23
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Bhat PR, Urooj A, Nalloor S. Changes in body composition in relation to estimated glomerular filtration rate and physical activity in predialysis chronic kidney disease. Chronic Dis Transl Med 2022; 8:305-313. [PMID: 36420172 PMCID: PMC9676115 DOI: 10.1002/cdt3.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/24/2022] [Accepted: 08/16/2022] [Indexed: 11/07/2022] Open
Abstract
Background Early body composition changes, associated with physical inactivity and disease advancement are devastating for patient-related outcomes in predialysis chronic kidney disease (CKD), thus warranting a detailed analysis of body composition beyond conventional measures. Methods The study included 40 subjects diagnosed with CKD; recruited between January to May 2021. Body composition was measured using the multifrequency analyzer, InBody 770. International Physical Activity Questionnaire-Short Form was used to assess physical activity. Suitable statistical analyses were performed using SPSS 21.0. Results The mean age of the subjects was 58.68 ± 12.24 years. Sarcopenic obesity was prevalent in 62.5% of the subjects. Body mass index under identified obesity by 15% compared to percent body fat, especially in subjects with low muscle mass. The decline in a unit of estimated glomerular filtration rate (eGFR) significantly correlated with a decrease in weight (p = 0.02), body fat mass (p = 0.05), visceral fat area (p = 0.05), and phase angle (p = 0.01) with marginal changes in waist-hip ratio and extracellular water/total body water. The effect of physical activity on skeletal muscle mass was homogeneous between low and moderate levels, but significantly different from high activity level. Conclusion Changes in fat and fluid compartment were associated with eGFR decline, whereas higher physical activity positively affected body composition.
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Affiliation(s)
- Prathiksha R. Bhat
- Department of Studies in Food Science and Nutrition, ManasagangotriUniveristy of MysoreMysuruKarnatakaIndia
| | - Asna Urooj
- Department of Studies in Food Science and Nutrition, ManasagangotriUniveristy of MysoreMysuruKarnatakaIndia
| | - Srinivas Nalloor
- Department of NephrologyApollo BGS hospitalsMysuruKarnatakaIndia
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24
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Shen FC, Chen ME, Wu WT, Kuo IC, Niu SW, Lee JJ, Hung CC, Chang JM, Hwang SJ. Normal weight and waist obesity indicated by increased total body fat associated with all-cause mortality in stage 3–5 chronic kidney disease. Front Nutr 2022; 9:982519. [PMID: 36185692 PMCID: PMC9523665 DOI: 10.3389/fnut.2022.982519] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic kidney disease (CKD) demonstrate a survival benefit with a high body mass index (BMI); this is the obesity paradox. Central obesity has a higher prognostic value than BMI, even in those with normal weight. Whether total body fat percentage (TBF%) provides more information than BMI and waist circumference (WC) remains unknown. We included 3,262 Asian patients with stage 3–5 CKD and divided these patients by TBF% and waist-to-height ratio (WHtR) quartiles (Q1–Q4). TBF% was associated with BMI, WC, nutritional markers, and C-reactive protein. In all patients, BMI but not TBF% or WHtR demonstrated a survival paradox. In patients with BMI <25 kg/m2, but not in those with BMI ≥ 25 kg/m2, TBF% Q4 and WHtR Q4 were associated with all-cause mortality, with hazard ratios [HRs; 95% confidence intervals (CIs)] of 2.35 (1.31–4.22) and 1.38 (1.06–1.80), respectively. The HRs of TBF% Q4 for all-cause mortality were 2.90 (1.50–5.58) in patients with a normal WC and 3.81 (1.93–7.50) in patients with normal weight and normal WC (All P for interaction < 0.05). In conclusion, TBF% can predict all-cause mortality in patients with advanced CKD and a normal weight, normal WC, or both.
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Affiliation(s)
- Feng-Ching Shen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-En Chen
- Department of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Tsung Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ching Kuo
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Wen Niu
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-Jung Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Chi-Chih Hung
| | - Jer-Ming Chang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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25
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Song P, Xu X, Zhao Y, Gu M, Chen X, Zhang H, Wu X, Yu C, Niu J, Ding W, Zhang S, Guo Q. Different stages of chronic kidney disease are associated with physical performance in adults over 60 years. Front Public Health 2022; 10:963913. [PMID: 36159314 PMCID: PMC9501662 DOI: 10.3389/fpubh.2022.963913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/10/2022] [Indexed: 01/24/2023] Open
Abstract
Objective The purpose of this study was to determine the association between different stages of chronic kidney disease (CKD) and sarcopenia and its components in the Chinese older population. Methods The study comprised of 2,213 participants aged ≥ 60 years (1,025 men; mean age: 70.7 years) recruited from Shanghai who were invited to participate in a comprehensive geriatric assessment. Sarcopenia was defined according to the AWGS 2019 consensus update on sarcopenia diagnosis criteria. The glomerular filtration rate (GFR) was estimated using the equation that originated from the CKD-EPI equation, the stages of CKD are classified according to the Kidney Disease-Improving Global Outcomes (KDIGO). Results The overall prevalence of sarcopenia was 19.0%, which increased with the severity of CKD. The prevalence of sarcopenia in patients with CKD 3-4 and kidney failure was significantly higher than that in normal and CKD 1-2 (p < 0.05). In logistic regression analysis model, compared with normal and CKD 1 patients, kidney failure was significantly associated with the increased risk of sarcopenia and low grip strength (p < 0.05); CKD 2, CKD 3-4 and kidney failure groups were significantly associated with an increased risk of low walking speed (p < 0.05), respectively; while the association between CKD and muscle mass was not shown. Conclusions In our study, only decreased physical performance, as represented by walking speed, was significantly associated with increased CKD severity. This may improve the evidence for the prevention and intervention of sarcopenia in patients with CKD.
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Affiliation(s)
- Peiyu Song
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xinghong Xu
- Shanghai Yongci Rehabilitation Hospital, Shanghai, China
| | - Yinjiao Zhao
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Minghong Gu
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hui Zhang
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Xinze Wu
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jianying Niu
- Department of Nephrology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suhua Zhang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China,Suhua Zhang
| | - Qi Guo
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China,Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China,*Correspondence: Qi Guo
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Norris T, Montgomery R, Cibrik D, Reintjes M, Chakraborty S, Fishback S, Gupta A. Pretransplant Psoas Muscle Cross-Sectional Area and Postkidney Transplant Outcomes. Transplant Proc 2022; 54:1816-1821. [PMID: 35933230 PMCID: PMC10506176 DOI: 10.1016/j.transproceed.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Sarcopenia is associated with adverse outcomes in end-stage kidney disease. We evaluated if pretransplant sarcopenia affects posttransplant outcomes in kidney transplant (KT) recipients. METHODS In this single-center retrospective study of adult patients with end-stage kidney disease, we analyzed the association between pre-KT psoas muscle cross-sectional area and critical posttransplant outcomes of decline in estimated glomerular filtration rate (eGFR), graft loss, rehospitalization, and mortality using Cox proportional hazard model adjusted for age, sex, and race. RESULTS Pre-KT abdomen and pelvic computed tomography scans performed during evaluation for KT eligibility were available for 573 KT recipients. Of these, 465 KT recipients received kidney alone transplant, 71 received simultaneous liver kidney transplant (SLK), and 37 received simultaneous pancreas kidney transplant (SPK). Patients were 49 (SD, 13) years old, 16% Black, and 60% men. For kidney alone transplant recipients, a higher psoas muscle cross-sectional area was associated with a shorter length of hospitalization (β coefficient = -0.003; 95% CI, -0.005 to -0.0007). Conversely, pre-KT psoas muscle cross-sectional area did not predict decline in eGFR, graft loss, mortality, or early rehospitalization. For SLK recipients, psoas muscle cross-sectional area did not predict any of the priori outcomes. For SPK recipients, higher pretransplant psoas muscle cross-sectional area predicted a longer length of hospitalization (β coefficient = 0.03; 95% CI, 0.01-0.05). There was no association between psoas muscle cross-sectional area and other outcomes assessed. CONCLUSIONS Pretransplant psoas muscle cross-sectional areas are not predictive of post-transplant decline in eGFR, graft loss, rehospitalization or mortality in kidney alone, SPK, or SLK transplants.
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Affiliation(s)
- Taylor Norris
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert Montgomery
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Diane Cibrik
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark Reintjes
- Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Shweta Chakraborty
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Shelby Fishback
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Aditi Gupta
- Division of Nephrology, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
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Zhang Y, Gu L, Wang L, Rong S, Yuan W. Low protein diet supplemented with ketoacids on muscle wasting in chronic kidney disease: A clinical trial. Front Med (Lausanne) 2022; 9:949108. [PMID: 36186800 PMCID: PMC9516635 DOI: 10.3389/fmed.2022.949108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Aim Nutrition is an important part of the care of patients with chronic kidney disease (CKD). However, there is limited clinical research on the skeletal muscle nutrition of patients with CKD. We carried out this study to find out whether a low-protein diet supplemented with ketoacids (LPD + KA) could improve muscle wasting in patients with CKD. Methods Patients were enrolled in this non-blind, parallel-group, randomized trial assessing the nutritional status of CKD, randomly assigned to either the LPD + KA group or conventional LPD group. Blood samples such as Hemoglobin, Cystatin C, Creatinine, BUN, Albumin, Pre- Albumin, Glycerin Trilaurate, and Cholesterol were measured at baseline and every 3 months. The parameters of skeletal muscle and other body composition were assessed before and after dietary intervention for 12 months. Results A total of 58 patients with CKD completed the study and were available for further analysis. The hemoglobin and albumin were observed to be markedly improved in the LPD + KA group during the follow-up as compared to baseline. Body mass index and total body water index of both groups were increased upon follow-up but the increase in the LPD + KA group was comparatively higher. Moreover, an increase in body fat%, skeletal muscle mass index, and appendicular skeletal muscle mass index was observed in both groups between baseline and follow-up, but it was statistically insignificant. Conclusion This study did not find a significant improvement of KAs on muscle wasting, and a long time or more indices study may need to find the effects of the LPD + KA diets. Clinical trial registration [www.ClinicalTrials.gov], identifier [NCT02568020].
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Thomas SS, Wu J, Davogustto G, Holliday MW, Eckel-Mahan K, Verzola D, Garibotto G, Hu Z, Mitch WE, Taegtmeyer H. SIRPα Mediates IGF1 Receptor in Cardiomyopathy Induced by Chronic Kidney Disease. Circ Res 2022; 131:207-221. [PMID: 35722884 PMCID: PMC10010047 DOI: 10.1161/circresaha.121.320546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by increased myocardial mass despite near-normal blood pressure, suggesting the presence of a separate trigger. A potential driver is SIRPα (signal regulatory protein alpha)-a mediator impairing insulin signaling. The objective of this study is to assess the role of circulating SIRPα in CKD-induced adverse cardiac remodeling. METHODS SIRPα expression was evaluated in mouse models and patients with CKD. Specifically, mutant, muscle-specific, or cardiac muscle-specific SIRPα KO (knockout) mice were examined after subtotal nephrectomy. Cardiac function was assessed by echocardiography. Metabolic responses were confirmed in cultured muscle cells or cardiomyocytes. RESULTS We demonstrate that SIRPα regulates myocardial insulin/IGF1R (insulin growth factor-1 receptor) signaling in CKD. First, in the serum of both mice and patients, SIRPα was robustly secreted in response to CKD. Second, cardiac muscle upregulation of SIRPα was associated with impaired insulin/IGF1R signaling, myocardial dysfunction, and fibrosis. However, both global and cardiac muscle-specific SIRPα KO mice displayed improved cardiac function when compared with control mice with CKD. Third, both muscle-specific or cardiac muscle-specific SIRPα KO mice did not significantly activate fetal genes and maintained insulin/IGF1R signaling with suppressed fibrosis despite the presence of CKD. Importantly, SIRPα directly interacted with IGF1R. Next, rSIRPα (recombinant SIRPα) protein was introduced into muscle-specific SIRPα KO mice reestablishing the insulin/IGF1R signaling activity. Additionally, overexpression of SIRPα in myoblasts and cardiomyocytes impaired pAKT (phosphorylation of AKT) and insulin/IGF1R signaling. Furthermore, myotubes and cardiomyocytes, but not adipocytes treated with high glucose or cardiomyocytes treated with uremic toxins, stimulated secretion of SIRPα in culture media, suggesting these cells are the origin of circulating SIRPα in CKD. Both intracellular and extracellular SIRPα exert biologically synergistic effects impairing intracellular myocardial insulin/IGF1R signaling. CONCLUSIONS Myokine SIRPα expression impairs insulin/IGF1R functions in cardiac muscle, affecting cardiometabolic signaling pathways. Circulating SIRPα constitutes an important readout of insulin resistance in CKD-induced cardiomyopathy.
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Affiliation(s)
- Sandhya S Thomas
- Nephrology Division, Department of Medicine, Michael E. Debakey VA Medical Center, Houston, TX (S.S.T.).,Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.T., J.W., M.W.H., Z.H., W.E.M.)
| | - Jiao Wu
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.T., J.W., M.W.H., Z.H., W.E.M.)
| | - Giovanni Davogustto
- Cardiology Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (G.D.)
| | - Michael W Holliday
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.T., J.W., M.W.H., Z.H., W.E.M.)
| | - Kristin Eckel-Mahan
- Center for Metabolic and Degenerative Diseases, Institute of Molecular Medicine, The University of Texas Health Science Center, Houston (K.E.-M.)
| | - Daniela Verzola
- Nephrology Division, Department of Medicine, Università degli Studi di Genova, Genoa, Italy (D.V., G.G.)
| | - Giacomo Garibotto
- Nephrology Division, Department of Medicine, Università degli Studi di Genova, Genoa, Italy (D.V., G.G.)
| | - Zhaoyong Hu
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.T., J.W., M.W.H., Z.H., W.E.M.)
| | - William E Mitch
- Nephrology Division, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.T., J.W., M.W.H., Z.H., W.E.M.)
| | - Heinrich Taegtmeyer
- Cardiology Division, Department of Medicine, McGovern Medical School at the University of Texas Health Science Center, Houston (H.T.)
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An JN, Kim JK, Lee HS, Kim SG, Kim HJ, Song YR. Serum cystatin C to creatinine ratio is associated with sarcopenia in non-dialysis-dependent chronic kidney disease. Kidney Res Clin Pract 2022; 41:580-590. [PMID: 35791742 PMCID: PMC9576455 DOI: 10.23876/j.krcp.21.214] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Jwa-Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung-Seok Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Hyung Jik Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
- Hallym University Kidney Research Institute, Anyang, Republic of Korea
- Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Republic of Korea
- Correspondence: Young Rim Song Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Republic of Korea. E-mail:
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The Role of Lifestyle Intervention, in Addition to Drugs, for Diabetic Kidney Disease with Sarcopenic Obesity. Life (Basel) 2022; 12:life12030380. [PMID: 35330131 PMCID: PMC8954787 DOI: 10.3390/life12030380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic kidney disease is the leading cause of end-stage renal disease in developing and developed countries. The growing prevalence and clinical challenges of sarcopenic obesity have been associated with the frailty and disability of diabetic kidney disease. It has been reported that insulin resistance, chronic inflammation, enhanced oxidative stress and lipotoxicity contribute to the pathophysiology of muscle loss and visceral fat accumulation. Sarcopenic obesity, which is diagnosed with dual-energy X-ray absorptiometry, is associated with worse outcomes in kidney disease. Growing evidence indicates that adherence to healthy lifestyles, including low protein diet, proper carbohydrate control, vitamin D supplement, and regular physical training, has been shown to improve clinical prognosis. Based on the higher risk of sarcopenic-obesity-related renal function decline, it has led to the exploration and investigation of the pathophysiology, clinical aspects, and novel approach of these controversial issues in daily practice.
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Mohanasundaram S, Fernando E. Uremic Sarcopenia. Indian J Nephrol 2022; 32:399-405. [PMID: 36568601 PMCID: PMC9775613 DOI: 10.4103/ijn.ijn_445_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/27/2022] Open
Abstract
"Uremic sarcopenia" refers to a progressive decrease in muscle mass, strength, and function despite normal skeletal muscle physiology in patients with chronic kidney disease (CKD). Sarcopenia involves multiple risk factors, comprising immunological changes, hormonal, metabolic acidosis, reduced protein intake, and physical inactivity. All these risk factors, along with complex pathophysiological mechanisms including ubiquitin, insulin/IGF-1, myostatin, and indoxyl sulfate, activate downstream pathways that ultimately increase muscle degradation while reducing muscle regeneration. Uremic sarcopenia not only affects the quality of life but also increases the risk of morbidity and mortality in patients with CKD. Of all the treatment modalities, aerobic and resistance exercise have shown prevention and reduced rate of muscle degeneration. A variety of pharmacological agents have been tried to target different steps in the known pathogenetic pathways, including the use of androgens and anabolic steroids, correction of vitamin D deficiency, use of growth hormone supplementation, and suppression of the ubiquitin pathway. Though some of these techniques have had beneficial results in animal experiments, human trials are still sparse. This review article relates to recent publications that describe the abnormalities in skeletal muscle that primarily leads to muscle wasting and its consequences in patients with CKD.
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Affiliation(s)
- Subashri Mohanasundaram
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India
| | - Edwin Fernando
- Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Edwin Fernando, Department of Nephrology, Government Stanley Medical College and Hospital, Chennai, Tamil Nadu, India. E-mail:
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Chatzipetrou V, Bégin MJ, Hars M, Trombetti A. Sarcopenia in Chronic Kidney Disease: A Scoping Review of Prevalence, Risk Factors, Association with Outcomes, and Treatment. Calcif Tissue Int 2022; 110:1-31. [PMID: 34383112 PMCID: PMC8732833 DOI: 10.1007/s00223-021-00898-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/29/2021] [Indexed: 12/14/2022]
Abstract
Sarcopenia, a condition characterized by loss of skeletal muscle mass and function, has important clinical ramifications. We aimed to map the existing literature about prevalence, risk factors, associated adverse outcomes, and treatment of sarcopenia in individuals with chronic kidney disease (CKD). A scoping review of the literature was conducted to identify relevant articles published from databases' inception to September 2019. Individuals with CKD, regardless of their disease stage and their comorbidities, were included. Only studies with sarcopenia diagnosed using both muscle mass and function, based on published consensus definitions, were included. For studies on treatment, only randomized controlled trials with at least one sarcopenia parameter as an outcome were included. Our search yielded 1318 articles, of which 60 from were eligible for this review. The prevalence of sarcopenia ranged from 4 to 42% according to the definition used, population studied, and the disease stage. Several risk factors for sarcopenia were identified including age, male gender, low BMI, malnutrition, and high inflammatory status. Sarcopenia was found to be associated with several adverse outcomes, including disabilities, hospitalizations, and mortality. In CKD subjects, several therapeutic interventions have been assessed in randomized controlled trial with a muscle mass, strength, or function endpoint, however, studies focusing on sarcopenic CKD individuals are lacking. The key interventions in the prevention and treatment of sarcopenia in CKD seem to be aerobic and resistance exercises along with nutritional interventions. Whether these interventions are effective to treat sarcopenia and prevent clinical consequences in this population remains to be fully determined.
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Affiliation(s)
- Varvara Chatzipetrou
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Marie-Josée Bégin
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
| | - Mélany Hars
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland
| | - Andrea Trombetti
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, 1205, Geneva, Switzerland.
- Division of Geriatrics, Department of Readaptation and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
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Assessment and management of obesity and metabolic syndrome in children with CKD stages 2-5 on dialysis and after kidney transplantation-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2022; 37:1-20. [PMID: 34374836 PMCID: PMC8674169 DOI: 10.1007/s00467-021-05148-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 12/12/2022]
Abstract
Obesity and metabolic syndrome (O&MS) due to the worldwide obesity epidemic affects children at all stages of chronic kidney disease (CKD) including dialysis and after kidney transplantation. The presence of O&MS in the pediatric CKD population may augment the already increased cardiovascular risk and contribute to the loss of kidney function. The Pediatric Renal Nutrition Taskforce (PRNT) is an international team of pediatric renal dietitians and pediatric nephrologists who develop clinical practice recommendations (CPRs) for the nutritional management of children with kidney diseases. We present CPRs for the assessment and management of O&MS in children with CKD stages 2-5, on dialysis and after kidney transplantation. We address the risk factors and diagnostic criteria for O&MS and discuss their management focusing on non-pharmacological treatment management, including diet, physical activity, and behavior modification in the context of age and CKD stage. The statements have been graded using the American Academy of Pediatrics grading matrix. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. The CPRs will be periodically audited and updated by the PRNT.
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Nunes CF, Carvalho TRD, Duarte RDS, Barboza YACO, Lemos MCCD, Pinho CPS. Prevalence of sarcopenia and associated factors in patients in hemodialysis. REVISTA CIÊNCIAS EM SAÚDE 2021. [DOI: 10.21876/rcshci.v11i4.1153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective: To assess the prevalence of sarcopenia and associated factors in patients with chronic kidney disease (CKD) undergoing hemodialysis (HD). Methods: This cross-sectional study evaluated patients with CKD undergoing HD from January to October 2016 in two dialysis centers located in Recife, Pernambuco. For the diagnosis of sarcopenia, the criteria proposed by the 2019 European Consensus on Sarcopenia, which advocates low muscle strength as the main criterion, were considered. Demographic, clinical, anthropometric, and behavioral covariates were evaluated. Results: 108 patients were included, with a mean age of 51.4 ± 17.0 years and homogeneous distribution between the sexes.Sarcopenia was present in 38.9% of the population, of which 69% had severe sarcopenia. A higher prevalence of sarcopenia was observed among men (60% vs. 17%; p < 0.001), in those without a partner (48.1% vs. 30.4%; p < 0.045), in smokers (50% vs. 30%; p < 0.034), with low weight (underweight 73.3%, eutrophic 33.9%, overweight 32.4%; p = 0.001) and those with normal albumin levels (47.5% vs. 28.6%; p = 0.045). Conclusion: Approximately one in three nephropathic patients on hemodialysis presented sarcopenia and, among these, most had the severe form of this condition.Uremic sarcopenia was more prevalent in males, in individuals without partners, underweight, in smokers, and among those with normal albumin levels.
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Weng SC, Chen CM, Chen YC, Wu MJ, Tarng DC. Trajectory of Estimated Glomerular Filtration Rate and Malnourishment Predict Mortality and Kidney Failure in Older Adults With Chronic Kidney Disease. Front Med (Lausanne) 2021; 8:760391. [PMID: 34912823 PMCID: PMC8666586 DOI: 10.3389/fmed.2021.760391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The trajectory patterns of estimated glomerular filtration rates (eGFR) in chronic kidney disease (CKD) older adults with malnourishment and their association with subsequent patient outcomes have not been elucidated. We aimed to assess the eGFR trajectory patterns for predicting patient survival and kidney failure in the elderly without or with malnourishment. Materials and Methods: Based on a prospective longitudinal cohort, CKD patients aged 65 years or older were enrolled from 2001 to 2013. Among the 3,948 patients whose eGFR trajectory patterns were analyzed, 1,872 patients were stratified by the absence or presence of malnourishment, and 765 patients were identified and categorized as having malnourishment. Four eGFR trajectory patterns [gradual decline (T0), early non-decline and then persistent decline (T1), persistent increase (T2), and low baseline and then progressive increase (T3)] were classified by utilizing a linear mixed-effect model with a quadratic term in time. The malnourishment was defined as body mass index < 22 kg/m2, serum albumin < 3.0 mg/dL, or Geriatric Nutritional Risk Index (GNRI) < 98. This study assessed the effectiveness of eGFR trajectory patterns in a median follow-up of 2.27 years for predicting all-cause mortality and kidney failure. Results: The mean age was 76.9 ± 6.7 years, and a total of 82 (10.7%) patients with malnourishment and 57 (5.1%) patients without malnourishment died at the end of the study. Compared with the reference trajectory T0, the overall mortality of T1 was markedly reduced [adjusted hazard ratio (aHR) = 0.52, 95% confidence interval (CI) 0.32–0.83]. In patients with trajectory, T3 was associated with a high risk for kidney failure (aHR = 5.68, 95% CI 3.12–10.4) compared with the reference, especially higher risk in the presence of malnourishment. Patients with high GNRI values were significantly associated with a lower risk of death and kidney failure, but patients with malnourishment and concomitant alcohol consumption had a higher risk of kidney failure. Conclusions: Low baseline eGFR and progressively increasing eGFR trajectory were high risks for kidney failure in CKD patients. These findings may be attributed to multimorbidity, malnourishment, and decompensation of renal function.
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Affiliation(s)
- Shuo-Chun Weng
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chyong-Mei Chen
- Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Ju Wu
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.,Center for Geriatrics and Gerontology, Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University, Taichung, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Cherng Tarng
- Institute of Clinical Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Kotsis V, Martinez F, Trakatelli C, Redon J. Impact of Obesity in Kidney Diseases. Nutrients 2021; 13:nu13124482. [PMID: 34960033 PMCID: PMC8703549 DOI: 10.3390/nu13124482] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 01/14/2023] Open
Abstract
The clinical consequences of obesity on the kidneys, with or without metabolic abnormalities, involve both renal function and structures. The mechanisms linking obesity and renal damage are well understood, including several effector mechanisms with interconnected pathways. Higher prevalence of urinary albumin excretion, sub-nephrotic syndrome, nephrolithiasis, increased risk of developing CKD, and progression to ESKD have been identified as being associated with obesity and having a relevant clinical impact. Moreover, renal replacement therapy and kidney transplantation are also influenced by obesity. Losing weight is key in limiting the impact that obesity produces on the kidneys by reducing albuminuria/proteinuria, declining rate of eGFR deterioration, delaying the development of CKD and ESKD, and improving the outcome of a renal transplant. Weight reduction may also contribute to appropriate control of cardiometabolic risk factors such as hypertension, metabolic syndrome, diabetes, and dyslipidemia which may be protective not only in renal damage but also cardiovascular disease. Lifestyle changes, some drugs, and bariatric surgery have demonstrated the benefits.
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Affiliation(s)
- Vasilios Kotsis
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Fernando Martinez
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
| | - Christina Trakatelli
- 3rd Department of Internal Medicine, Hypertension-24h ABPM ESH Center of Excellence, Papageorgiou Hospital, Aristotle University of Thessaloniki, 564 29 Pavlos Melas, Greece; (V.K.); (C.T.)
| | - Josep Redon
- Internal Medicine Hospital Clínico de Valencia, 46010 Valencia, Spain;
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, 46010 Valencia, Spain
- CIBERObn Carlos III Institute, 28029 Madrid, Spain
- Correspondence:
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Ferreira MF, Böhlke M, Pauletto MB, Frühauf IR, Gonzalez MC. Sarcopenia diagnosis using different criteria as a predictor of early mortality in patients undergoing hemodialysis. Nutrition 2021; 95:111542. [PMID: 35026482 DOI: 10.1016/j.nut.2021.111542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Chronic kidney disease (CKD) is a public health problem, causing secondary sarcopenia. The aim of this study was to evaluate sarcopenia using the definitions proposed by European Working Group on Sarcopenia in Older People in 2010 (EWGSOP2010) and 2019 (EWGSOP2019) as an independent prognostic factor for worse survival in patients with CKD undergoing hemodialysis. METHODS Muscle mass, muscle strength, and physical performance were assessed in a cohort of patients with CKD on hemodialysis. The sample consisted of 127 patients (40% >60 y of age) and 36 patients (28.3%) died after a median follow-up length of 23.5 mo (interquartile range= 14.9 - 29). The EWGSOP2010 and EWGSOP2019 definitions were used for diagnosing sarcopenia. Sarcopenia association with mortality by both definitions was investigated using Kaplan-Meier curves and Cox proportional hazard models. The area under the curve, sensitivity, specificity, positive, and negative predictive values for both definitions were also compared. RESULTS Patients diagnosed with sarcopenia by both criteria had almost three times higher risk for mortality (95% confidence interval,1.45-6.06 and 1.44-6.13, respectively). Patients classified with severe sarcopenia by both definitions had a significantly lower survival, even after the adjusted analysis. The areas under the curve for EWGSOP2010 and EWGSOP2019 did not significantly differ. The sensitivity/specificity analysis was considered similar for both criteria, and around 70% of the patients was correctly classified. CONCLUSION Sarcopenia, notably severe sarcopenia, diagnosed by EWGSOP2010 or EWGSOP2019 criteria, is an independent prognostic factor for worse survival in this population. Early detection with effective interventions may decrease the higher mortality risk among patients with sarcopenia and CKD.
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Affiliation(s)
| | - Maristela Böhlke
- PostGraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | | | | | - Maria Cristina Gonzalez
- PostGraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil.
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Yildirim S, Colak T, Bayraktar N, Sezer S. Evaluation of Dynapenia and Sarcopenia and Their Associations With Serum Insulin-Like Growth Factor-1 Levels in Renal Transplant Recipients. J Ren Nutr 2021; 32:354-362. [PMID: 34716090 DOI: 10.1053/j.jrn.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Dynapenia and sarcopenia are related to increased morbidity and mortality in the general population. Chronic kidney disease (CKD) causes sarcopenia and dynapenia with different mechanisms. The aim of this study is to compare the muscle parameters in renal transplant recipients to CKD patients and patients without kidney disease and assess their associations with serum insulin-like growth factor-1 (IGF-1) levels. METHOD In total, 120 renal transplant recipients (mean age: 40.4 ± 10.5 years), 60 CKD patients (mean age: 41.9 ± 11.4 years), and 60 control subjects with normal kidney function (mean age: 38.8 ± 9.9 years) were enrolled. Body mass index, hand grip strength, bioelectrical impedance analysis, 6-minute walking test, and serum IGF-1 level were measured and compared between groups. Muscle parameters were evaluated according to The Foundation for the National Institutes of Health Biomarkers Consortium Sarcopenia Project criteria. RESULTS IGF-1 levels were highest in the renal transplantation group and lowest in the control group (P = .029). In total, 12.5% of patients in the renal transplantation group (13.3% overweight, 20% obese), 11.6% in the CKD group, and 1.6% in the control group had dynapenia (P = .015). In addition, 8.3% of patients in the CKD group, 3.3% in the renal transplantation group (50% overweight), and none of the patients in the control group had sarcopenia (P = .054). In multivariate analyses, muscle strength was associated with IGF-1 levels in renal transplant recipients (beta = 2.314, t = 3.456, P = .001). CONCLUSIONS Serum IGF-1 is closely associated with muscle strength in renal transplant recipients. The negative effects of CKD on muscle system cannot be completely resolved with renal transplantation. Sarcopenic obesity and dynapenic obesity need special attention and therefore body mass index cannot be used as the only parameter to evaluate frailty in renal transplant recipients.
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Affiliation(s)
- Saliha Yildirim
- Baskent University Faculty of Medicine, Internal Medicine Department, Ankara, Turkey.
| | - Turan Colak
- Baskent University Faculty of Medicine, Nephrology Department, Ankara, Turkey
| | - Nilufer Bayraktar
- Baskent University Faculty of Medicine, Biochemistry Department, Ankara, Turkey
| | - Siren Sezer
- Baskent University Faculty of Medicine, Nephrology Department, Ankara, Turkey
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Tsai PH, Yang HC, Lin C, Sung CC, Chu P, Hsu YJ. Association of Serum Phosphate with Low Handgrip Strength in Patients with Advanced Chronic Kidney Disease. Nutrients 2021; 13:3605. [PMID: 34684606 PMCID: PMC8540460 DOI: 10.3390/nu13103605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 12/27/2022] Open
Abstract
Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels between advanced CKD patients with (n = 51) and those without sarcopenia indicators (n = 83). Low appendicular skeletal muscle mass index (ASMI), low handgrip strength, and low gait speed were defined per the standards of the Asian Working Group for Sarcopenia. Mean serum Pi level was significantly higher in advanced CKD patients with sarcopenia indicators than those without sarcopenia indicators (3.88 ± 0.86 vs. 3.54 ± 0.73 mg/dL; p = 0.016). Univariate analysis indicated that serum Pi was negatively correlated with ASMI, handgrip strength, and gait speed. Multivariable analysis revealed that serum Pi was significantly associated with handgrip strength (standardized β = -0.168; p = 0.022) and this association persisted even after adjustments for potential confounders. The optimal serum Pi cutoff for predicting low handgrip strength was 3.65 mg/dL, with a sensitivity of 82.1% and specificity of 56.6%. In summary, low handgrip strength is common in advanced CKD patients and serum Pi level is negatively associated with handgrip strength.
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Affiliation(s)
- Ping-Huang Tsai
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.T.); (C.-C.S.); (P.C.)
| | - Hsiu-Chien Yang
- Division of Nephrology, Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung 81342, Taiwan;
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan;
- Department of Research and Development, National Defense Medical Center, Taipei 114, Taiwan
| | - Chih-Chien Sung
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.T.); (C.-C.S.); (P.C.)
| | - Pauling Chu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.T.); (C.-C.S.); (P.C.)
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (P.-H.T.); (C.-C.S.); (P.C.)
- Department of Biochemistry, National Defense Medical Center, Taipei 114, Taiwan
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Baker JF, Giles JT, Weber D, George MD, Leonard MB, Zemel BS, Long J, Katz P. Sarcopenic Obesity in Rheumatoid Arthritis: Prevalence and Impact on Physical Functioning. Rheumatology (Oxford) 2021; 61:2285-2294. [PMID: 34559201 DOI: 10.1093/rheumatology/keab710] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/07/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We determined the prevalence of sarcopenic obesity in patients with rheumatoid arthritis (RA) using multiple methods and assessed associations with physical functioning. METHODS This study evaluated data from three RA cohorts. Whole-body dual-energy absorptiometry (DXA) measures of appendicular lean mass index (ALMI, kg/m2) and fat mass index (FMI) were converted to age, sex, and race-specific Z-Scores and categorized using a recently validated method and compared it to a widely-used existing method. The prevalence of body composition abnormalities in RA was compared with two reference populations. In the RA cohorts, associations between body composition and change in the Health Assessment Questionnaire (HAQ) and the Short Physical Performance Battery (SPPB) in follow-up were assessed using linear and logistic regression, adjusting for age, sex, race, and study. RESULTS The prevalence of low lean mass and sarcopenic obesity were higher in patients with RA (14.2; 12.6%, respectively) compared with the reference population cohorts (7-10%; 4-4.5%, respectively, all p< 0.05). There was only moderate agreement among methods of sarcopenic obesity categorization (Kappa 0.45). The recently validated method categorized fewer subjects as obese, and many of these were categorized as low lean mass only. Low lean mass, obesity, and sarcopenic obesity were each associated with higher HAQ and lower SPPB at baseline and numerically greater worsening. CONCLUSION RA patients had higher rates of low lean mass and sarcopenic obesity than the general population. The recently validated methods characterized body composition changes differently from traditional methods and were more strongly associated with physical function.
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Affiliation(s)
- Joshua F Baker
- Philadelphia VA Medical Center, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David Weber
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael D George
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Mary B Leonard
- Stanford University School of Medicine, Stanford, CA, USA
| | - Babette S Zemel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jin Long
- Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia Katz
- University of California San Francisco, San Francisco, CA, USA
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Synergic association of diabetes mellitus and chronic kidney disease with muscle loss and cachexia: results of a 16-year longitudinal follow-up of a community-based prospective cohort study. Aging (Albany NY) 2021; 13:21941-21961. [PMID: 34528898 PMCID: PMC8507303 DOI: 10.18632/aging.203539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 12/17/2022]
Abstract
Muscle loss is a serious complication in patients with diabetes mellitus (DM) and chronic kidney disease (CKD). However, studies on a long-term change in muscle mass presence or absence of DM and CKD are scarce. We included 6247 middle-aged adults from the Korean Genome and Epidemiology Study (KoGES) between 2001 and 2016. Bioimpedance analysis (BIA) was performed biennially. Patients were classified into four groups according to the presence or absence of DM and CKD. The primary outcome was muscle depletion, which was defined as a decline in fat-free mass index (FFMI) below the 10th percentile of all subjects. The secondary outcomes included the occurrence of cachexia, all-cause mortality, and the slopes of changes in fat-free mass and weight. During 73,059 person-years of follow-up, muscle depletion and cachexia occurred in 460 (7.4%) and 210 (3.4%), respectively. In the multivariable cause-specific hazards model, the risk of muscle depletion was significantly higher in subjects with DM alone than in those without DM and CKD (HR, 1.37; 95% CI, 1.04-1.80) and was strongly pronounced in subjects with both conditions (HR, 3.38; 95% CI, 1.30-8.75). The secondary outcome analysis showed consistent results. The annual decline rates in FFMI, fat mass, and body mass index (BMI) were the steepest in subjects with DM and CKD among the four groups. DM and CKD are synergically associated with muscle loss over time. In addition, the mortality risk is higher in individuals with muscle loss.
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Late stage 3 chronic kidney disease is an independent risk factor for sarcopenia, but not proteinuria. Sci Rep 2021; 11:18472. [PMID: 34531464 PMCID: PMC8446068 DOI: 10.1038/s41598-021-97952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022] Open
Abstract
Most epidemiologic studies assessing the relationship between chronic kidney disease (CKD) and sarcopenia have been performed in dialysis patients. This study aimed to evaluate the relationship between estimated glomerular filtration rate (eGFR), proteinuria, and sarcopenia in patients with non-dialysis-dependent CKD. A total of 892 outpatients who did not show any rapid changes in renal function were enrolled in this observational cohort study. We measured the muscle mass using bioimpedance analysis and handgrip strength (HGS), and sarcopenia was defined as low HGS and low muscle mass. Sarcopenia was found in 28.1% of the patients and its prevalence decreased as the body mass index (BMI) increased; however, in patients with BMI ≥ 23 kg/m2, the prevalence did not increase with BMI. As eGFR decreased, the lean tissue index and HGS significantly decreased. However, the eGFR did not affect the fat tissue index. The risk of sarcopenia increased approximately 1.6 times in patients with eGFR < 45 mL/min/1.73 m2. However, proteinuria was not associated with sarcopenia. With a decrease in eGFR, the lean muscle mass and muscle strength decreased, and the prevalence of sarcopenia increased. In patients with late stage 3 CKD, further assessment of body composition and screening for sarcopenia may be needed.
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Wu IW, Liao PJ, Ting MK, Chen SW, Yang NI, Hsu KH. Combination of Thigh Circumference and Indices of Central Obesity Helps Predict Incident Chronic Kidney Disease: A 14-Year Prospective Cohort Study Using a Three-Dimensional Body Laser Scanner. J Ren Nutr 2021; 32:405-413. [PMID: 34330568 DOI: 10.1053/j.jrn.2021.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Obesity, high body mass index, and visceral fat accumulation are associated with renal diseases. However, the association between body measurements and chronic kidney disease (CKD) is still unclear. METHODS A cohort of 7,825 participants scheduled for follow-up of CKD was recruited from 2000 to 2008 in Taiwan. A questionnaire was developed to collect the basic demographics, lifestyle variables, personal disease history, and family disease history of the participants. A 3-dimensional body surface scanning system was used to take their body measurements. The participants underwent an average follow-up of 14.3 years for evaluation of the incidence of CKD. A multiple Cox regression model was built. RESULTS Three body measurements, namely chest width (hazard ratio [HR] 1.059, 95% confidence interval [CI] 1.011-1.110), waist circumference (HR 1.017, 95% CI 1.006-1.029), and thigh circumference (HR 0.941, 95% CI 0.922-0.961), were significantly associated with CKD. Two combinations of body measurements, namely the waist-to-thigh ratio and chest-to-thigh ratio, were derived to predict the occurrence of CKD. Participants with the highest quartile of waist-to-thigh ratio and chest-to-thigh ratio had a 2.175-fold and 2.182-fold risk of developing CKD, respectively. CONCLUSIONS This study suggests that along with central obesity, body limb measurements can be used as an indicator to predict the occurrence of CKD. The effects of limb measurements on CKD could help provide an innovative perspective regarding the intervention to be developed for the treatment of CKD and a preventive medicine for high-risk individuals. The association of thigh circumference with CKD warrants further investigation.
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Affiliation(s)
- I-Wen Wu
- Department of Nephrology, Chang Gung Memorial Hospital, Keelung; College of Medicine, Chang Gung University, Taiwan
| | - Pei-Ju Liao
- Master Degree Program in Healthcare Industry, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Kuo Ting
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shuo-Wei Chen
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ning-I Yang
- Division of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuang-Hung Hsu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Laboratory for Epidemiology, Department of Health Care Management, Chang Gung University, Taoyuan, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, Taipei, Taiwan.
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44
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Suzuki S, Kanaji S, Urakawa N, Takiguchi G, Hasegawa H, Yamashita K, Matsuda T, Oshikiri T, Nakamura T, Kakeji Y. Impact of chronic kidney disease stage on morbidity after gastrectomy for gastric cancer. Ann Gastroenterol Surg 2021; 5:519-527. [PMID: 34337301 PMCID: PMC8316737 DOI: 10.1002/ags3.12441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
AIM The outcomes of gastrectomy for gastric cancer in patients at each severity of chronic kidney disease (CKD) remain unknown. METHODS We retrospectively analyzed the outcomes of 560 patients who underwent distal or total gastrectomy for gastric cancer between 2009 and 2018. We classified the patients into four groups based on estimated glomerular filtration rate: stage 1/2 (normal to mild, n = 375), stage 3a (mild to moderate, n = 122), stage 3b (moderate to severe, n = 43), and stage 4/5 (severe to end-stage, n = 20) CKD. The relationship between CKD stage and the incidence of postoperative morbidity was analyzed. RESULTS CKD was a predictor of overall morbidity independent of age, gender, American Society of Anesthesiologists Performance Status, pulmonary comorbidity, extent of lymphadenectomy, and operation time in a multivariate analysis. The incidences of overall and severe morbidity were significantly increased with CKD progression (both P < .001). Compared to stage 1/2 CKD, the odds of overall morbidity were significantly elevated in stage 3a (odds ratio [OR] 1.87, P = .007), stage 3b (OR 3.86, P < .001), and stage 4/5 (OR 8.60, P < .001). The risk of procedure-related morbidity was strikingly increased in stage 3b (OR 2.93, P = .004). The risk of procedure-unrelated morbidity elevated markedly in stage 3a (OR 2.77, P = .001). A significant graded association between CKD progression and overall morbidity was also revealed in elderly patients (P = .001). CONCLUSIONS The severity of CKD predicts the likelihood and type of morbidity after gastrectomy and can guide surgical decision-making for patients with gastric cancer.
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Affiliation(s)
- Satoshi Suzuki
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Shingo Kanaji
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Naoki Urakawa
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Gosuke Takiguchi
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Hiroshi Hasegawa
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Kimihiro Yamashita
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Takeru Matsuda
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Taro Oshikiri
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Tetsu Nakamura
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
| | - Yoshihiro Kakeji
- Division of Gatrointestinal SurgeryDepartment of SurgeryGraduate School of medicineKobe UniversityKobeJapan
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Bichels AV, Cordeiro AC, Avesani CM, Amparo FC, Giglio J, Souza NC, Pinho N, Amodeo C, Carrero JJ, Lindholm B, Stenvinkel P, Kamimura MA. Muscle Mass Assessed by Computed Tomography at the Third Lumbar Vertebra Predicts Patient Survival in Chronic Kidney Disease. J Ren Nutr 2021; 31:342-350. [DOI: 10.1053/j.jrn.2020.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/20/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022] Open
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van Gastel MDA, Meijer E. To Add Weight to Overweight. Clin J Am Soc Nephrol 2021; 16:850-852. [PMID: 34117079 PMCID: PMC8216613 DOI: 10.2215/cjn.04150321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Maatje D A van Gastel
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Huml AM, Schold JD. Kidney Transplantation and Candidate BMI: Viability Is in the Eye of the Beholder. Am J Kidney Dis 2021; 78:484-486. [PMID: 34059332 DOI: 10.1053/j.ajkd.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Anne M Huml
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Center for Reducing Health Disparities, Case Western Reserve University, Cleveland, OH
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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β2-adrenergic receptor agonist counteracts skeletal muscle atrophy and oxidative stress in uremic mice. Sci Rep 2021; 11:9130. [PMID: 33911115 PMCID: PMC8080640 DOI: 10.1038/s41598-021-88438-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
In patients with chronic kidney disease, skeletal muscle dysfunction is associated with mortality. Uremic sarcopenia is caused by ageing, malnutrition, and chronic inflammation, but the molecular mechanism and potential therapeutics have not been fully elucidated yet. We hypothesize that accumulated uremic toxins might exert a direct deteriorative effect on skeletal muscle and explore the pharmacological treatment in experimental animal and culture cell models. The mice intraperitoneally injected with indoxyl sulfate (IS) after unilateral nephrectomy displayed an elevation of IS concentration in skeletal muscle and a reduction of instantaneous muscle strength, along with the predominant loss of fast-twitch myofibers and intramuscular reactive oxygen species (ROS) generation. The addition of IS in the culture media decreased the size of fully differentiated mouse C2C12 myotubes as well. ROS accumulation and mitochondrial dysfunction were also noted. Next, the effect of the β2-adrenergic receptor (β2-AR) agonist, clenbuterol, was evaluated as a potential treatment for uremic sarcopenia. In mice injected with IS, clenbuterol treatment increased the muscle mass and restored the tissue ROS level but failed to improve muscle weakness. In C2C12 myotubes stimulated with IS, although β2-AR activation also attenuated myotube size reduction and ROS accumulation as did other anti-oxidant reagents, it failed to augment the mitochondrial membrane potential. In conclusion, IS provokes muscular strength loss (uremic dynapenia), ROS generation, and mitochondrial impairment. Although the β2-AR agonist can increase the muscular mass with ROS reduction, development of therapeutic interventions for restoring skeletal muscle function is still awaited.
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Sarcopenic Obesity in Non-Alcoholic Fatty Liver Disease-The Union of Two Culprits. Life (Basel) 2021; 11:life11020119. [PMID: 33557355 PMCID: PMC7914533 DOI: 10.3390/life11020119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) continues to rise and has become the most common cause of chronic liver disease among all ages and ethnicities. Metabolic disorders, such as obesity and insulin resistance, are closely associated with sarcopenia and NAFLD. Sarcopenic obesity is a clinical disorder characterized by the simultaneous loss of skeletal muscle and gain of adipose tissue. It is associated with worse outcomes in individuals with NAFLD. It is projected that NAFLD and sarcopenia will rise as the prevalence of obesity continues to increase at an unparallel rate. Recently, sarcopenia and sarcopenic obesity have gained considerable interest, but we still lack a well-defined definition and a management approach. Therefore, it is imperative to continue shining the light on this topic and better understand the underlying mechanism as well as treatment options. In this review article, we aimed to address the pathophysiology, impact, and outcomes of sarcopenic obesity on NAFLD.
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50
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Elevated Creatinine-Based Estimated Glomerular Filtration Rate is Associated with Increased Risk of Sarcopenia, Dysphagia, and Reduced Functional Recovery after Stroke. J Stroke Cerebrovasc Dis 2021; 30:105491. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023] Open
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