Low tongue pressure in peritoneal dialysis patients as a risk factor for malnutrition and sarcopenia: a cross-sectional study

Abstract Background and Aims Despite evidence suggesting that a lack of fecal oxalate-degrading bacteria colonization is a risk factor for calcium oxalate stone formation, little is known about the oxalate-degrading activity (ODA) in fecal microbiota in end-stage renal disease (ESRD) patients. In addition, to date, there has been a general lack of research on the effect of fecal ODA on oxalate homeostasis in dialysis patients. The present pilot cross-sectional study was performed to compare the oxalate homeostasis profiles depending on ODA in fecal microbiota in ESRD patients. Method The data of a cross-sectional pilot study examining ODA in fecal microbiota, plasma oxalate concentration (POx) and urinary oxalate excretion (UOx) in 32 ESRD patients were represented in this study. Among the patients, there were 21 hemodialysis (HD) patients and 11 peritoneal dialysis (PD) patients. The average age of the patients was 52.5 [39; 65] years. The redoximetric titration with KMnO4 was adopted to evaluate total ODA in fecal microbiota. The results were expressed in % oxalate degradation per 0.01 g of feces. POx concentration and UOx excretion were measured spectrophotometrically using a commercially available kit (MAK-315, Sigma, Spain) and an oxalate oxidase/peroxidase reagent (BioSystems, Spain), respectively. Predialysis plasma samples were collected from HD patients. For further analysis, the patients were allocated to 2 groups according to ODA in feces. Group 1 included the patients with ≥ 1 % oxalate degradation per 0.01 g of feces. Group 2 included the patients with negative ODA (≤ 0 % /0.01 g). For the statistical analysis, we used the nonparametric Kruskal-Wallis test. The median (Me) and interquartile ranges [Q25; Q75] were calculated. The Spearman test was used for the correlation analysis. Univariate logistic regression analysis was used for predicting hyperoxalemia. All statistical analyses were performed using MedCalc. Results ODA in fecal microbiota ranged from -23 to 24 %/0.01 g of feces in ESRD patients and was statistically higher in HD patients compared with PD patients (3.2 [-0.5; 16] vs -4 [-6.5; 6.2], p=0.05). Negative ODA in fecal microbiota (≤ 0 % /0.01 g) was observed in 5/21 (23.8%) HD patients and 7/11 (63.6%) PD patients (χ2=3.9, p=0.04). Consequently, it might be associated with the negative effects of peritoneal dialysis solution. High POx concentration and low UOx excretion were diagnosed in patients with negative ODA in fecal microbiota (Group 2): 30.7 [25.5; 41.5] vs 50 [43.3; 75.5] μmol/L, p=0.01 and 60.9 [51; 65] vs 34.2 [24.4; 39] mg/d, p=0.0002, respectively (Fig. 1). Fecal ODA was directly associated with daily UOx excretion (r=0.85; p<0.0001) (Fig. 2) and had an inverse correlation with POx concentration (r=-0.36; p=0.04) (Fig. 3). In univariate logistic regression analysis, negative fecal ODA was determined as an independent risk factor for high POx concentration (OR: 40; 95% CI: 4.8-331, p<0.0001). Conclusion Our pilot cross-sectional study firstly demonstrated a close association between ODA in fecal microbiota and oxalate homeostasis in ESRD patients: less ODA in fecal microbiota was, higher POx concentration and lower UOx excretion occurred. We suppose that the potential significance of our findings provides preliminary information on the feasibility and necessity of further research in this area.

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Sevelamer Hydrochloride in Peritoneal Dialysis Patients: Results of a Multicenter Cross-Sectional Study

Peritoneal Dialysis International ◽

10.1177/089686080702700618 ◽

2007 ◽

Vol 27 (6) ◽

pp. 697-701 ◽

Cited By ~ 7

Author(s):

Rosa Ramos ◽

Francesc Moreso ◽

Mercè Borras ◽

Esther Ponz ◽

Joan M. Buades ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Ldl Cholesterol ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Serum Phosphate ◽

Sectional Study ◽

C Reactive Protein ◽

Dialysis Patients ◽

Cross Sectional ◽

Reactive Protein

Background Sevelamer hydrochloride is a phosphate binder widely employed in hemodialysis patients. Until now, information about its efficacy and safety in peritoneal dialysis patients has been scarce. Patients and Methods In September 2005 a cross-sectional study of demographic, biochemical, and therapeutic data of patients from 10 peritoneal dialysis units in Catalonia and the Balearic Islands, Spain, was conducted. Results We analyzed data from 228 patients. At the time of the study, 128 patients (56%) were receiving sevelamer. Patients receiving sevelamer were younger ( p < 0.01), showed a longer period of time on dialysis ( p < 0.01), and had a lower Charlson Comorbidity Index ( p < 0.01). Serum calcium and intact parathyroid hormone levels were not different between the two groups, while phosphate levels <5.5 mg/dL were observed more frequently in patients not receiving sevelamer (79% vs 61%, p < 0.01). Serum total cholesterol (167 ± 41 vs 189 ± 42 mg/dL, p < 0.01) and low density lipoprotein (LDL) cholesterol (90 ± 34 vs 109 ± 34 mg/dL, p < 0.01), but not high density lipoprotein cholesterol or triglycerides, were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed a higher serum albumin (38 ± 5 vs 36 ± 4 g/L, p < 0.01) and a lower C-reactive protein (4.9 ± 12.8 vs 8.8 ± 15.7 mg/L, p < 0.01). Blood bicarbonate levels <22 mmol/L were observed more frequently in patients receiving sevelamer (22% vs 5%, p < 0.01). Logistic regression analysis adjusting by confounding variables confirmed that sevelamer therapy was associated with serum total cholesterol <200 mg/dL [relative risk (RR): 2.77, 95% confidence interval (CI): 1.44 – 5.26, p = 0.002] and blood bicarbonate <22 mmol/L (RR: 8.5, 95% CI: 2.6 – 27.0, p < 0.001), but not with serum phosphate >5.5 mg/dL, calcium–phosphate product >55 mg2/dL2, serum albumin <35 g/L, or C-reactive protein >5 mg/L. Conclusions This uncontrolled cross-sectional study in peritoneal dialysis patients showed that sevelamer hydro-chloride treatment allows an adequate serum phosphate level in about 60% of patients and significantly reduces total and LDL-cholesterol levels. Since this treatment is associated with metabolic acidosis in 22% of patients, we recommend close monitoring of bicarbonate levels in this group of patients until the clinical significance of this result is clarified.

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