Relationship between Vascular Calcification, Protein-Energy Wasting Syndrome, and Sarcopenia in Maintenance Automated Peritoneal Dialysis

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

Download Full-text

The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study

Frontiers in Medicine ◽

10.3389/fmed.2021.702749 ◽

2021 ◽

Vol 8 ◽

Author(s):

Cristina Techy Roth-Stefanski ◽

Naiane Rodrigues de Almeida ◽

Gilson Biagini ◽

Natália K. Scatone ◽

Fabiana B. Nerbass ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Muscle Mass ◽

Chronic Peritoneal Dialysis ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Protein Energy ◽

Multifrequency Bioimpedance ◽

Study Population ◽

The Mean ◽

Main Factor

Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients.Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods.Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements.Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.

Download Full-text

Protein-Energy Wasting and Mortality Risk Prediction Among Peritoneal Dialysis Patients

Journal of Renal Nutrition ◽

10.1053/j.jrn.2020.11.007 ◽

2021 ◽

Author(s):

Piyawan Kittiskulnam ◽

Piyatida Chuengsaman ◽

Talerngsak Kanjanabuch ◽

Sirarat Katesomboon ◽

Somkanya Tungsanga ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Risk Prediction ◽

Mortality Risk ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Protein Energy

Download Full-text

Protein-energy wasting and peritoneal function in elderly peritoneal dialysis patients

Clinical and Experimental Nephrology ◽

10.1007/s10157-012-0631-5 ◽

2012 ◽

Vol 16 (5) ◽

pp. 792-798 ◽

Cited By ~ 2

Author(s):

Rui Zhang ◽

Ye-ping Ren

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Protein Energy ◽

Peritoneal Function

Download Full-text

Association of inflammation and protein-energy wasting with endothelial dysfunction in peritoneal dialysis patients

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfp598 ◽

2009 ◽

Vol 25 (4) ◽

pp. 1266-1271 ◽

Cited By ~ 23

Author(s):

H. Y. Choi ◽

J. E. Lee ◽

S. H. Han ◽

T. H. Yoo ◽

B. S. Kim ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Endothelial Dysfunction ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Protein Energy

Download Full-text

Comparison of Hemodialysis and Peritoneal Dialysis Patients’ Dietary Behaviors

10.21203/rs.2.17406/v3 ◽

2020 ◽

Author(s):

Seonmi Kim ◽

Byung Chin Kang ◽

Hyun-Jung Kim ◽

Min-Sook Kyung ◽

Hyung Jung Oh ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Nutrient Intake ◽

Protein A ◽

Dietary Behavior ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Nutritional Factors ◽

Mortality And Morbidity ◽

Protein Energy ◽

Group Serum

Abstract Background: Nutritional factors are associated with high mortality and morbidity in dialysis patients, and protein-energy wasting is regarded as an important one. The modality of dialysis may affect patients’ dietary behavior and nutritional status, but no study has compared the dietary behavior, nutrient intake, and nutritional adequacy of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods: From December 2016 to May 2017, a dietary behavior survey and Semi-quantitative Food Frequency Questionnaire (Semi-FFQ) were conducted on 30 HD patients and 30 PD patients in Ewha Womans University Mokdong Hospital, and laboratory parameters were obtained. The results of prevalent HD and PD patients were then compared. Results: The mean age of HD patients was higher than that of PD patients; HD: 58.5±9.1 years, PD: 49.3±9.7 years ( p = 0.001). In the dietary behavior survey, HD patients showed more appropriate dietary behavior patterns overall than PD patients. In the dietary intake analysis with the Semi-FFQ, energy intake was significantly lower in the PD group than in the HD group due to the lower intake of carbohydrates, fat, and protein. A comparison of nutrient intake-to-recommended allowance ratio between the HD and PD groups revealed that the HD group showed higher nutrient intake than the PD group. Serum albumin and potassium levels were significantly higher in HD than in PD patients. Conclusion: According to this study, the dietary behavior and nutritional intake of prevalent PD patients were worse than those of HD patients.

Download Full-text

NT-proBNP, Cardiometabolic Risk Factors, and Nutritional Status in Hemodialysis Patients

International Journal of Nephrology ◽

10.1155/2017/1312547 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Jacques Ducros ◽

Laurent Larifla ◽

Henri Merault ◽

Lydia Foucan

Keyword(s):

Nutritional Status ◽

Cross Sectional Study ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Cross Sectional ◽

Logistic Regression Models ◽

Wasting Syndrome ◽

Protein Energy ◽

Catabolic Rate ◽

Dialysis Vintage

Background.We aimed to evaluate the association between NT-proBNP and malnutrition in HD patients while taking into account the four established categories of parameters for diagnosis of protein energy wasting (PEW).Methods. A cross-sectional study was performed in Afro-Caribbean dialysis patients. One component in each of the 4 categories for the wasting syndrome was retained: serum albumin ≤ 38 g/L, BMI ≤ 23 Kg/m2, serum creatinine ≤ 818 µmol/L, and normalized protein catabolic rate (nPCR) ≤ 0.8 g/kg/day. NT-proBNP was assessed using a chemiluminescence immunoassay. Two multivariate logistic regression models were performed to determine the parameters associated with high NT-proBNP concentrations.Results.In 207 HD patients, 16.9% had PEW (at least three components). LVEF lower than 60% was found in 13.8% of patients. NT-proBNP levels ranged from 125 to 33144 pg/mL. In model 1, high levels of NT-proBNP (≥6243 pg/mL) were independently associated with PEW OR 14.2 (3.25–62.4), male gender 2.80 (1.22–6.57), hsCRP > 5 mg/L 3.90 (1.77–8.57), and dialysis vintage > 3 years 3.84 (1.35–10.8). In model 2, LVEF OR was 0.93 (0.88–0.98). NT-proBNP concentrations were significantly higher when the PEW component number was higher.Conclusion.In dialysis patients, high NT-proBNP levels must draw attention to cardiac function but also to nutritional status.

Download Full-text

Comparison of Hemodialysis and Peritoneal Dialysis Patients’ Dietary Behaviors

10.21203/rs.2.17406/v1 ◽

2019 ◽

Author(s):

Seonmi Kim ◽

Byung Chin Kang ◽

Hyun-Jung Kim ◽

Min-Sook Kyung ◽

Hyung Jung Oh ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Nutrient Intake ◽

Dietary Behavior ◽

Albumin Concentration ◽

Dialysis Patients ◽

Protein Energy Wasting ◽

Mortality And Morbidity ◽

Protein Energy ◽

Major Nutrients

Abstract Background: Nutritional factors are associated with high mortality and morbidity in dialysis patients, and protein-energy wasting is regarded as an important one. The modality of dialysis may affect patients’ dietary behavior and nutritional status, but no study has compared the dietary behavior, nutrient intake, and nutritional adequacy of hemodialysis (HD) and peritoneal dialysis (PD) patients. Methods: From December 2016 to May 2017, a dietary behavior survey and Semi-quantitative Food Frequency Questionnaire (Semi-FFQ) were conducted, and laboratory parameters were obtained. The results of prevalent HD and PD patients were then compared. Results: In the dietary behavior survey, HD patients showed more appropriate dietary behavior patterns overall than PD patients. In the dietary intake analysis with the Semi-FFQ, energy intake was significantly lower in the PD group than in the HD group due to the lower intake of carbohydrates, fat, and protein. In the nutrient intake-to-recommended allowance ratio analysis, both HD and PD patients revealed inadequate intake amounts for most major nutrients. Serum albumin and potassium levels were significantly higher in HD than in PD patients. Serum albumin concentration showed a positive correlation with dietary protein and calcium intake in the PD group. Conclusion: According to this study, the dietary behavior and nutritional intake of prevalent PD patients were worse than those of HD patients.

Download Full-text

Sarcopenia is Associated with Malnutrition but Not with Systemic Inflammation in Older Persons with Advanced CKD

Nutrients ◽

10.3390/nu11061378 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1378 ◽

Cited By ~ 10

Author(s):

Simone Vettoretti ◽

Lara Caldiroli ◽

Silvia Armelloni ◽

Camilla Ferrari ◽

Matteo Cesari ◽

...

Keyword(s):

Systemic Inflammation ◽

Older Patients ◽

Older Persons ◽

Wide Spectrum ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Protein Energy Wasting ◽

Wasting Syndrome ◽

Protein Energy ◽

Inflammation Score

Background: In patients with chronic kidney disease (CKD), sarcopenia can be determined by a wide spectrum of risk factors. We evaluated the association of sarcopenia with nutritional, behavioral and inflammatory patterns in older patients with advanced CKD. Methods: we cross-sectionally evaluated 113 patients with CKD stages 3b-5. Sarcopenia was defined according to the EWGSOP2 criteria. We assessed: anthropometry, bioelectrical impedance analysis, physical, and psychological performance. Nutritional status was assessed using the Malnutrition Inflammation Score (MIS) and by verifying the eventual presence Protein Energy Wasting syndrome (PEW). Systemic inflammation was assessed by dosing: CRP, IL6, TNFα, MCP1, IL10, IL17, fetuin, IL12. Results: 24% of patients were sarcopenic. Sarcopenic individuals had lower creatinine clearance (18 ± 11 vs. 23 ± 19 mL/min; p = 0.0087) as well as lower BMI (24.8 ± 3.0 vs. 28.4 ± 5.5 Kg/m2; p < 0.0001) and a lower FTI (11.6 ± 3.9 vs. 14.4 ± 5.1 kg/m2, p = 0.023). Sarcopenic persons had higher prevalence of PEW (52 vs. 20%, p < 0.0001) and a tendency to have higher MIS (6.6 ± 6.5 vs. 4.5 ± 4.0, p = 0.09); however, they did not show any difference in systemic inflammation compared to non-sarcopenic individuals. Conclusions: CKD sarcopenic patients were more malnourished than non-sarcopenic ones, but the two groups did not show any difference in systemic inflammation.

Download Full-text