Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients

Pajek, Maja; Jerman, Alexander; Osredkar, Joško; Ponikvar, Jadranka Buturović; Pajek, Jernej

doi:10.3390/toxins10100403

Cited by 16 publications

(16 citation statements)

References 54 publications

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“…After kidney transplantation, the elimination of toxins is more efficient and as a result the physical capacity of patients is improved [28]. The deleterious action of uremic toxins can be explained by the release of proinflammatory cytokines, which results in a low-grade chronic inflammatory state [29], and the appearance of muscle mitochondrial dysfunction [30]. Of note, total ambulatory EE in our study was fairly close to that of clinical guidelines (30e35 kcal/kg BW/d) [31].…”

Section: Discussionsupporting

confidence: 73%

Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Aniort

Montaurier

Poyet³

et al. 2021

Clinical Nutrition

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Rationale: Automated peritoneal dialysis (APD) treatment for end-stage kidney disease affords patients a degree of autonomy in everyday life. Clinical investigations of their energy expenditure (EE) are usually based on resting EE, which could mask day and night variations in EE. The aim of this study, therefore, was to compare the components of EE in APD patients and healthy control (C) subjects. Material and method: Patients treated with APD for more than 3 months were compared with C volunteers matched for age and lean body mass (LBM). Biochemical analyses were performed and body composition was determined by DEXA to adjust EE to LBM. Total EE, its different components and respiratory quotients (RQ) were measured by a gas exchange method in calorimetric chambers. Spontaneous total and activity-related EE (AEE) were also measured in free-living conditions over 4 days by a calibrated accelerometer and a heart rate monitor. Results: APD (n ¼ 7) and C (n ¼ 7) patients did not differ in age and body composition. REE did not differ between the two groups. However, prandial increase in EE adjusted for dietary energy intake was higher in APD patients (þ57.5 ± 12.71 kcal/h) than in C subjects (þ33.8 ± 10.5 kcal/h, p ¼ 0.003) and nocturnal decrease in EE tended to be lower in APD patients undergoing dialysis sessions (-4.53 ± 8.37 kcal/h) than in subjects (-11.8 ± 7.69 kcal/h, p ¼ 0.059). Resting RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p ¼ 0.032) and nocturnal RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p ¼ 0.032) were significantly higher in APD patients, indicating a preferential use of glucose substrate potentially absorbed across the peritoneum. AEE was lower in APD patients (595.9 ± 383.2 kcal/d) than in C subjects (1205.2 ± 370.5 kcal/d, p ¼ 0.011). In contrast, energy intakes were not significantly different (1986 ± 465 vs 2083 ± 377 kcal/d, p ¼ 0.677). Conclusion: Although the two groups had identical resting EE, APD patients had a higher prandial increase in EE, a lower activity-related EE and higher resting and nocturnal RQ than healthy subjects.

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Section: Discussionsupporting

confidence: 73%

Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Aniort

Montaurier

Poyet³

et al. 2021

Clinical Nutrition

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“…A study conducted in a Japanese dialysis population found a positive correlation between walking test performance and transferrin saturation only, even in a sample of older individuals with lower mean hemoglobin and higher serum phosphorus 17 . In a Slovenian study, it was found that the worst performance in the walking test was associated with higher serum levels of ultrasensitive CRP (variable in ammation cellular), a variable not measured in the present study and perhaps explaining the difference in performance between hemodialysis patients -degree of subclinical in ammation presented and not measured in clinical practice 18 .…”

Section: Discussioncontrasting

confidence: 63%

Positive correlation between six-minute walk test and heart rate variability in hemodialysis patients

Carneiro

Azoubel

Sá

et al. 2020

Preprint

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Background Autonomic dysfunction is a prevalent clinical condition in chronic renal patients on hemodialysis and adds patient’s worse cardiovascular outcome, some studies in several populations relate worse cardiorespiratory performance with higher dysautonomia, but among chronic renal patients on hemodialysis these studies are still limited. The aim of this study was to verify whether there is an association between autonomic cardiac dysfunction and walking test performance in hemodialysis patients. Methods A cross-sectional study was performed in 61 patients undergoing hemodialysis therapy performed clinical examination, blood sampling, electrocardiography of heart rate variability and 6-minute walk test. Results There was a positive correlation between the 6 minute walking test and the heart rate variability variables RMSSD (r = 0.37 p = 0.005) and SD1 (r = 0.37 p = 0.0059) (Figures 1) (showing parasympathetic integrity), and there was a negative correlation with the pretest walking heart rate with these same variables (r = -0.33 p = 0.014) and (r = -0.34 p = 0.015) Regarding the walking test, it was negatively correlated with age (r = -0.39 p = 0.003) and positive with time on hemodialysis (r = 0.27 p = 0.04) Conclusions Therefore, it is verified that the 6-minute walking test can be used to estimate autonomic dysfunction in hemodialysis patients and thus help in the screening of this dysfunction including the elaboration of treatment strategies.

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“…Indoxyl sulfate contributes to renal disease progression, vascular disease, and adverse effects on bones and the central nervous system 23 . No consistent association of various uremic toxin levels, including indoxyl sulfate, with physical performance have been reported, but inflammation is one of the pathways contributing to physical impediment in hemodialysis patients 24 . Considering that higher central or peripheral level of proinflammatory cytokines reduce central BDNF expression and thus impact on neurogenesis and neurotransmitter release, 12 we presume that increased indoxyl sulfate concentrations due to declining kidney function along with longer hemodialysis vintage would be accompanied by proinflammatory responses, which would negatively affect the production of BDNF in skeletal muscles and megakaryocytes, indirectly resulting in impaired physical performances.…”

Section: Discussionmentioning

confidence: 99%

Brain‐derived neurotrophic factor is associated with sarcopenia and frailty in Japanese hemodialysis patients

Miyazaki

Iino²,

Koda³

et al. 2020

Geriatrics Gerontology Int

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AimWe evaluated several sarcopenia‐related hormones, cytokines and uremic toxins to identify the humoral factors associated with sarcopenia and frailty in Japanese hemodialysis patients.MethodsTwenty Japanese patients aged ≥65 years who underwent maintenance hemodialysis therapy at Uonuma Kikan Hospital for more than 6 months were included in this retrospective cross‐sectional study. Clinical data, including physical function and mental state, were obtained from the clinical records collected during the regular evaluation at the beginning of each hemodialysis therapy session, 3 days after the previous hemodialysis therapy. The diagnosis of sarcopenia and frailty was based on the Asian Working Group for Sarcopenia 2019 and the Japanese version of the Cardiovascular Health Study, respectively. The mental state of patients was evaluated using the Japanese version of the Patient Health Questionnaire 9 (J‐PHQ‐9).ResultsIn univariate analyses, plasma brain‐derived neurotrophic factor (BDNF) levels were significantly lower in patients with severe sarcopenia and frailty. The plasma BDNF concentration was correlated with muscle strength and physical performances, such as the 6‐m walk test, Short Physical Performance Battery and 5‐time chair stand test. BDNF was also correlated with body weight, hemodialysis vintage, and serum levels of total protein and indoxyl sulfate but not with body mass index, appendicular skeletal muscle mass, serum interleukin 6 levels, or J‐PHQ‐9 scores. The odds ratio per 100 pg/mL of BDNF for the prevalence of frailty was 0.353.ConclusionsBDNF is associated with decreased physical performance and the prevalence of severe sarcopenia and frailty in Japanese maintenance hemodialysis patients. Geriatr Gerontol Int 2021; 21: 27–33.

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Association of Uremic Toxins and Inflammatory Markers with Physical Performance in Dialysis Patients

Cited by 16 publications

References 54 publications

Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Positive correlation between six-minute walk test and heart rate variability in hemodialysis patients

Brain‐derived neurotrophic factor is associated with sarcopenia and frailty in Japanese hemodialysis patients

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