Body weight-for-height relationships predict mortality in maintenance hemodialysis patients

Kopple, Joel D.; Zhu, Xiaofei; Lew, Nancy L.; Lowrie, Edmund G.

doi:10.1046/j.1523-1755.1999.00615.x

Cited by 359 publications

(256 citation statements)

References 20 publications

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“…[18][19][20] However, there is the possibility that the protective link observed between obesity and mortality may not actually exist. Most studies have not completely accounted for known mortality risk factors such as smoking, BP and medication.…”

Section: Discussionmentioning

confidence: 99%

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

Nakagawa

Yao²,

Hirayama³

et al. 2011

Hypertens Res

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Although metabolic syndrome confers an increased risk of cardiovascular disease in the general population, little is known about the alteration of abdominal adiposity and its association with adipocytokines in hemodialysis patients. We investigated the plasma high-molecular-weight (HMW) adiponectin level and its relationship to visceral fat area (VFA) and various markers of atherosclerosis in hemodialysis patients. In a cross-sectional study, conventional cardiovascular risk factors, plasma total and HMW adiponectin, the number of components of the metabolic syndrome and, using computed tomography, the distribution of abdominal adiposity were assessed in 144 hemodialysis patients (90 men and 54 women; mean age, 60.7 years) and 30 age-and sex-matched patients with chronic kidney disease (CKD). Plasma HMW adiponectin levels in hemodialysis patients were significantly higher than those in patients with CKD, negatively associated with VFA and serum triglycerides and positively associated with plasma total adiponectin, as well as the HMW-to-total adiponectin ratio in men and women (all Po0.05) in a simple regression analysis. In a multiple regression analysis, VFA was a significant determinant of HMW adiponectin in hemodialysis patients. Furthermore, after adjustment for classical risk factors, HMW adiponectin levels were significantly higher in patients undergoing treatment with renin-angiotensin system inhibitors or calcium channel blockers compared with patients not undergoing such treatment. This study shows that plasma HMW adiponectin levels were negatively associated with VFA and positively associated with treatment with blockade of the renin-angiotensin system and of the calcium channel. Therefore, these drugs might be effective for improving adipocytokine-related metabolic abnormalities in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

Nakagawa

Yao²,

Hirayama³

et al. 2011

Hypertens Res

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“…This malnutrition is resistant to intervention (2) and is a major predictor of morbidity and mortality in patients who receive both peritoneal dialysis (PD) and hemodialysis (3,4). There is a linear correlation between body mass index (BMI) and survival in dialysis patients (5), to the extent that the usual association of increased mortality with obesity is reversed in patients who receive renal replacement therapy (6). Nutritional parameters that have been correlated independently with increased mortality and morbidity include low serum albumin (4,7,8), low serum cholesterol (7,9), and a low measured subjective global assessment score of nutrition (4,10).…”

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confidence: 99%

Subcutaneous Ghrelin Enhances Acute Food Intake in Malnourished Patients Who Receive Maintenance Peritoneal Dialysis

Wynne

Giannitsopoulou

Small

et al. 2005

Journal of the American Society of Nephrology

192

111

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Anorexia and malnutrition confer significant morbidity and mortality to patients with end-stage kidney disease but are resistant to therapy. The aim of this study was to determine whether subcutaneous administration of ghrelin, an appetitestimulating gut hormone, could enhance food intake in patients who are receiving maintenance peritoneal dialysis and have evidence of malnutrition. The principal outcome measure was energy intake during a measured study meal. Secondary outcome measures were BP and heart rate and 3-d food intake after intervention. Nine peritoneal dialysis patients with mild to moderate malnutrition (mean serum albumin 28.6 ؎ 5.0 g/L, total cholesterol 4.4 ؎ 0.6 mmol/L, subjective global assessment score of 5.7 ؎ 1.7) were given subcutaneous ghrelin (3.6 nmol/kg) and saline placebo in a randomized, double-blind, crossover protocol. Administration of subcutaneous ghrelin significantly increased the group mean absolute energy intake, compared with placebo, during the study meal (690 ؎ 190 versus 440 ؎ 250 kcal; P ‫؍‬ 0.0062). When expressed as proportional energy increase for each individual, ghrelin administration resulted in immediate doubling of energy intake (204 ؎ 120 versus 100%; P ‫؍‬ 0.0319). Administration of ghrelin maintained a nonsignificant increase in energy intake over 24 h after intervention (2009 ؎ 669 versus 1579 ؎ 330 kcal) and was not followed by subsequent underswing (1790 ؎ 370 versus 1670 ؎ 530 and 1880 ؎ 390 versus 1830 ؎ 530 kcal on days 2 and 3, respectively). Ghrelin administration resulted in a significant fall in mean arterial BP (P ‫؍‬ 0.0030 by ANOVA). There were no significant adverse events during the study. Subcutaneous ghrelin administration enhances short-term food intake in dialysis patients with mild to moderate malnutrition.

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“…Paradoxalmente, alguns estudos recentes têm demonstrado evidên-cias de sobrepeso e obesidade nessa população. Curiosamente, o excesso de peso, considerado um fator de risco para mortalidade em indivíduos saudáveis, tem apresentado influência positiva na sobrevida dos pacientes em hemodiálise 6 , e a esse fenômeno denominou-se epidemiologia reversa da obesidade 7 . Entretanto, alguns autores postulam que a vantagem de sobrevida de pacientes com peso acima da normalidade é limitada para aqueles com massa muscular normal ou elevada 8 .…”

Section: N T R O D U ç ã Ounclassified

“…Foi identificada maior proporção de sobrepeso e/ou obesidade (22,8%) em relação à desnutrição, e essa tendência também foi observada, com maiores proporções, em outros estudos 24 . A esse respeito, alguns investigadores têm mostrado que um IMC maior apresenta uma influência positiva na sobrevida desses pacientes, e este fenômeno tem sido denominado epidemiologia reversa da obesidade 6,7 . Entretanto, alguns autores postulam que a vantagem de sobrevida de pacientes com peso acima da normalidade é limitada para aqueles com massa muscular normal ou elevada 8 .…”

Section: I S C U S S ã Ounclassified

Diagnóstico nutricional de pacientes em hemodiálise na cidade de São Luís (MA)

et al. 2009

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R E S U M O ObjetivoAvaliar o estado nutricional de pacientes em hemodiálise na cidade de São Luís (MA). MétodosForam avaliados 399 pacientes dos três centros de diálise da cidade, que preencheram os seguintes critérios de inclusão: possuir idade maior ou igual a 18 anos, encontrar-se em tratamento hemodialítico três vezes na semana há no mínimo três meses, não ser portador de doenças consumptivas. Para avaliação do estado nutricional foram utilizados índice de massa corporal, circunferência muscular do braço, prega cutânea tricipital, percentual de gordura corporal, níveis séricos de albumina, creatinina, colesterol total e avaliação subjetiva global. ResultadosOs pacientes (idade de 49,6 anos, DP=15,6, sendo 248 homens) apresentaram eutrofia, quando avaliados por meio do índice de massa corporal (62,5%) e pelo percentual de gordura corporal (54,9%), e desnutrição, segundo a circunferência muscular do braço (63,0%) e a prega cutânea tricipital (63,0%). A medida da circunferência muscular do braço evidenciou maior proporção de desnutrição nos homens (75,9%), enquanto que a da prega cutânea tricipital nas mulheres (72,7%). O nível sérico de albumina ficou abaixo de 4,0g/dL em 67% dos pacientes estudados. A população como um todo apresentou níveis séricos de creatinina dentro do esperado e de colesterol total na faixa mínima de normalidade. A avaliação subjetiva global demonstrou desnutrição em 61,0% dos pacientes. ConclusãoA maior parte da população estudada foi classificada como desnutrida, considerando os critérios de circunferência muscular do braço, prega cutânea tricipital, avaliação subjetiva global e albumina, e em risco nutricional, considerando os critérios bioquímicos creatinina e colesterol total. Estes dados indicam a necessidade de medidas para melhoria do estado nutricional desta população. Termos de indexação:Avaliação nutricional. Antropometria. Desnutrição. Dialise renal. Falência crônica. A B S T R A C T ObjectiveThe objective was to evaluate the nutritional status of patients undergoing hemodialysis in São Luís (MA). Methods

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Body weight-for-height relationships predict mortality in maintenance hemodialysis patients

Cited by 359 publications

References 20 publications

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

Potential impact of renin–angiotensin system inhibitors and calcium channel blockers on plasma high-molecular-weight adiponectin levels in hemodialysis patients

Subcutaneous Ghrelin Enhances Acute Food Intake in Malnourished Patients Who Receive Maintenance Peritoneal Dialysis

Diagnóstico nutricional de pacientes em hemodiálise na cidade de São Luís (MA)

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