Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study

Kikuchi, Hiroaki; Kanda, Eiichiro; Mandai, Shintaro; Akazawa, Masanobu; Iimori, Soichiro; Katsuyuki, OI; Naito, Seiji; Noda, Yumi; Toda, Takayuki; Tamura, Tomohide; Sasaki, Sei; Sohara, Eisei; Okado, Tomokazu; Rai, Tatemitsu; Uchida, Shinichi

doi:10.1007/s10157-016-1251-2

Cited by 31 publications

(22 citation statements)

References 32 publications

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“…Reduced serum albumin levels have been shown to indicate malnutrition risk in people on haemodialysis; additionally, they serve as a powerful predictor of mortality risk in this population 21 . It has been proposed that factors causing low albumin levels, rather than hypoalbuminaemia per se, may be associated with high mortality and morbidity in people on haemodialysis 6 . For example, inflammation, infection, advanced age and hospitalizations have all been associated with hypoalbuminemia and are also associated with poor survival 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Elevated malnutrition risk was associated with the presence of major comorbidities; reduced haemoglobin; elevated C‐reactive protein; and need for feeding assistance 5 . In that study, malnutrition risk was defined as BMI <23 kg/m 2 and/or serum albumin <3.8 g/L, thus capturing depletion of both somatic and visceral protein stores and permitting the inclusion of heavier individuals, many of whom have diabetes, a group previously excluded from the malnutrition risk definition 6 . This definition contrasts with that of the International Society for Renal Nutrition and Metabolism (ISRNM), which requires the presence of abnormalities in three of the four following areas: serum chemistry measures, body mass, muscle mass measures and/or dietary 7 …”

Section: Introductionmentioning

confidence: 99%

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Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

2021

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Background Increased malnutrition risk has been observed in more than 40% people on haemodialysis in Israel. It is not clear that this risk is homogeneously distributed among people with versus without diabetes. Objectives To examine the influence of diabetes on malnutrition risk among people on haemodialysis. Methods This cross‐sectional study included a representative sample of 375 individuals on haemodialysis treated in hospital dialysis centres throughout Israel. Of these, 126 had diabetes. Dietary intake, biochemistry, anthropometric and hemodynamic measures were recorded. Malnutrition risk categories were defined: “minimal”: body mass index (BMI) ≥23 kg/m2 and serum albumin ≥38 mmol/L; “mild”: BMI <23 kg/m2 and albumin ≥38 mmol/L; “moderate”: BMI ≥23 kg/m2 and albumin <38 mmol/L; “severe”: BMI<23 k/m2 and serum albumin <38 mmol/L. These categories were dichotomized to “minimal” versus elevated malnutrition risk. Results Despite greater BMI, elevated malnutrition risk was identified in 58.8% of individuals with versus 39.3% without diabetes. Adherence to International Society for Renal Nutrition and Metabolism nutrition guidelines was poor regardless of diabetes status. In multivariable logistic regression analysis, diabetes: OR 2.15; C‐reactive protein (nmol/L): OR 1.02; delivered dialysis dose (Kt/V): OR 6.07; and haemoglobin (g/L): OR 0.79, predicted elevated malnutrition risk, even after controlling for age, sex and years on haemodialysis. Discussion Individuals on haemodialysis who have diabetes have elevated malnutrition risk compared to those without diabetes despite greater BMI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

2021

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“…Therefore, albumin itself plays an essential role in maintaining microcirculation in systemic tissues via the body- fluid movement, mainly between the vessels and interstitium [ 29 ]. To date, serum albumin concentration has reportedly been associated with CKD progression [ 30 ], prognosis in CKD patients [ 31 ], and trajectory of cognitive function in community-dwelling adults [ 32 ]. Moreover, the assessment of the cognitive function subscale of the Kidney Disease Quality of Life showed the possibility to have an association between cognitive function and serum albumin concentration in CKD patients, including those undergoing HD [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Association of cerebral oxygenation with estimated glomerular filtration rate and cognitive function in chronic kidney disease patients without dialysis therapy

Miyazawa

Ookawara

et al. 2018

PLoS ONE

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BackgroundA decline in estimated glomerular filtration rate (eGFR) is reportedly associated with increased prevalence rates of cognitive impairment. However, data concerning the association between the cerebral saturation of oxygen (rSO2) and cognitive function of patients with chronic kidney disease (CKD) is limited. This study aimed to (i) elucidate the clinical factors associating with cerebral rSO2 and (ii) investigate the association between cerebral rSO2 and cognitive assessment in CKD patients.MethodsA total of 40 CKD patients not requiring dialysis (26 men and 14 women; mean age, 61.0 ± 2.7 years) were recruited. The numbers of patients at each CKD stage were as follows: G1, 5; G2, 8; G3a, 6; G3b, 5; G4, 11; and G5, 5. Cerebral rSO2 was monitored at the forehead using the oxygen saturation monitor INVOS 5100C. The cognitive function of each patient was confirmed using the Mini-Mental State Examination (MMSE).ResultsCerebral rSO2 levels were significantly higher in CKD patients than in hemodialysis patients (63.8 ± 1.5% vs. 44.9 ± 2.2%, p < 0.001). Multiple regression analysis showed that cerebral rSO2 was independently associated with eGFR (standardized coefficient: 0.530), serum albumin concentration (standardized coefficient: 0.365), and serum sodium concentration (standardized coefficient: 0.224). Furthermore, MMSE showed a significantly positive correlation with cerebral rSO2 (r = 0.624, p < 0.001).ConclusionsCerebral rSO2 was affected by eGFR and serum albumin and sodium concentrations in CKD patients. Furthermore, cerebral rSO2 monitoring, which reflected MMSE scores, might be a useful method for assessing cognitive function in CKD patients.

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“…The combination of low BMI and hypoalbuminemia, capturing reduced somatic and visceral protein stores, has been shown to predict disease progression in patients with chronic kidney disease (CKD) [16]. Yet, it has been reported that using ISRNM criteria for diagnosis of PEW may result in an underestimate of malnutrition in HD patients [17].…”

Section: Introductionmentioning

confidence: 99%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

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Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

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Combination of low body mass index and serum albumin level is associated with chronic kidney disease progression: the chronic kidney disease-research of outcomes in treatment and epidemiology (CKD-ROUTE) study

Abstract: This study suggests that combined effects of low BMI (<23.5 kg/m) and serum albumin level (<4 g/dL) are associated with CKD progression.

Cited by 31 publications

References 32 publications

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

Status of Nutrition In Hemodialysis Patients Survey (SNIPS): Malnutrition risk by diabetes status

Association of cerebral oxygenation with estimated glomerular filtration rate and cognitive function in chronic kidney disease patients without dialysis therapy

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

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