Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality

Honda, Hirokazu; Qureshi, Abdul Rashid; Axelsson, Jonas; Heimbürger, Olof; Suliman, Mohamed E.; Bárány, Peter; Stenvinkel, Peter; Lindholm, Bengt

doi:10.1093/ajcn/86.3.633

Cited by 254 publications

(228 citation statements)

References 32 publications

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“…The quality of three of 27 studies was good according to all of the established quality criteria (17,22); the remainder of studies was (somewhat) compromised. In 15 studies (56%), the representativeness of the exposed cohort was (somewhat) compromised, because the population proved to be either selected (not black or white race [41] or not $2 years Medicare follow-up before entering the study) or highly selected (exclusion of elderly patients [30], early deaths [43], and one study included 17% prevalent patients who were on chronic hemodialysis before peritoneal dialysis was initiated [24]). The remaining studies applied baseline assessment of geriatric impairments $7 days after the start of dialysis.…”

Section: Quality Assessmentmentioning

confidence: 99%

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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Background and objectives With aging of the general population, patients who enter dialysis therapy will more frequently have geriatric impairments and a considerable comorbidity burden. The most vulnerable among these patients might benefit from conservative therapy. Whether assessment of geriatric impairments would contribute to the decision-making process of dialysis initiation is unknown.Design, setting, participants, & measurements A systematic Medline and Embase search was performed on December 1, 2015 to identify studies assessing the association between risk of mortality or hospitalization and one or more geriatric impairments at the start of dialysis therapy, including impairment of cognitive function, mood, performance status or (instrumental) activities of daily living, mobility (including falls), social environment, or nutritional status.Results Twenty-seven studies were identified that assessed one or more geriatric impairments with respect to prognosis. The quality of most studies was moderate. Only seven studies carried out an analysis of elderly patients ($70 years old). Malnutrition and frailty were systematically assessed, and their relation with mortality was clear. In addition, cognitive impairment and functional outcomes at the initiation of dialysis were related to an increased mortality in most studies. However, not all studies applied systematic assessment tools, thereby potentially missing relevant impairment. None of the studies applied a geriatric assessment across multiple domains.Conclusions Geriatric impairment across multiple domains at dialysis initiation is related to poor outcome. However, information in the elderly is sparse, and a systematic approach of multiple domains with respect to poor outcome has not been performed. Because a geriatric assessment has proved useful in predicting outcome in other medical fields, its potential role in the ESRD population should be the subject of future research.

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Section: Quality Assessmentmentioning

confidence: 99%

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Loon

Wouters²,

Boereboom

et al. 2016

CJASN

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“…6 The conicity index is an easy anthropometric estimate using WC, height, and weight to model the relative accumulation of abdominal fat without requiring the hip circumference to assess fat distribution. 9 This method could be useful to identify CKD patients with abdominal obesity who are not necessarily overweight, 10 and it constitutes a risk estimate of the wasting component 11 : …”

Section: Definition and Assessment Of Obesitymentioning

confidence: 99%

“…Indeed, obesity may be associated with better stem cell mobilization, more efficient disposal of lipophilic uremic toxins, better bone strength, and improved hemodynamic tolerance. 93 In addition, although obesity can be associated with muscle wasting and catabolism, 11 increased fat stores usually reflect well preserved energy stores and preserved appetite. 94 In this case, the overall protective nutritional effect presumably overrides the cumulative longterm metabolic adverse effects of obesity.…”

Section: Should Nephrologists Promote Weight Gain In Dialysis Patients?mentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

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172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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“…Sarcopenic obesity specifically was highly prevalent among persons with CKD and not those without CKD 8. Sarcopenic obesity may have a particularly poor prognosis and associated with an increased risk of death in patients with end‐stage renal disease (ESRD) 9. Early detection of sarcopenic obesity in patients on maintenance hemodialysis is therefore of importance.…”

mentioning

confidence: 99%

Considering technique of assessment and method for normalizing skeletal muscle mass

Saitoh

Ishida

Springer

2017

J cachexia sarcopenia muscle

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Obese sarcopenia in patients with end-stage renal disease is associated with inflammation and increased mortality

Cited by 254 publications

References 32 publications

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

Obesity in CKD—What Should Nephrologists Know?

Considering technique of assessment and method for normalizing skeletal muscle mass

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