Range of serum transthyretin levels in hemodialysis patients at a high risk of 1‐year mortality: A retrospective cohort study

Kumagai, Etsuko; Hosohata, Keiko; Furumachi, Kazuhiro

doi:10.1111/1744-9987.13768

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…In the meantime, the use of TTR is encouraged in most Asian countries such as China [72][73][74][91][92][93][94], Japan [75,[95][96][97][98][99], and South Korea [100][101][102] focusing more specific attention on matters having major public health impact. Many other Eastern countries, notably Indonesia [103], Thailand [104], India [105], Iran [106], and Australia [107] are working along similar lines, having provided substantial contributions.…”

Section: Discussionmentioning

confidence: 99%

Plasma transthyretin is a nutritional biomarker in human morbidities

Ingenbleek

2022

Front. Med.

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Transthyretin (TTR) is a small liver-secreted plasma protein that shows close correlations with changes in lean body mass (LBM) during the entire human lifespan and agglomerates the bulk of nitrogen (N)-containing substrates, hence constituting the cornerstone of body building. Amino acids (AAs) dietary restriction causes inhibition of TTR production and impairs the accretion of LBM reserves. Inflammatory disorders result in cytokine-induced abrogation of TTR synthesis and urinary leakage of nitrogenous catabolites. Taken together, the data indicate that malnutrition and inflammation may similarly suppress the production of TTR through distinct and unrelated pathophysiological mechanisms while operating in concert to downsize LBM stores. The hepatic synthesis of TTR integrates both machineries, acting as a marker of reduced LBM resources still available for defense and repair processes. TTR operates as a universal surrogate analyte that allows for the grading of residual LBM capacity to reflect disease burden. Measurement of TTR is a simple, rapid, and inexpensive micro-method that may be reproduced on a daily basis, hence ideally suited for the follow-up of the most intricated clinical situations and as a reliable predictor of any morbidity outcome.

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Section: Discussionmentioning

confidence: 99%

Plasma transthyretin is a nutritional biomarker in human morbidities

Ingenbleek

2022

Front. Med.

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“…Assuming that 12% of patients can meet the primary endpoint, 27 28 267 haemodialysis patients need to be recruited to yield 90% power to detect a significant association for a relative risk of 3.14 for transthyretin. 28 Based on consultation with haemodialysis research experts in Iran, the attrition rate is anticipated to be about 10%. Therefore, the recruitment target of the NIOS-HD is 300 patients.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The sample size calculation was done based on all-cause mortality as the primary endpoint using free power and sample size calculator (available at: http://powerandsamplesize.com). Assuming that 12% of patients can meet the primary endpoint,27 28 267 haemodialysis patients need to be recruited to yield 90% power to detect a significant association for a relative risk of 3.14 for transthyretin 28. Based on consultation with haemodialysis research experts in Iran, the attrition rate is anticipated to be about 10%.…”

Section: Methods and Analysismentioning

confidence: 99%

Association between nutritional, inflammatory and oxidative status (NIOS) and risk of adverse outcomes in patients on haemodialysis (HD): the NIOS-HD prospective cohort study protocol

et al. 2022

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IntroductionThe mortality of patients on chronic haemodialysis is 10–30 times greater than that of the general population and over 60% of these individuals die within the first 5 years of beginning haemodialysis. Although causes for excessive mortality in haemodialysis patients are not clearly defined, it seems that nutrition, inflammation and oxidative stress play key roles in this regard. Until now, no cohort study has focused on the association between nutritional, inflammatory or oxidative status and risk of complications and adverse outcomes in Iranian haemodialysis patients. Therefore, we sought to fill this gap and designed the Nutritional, Inflammatory, and Oxidative Status in Hemodialysis (NIOS-HD) prospective cohort study to determine the association of dietary factors, malnutrition, anthropometric indices, body composition, inflammation and oxidative stress with quality of life, dialysis access infections, hospitalisation, potential years of life lost and mortality in adults on maintenance haemodialysis in Isfahan, Iran.Methods and analysisThe sample size of this cohort was estimated to be 300 participants. At baseline, demographic, medical and dialysis-related data of eligible patients will be recorded. In addition, participants will undergo anthropometric measurements, malnutrition assessment and body composition analysis. Also, their dietary intake and quality of life will be evaluated through interviewer-administered questionnaires. Moreover, their fasting blood samples will be collected and stored for biochemical assays including transthyretin, albumin, serum amyloid A, pentraxin-3, trimethylamine N-oxide, myeloperoxidase, paraoxonase-1 and superoxide dismutase. After baseline evaluation, patients will be followed up to 3 years to update exposure information (except biochemical assays) and measure adverse outcomes. Finally, collected data will be analysed using descriptive and inferential statistics.Ethics and disseminationThe NIOS-HD is in agreement with the Declaration of Helsinki and has been approved by the Ethics Committee of Isfahan University of Medical Sciences (reference number: IR.MUI.RESEARCH.REC.1399.605). Findings of this study will be published in academic journals.

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Efficacy and safety of intradialytic parenteral nutrition using ENEFLUID® in malnourished patients receiving maintenance hemodialysis: An exploratory, multicenter, randomized, open-label study

Kabasawa,

Hosojima,

Kanda

et al. 2024

PLoS ONE

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The objective of this study was to investigate the efficacy and safety of intradialytic parenteral nutrition (IDPN) using ENEFLUID® (310 kcal, 550 mL) in mild-moderate malnutrition patients receiving maintenance hemodialysis. A total of 40 adult patients with a Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) score of 5–10 were enrolled in this multicenter, randomized, open-label study. Patients in the intervention group received IDPN using ENEFLUID® via the dialysis circuit 3 times a week for 12 weeks; those in the control group did not. The primary endpoint was change in serum transthyretin (TTR). The secondary endpoints were changes in nutritional laboratory tests, nutritional parameters, food intake, plasma amino acids, and blood glucose. For both groups, mean age (72.1±11.4 years) and BMI (20.3±3.0), and median NRI-JH score [7.0 (interquartile range, 6–8)], did not differ. One patient withdrew before intervention, leaving 20 intervention and 19 control patients. Mean (95% confidence interval) change in serum TTR (mg/dL) at 12 weeks did not differ between groups: Intervention, 1.0 (-1.1–3.2); Control, -0.3 (-2.4–1.9); Intragroup difference, 1.3 (-1.7–4.3); P = 0.41. The values reflecting protein intake at 12 weeks compared to those on the study initiation day increased in the intervention group [the changes of blood urea nitrogen, 9.4 (2.6–16.2) mg/dL; P = 0.007, and normalized protein catabolic rate, 0.10 (0.02–0.18) g/kg/day; P = 0.02]. Mean food protein intake (g/kg/day) at 12 weeks increased in the intervention group and decreased in the control group, and differed between groups: Intervention, 0.12 (-0.03–0.28); Control, -0.18 (-0.43–0.08); Inter-group difference, 0.30 (0.00–0.60); P = 0.050. No adverse events occurred. In patients with mild to moderate malnutrition receiving ENEFLUID® for 12 weeks as IDPN, serum TTR was not improved, decreases in protein intake was mitigated, no adverse events occurred. Trial registration Name of the registry: Japan Registry of Clinical Trials Registration number: jRCTs031220296.

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Range of serum transthyretin levels in hemodialysis patients at a high risk of 1‐year mortality: A retrospective cohort study

Cited by 3 publications

References 14 publications

Plasma transthyretin is a nutritional biomarker in human morbidities

Plasma transthyretin is a nutritional biomarker in human morbidities

Association between nutritional, inflammatory and oxidative status (NIOS) and risk of adverse outcomes in patients on haemodialysis (HD): the NIOS-HD prospective cohort study protocol

Efficacy and safety of intradialytic parenteral nutrition using ENEFLUID® in malnourished patients receiving maintenance hemodialysis: An exploratory, multicenter, randomized, open-label study

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