This study aimed to investigate changes in nutritional markers in patients with predialysis chronic kidney disease (CKD) and stable body mass index (BMI).
Methods
We analyzed data from a nationwide cohort of US Veterans with advanced CKD who transitioned to kidney replacement therapy from October 1, 2007, through March 31, 2015. We identified 20,164 U.S. veterans with stable BMI and multiple serum albumin measurements. We calculated intraindividual slopes of serum albumin using mixed effects models for 3 years preceding dialysis. We examined the association of serum albumin slope with mortality after dialysis initiation using Cox proportional hazards models adjusted for demographic characteristics, comorbidities, and baseline estimated glomerular filtration rate and serum albumin.
Results
The cohort had a mean age of 64 years, with 98.3% male and 30% African American participants. Despite maintaining stable BMI, 81% of patients displayed a decline in serum albumin levels in the predialysis period (median slope: −0.09 g/dL/year, 25th and 75th percentile: −0.17, −0.02). A steeper decline in serum albumin over time was associated with significantly higher postdialysis mortality (multivariable-adjusted hazard ratio associated with −1 g/dL/year decline in serum albumin: 1.86, 95% confidence interval: 1.65-2.10, P < .001).
Conclusion
A large proportion of patients with advanced CKD display a clinically relevant decline in serum albumin despite maintaining a stable BMI. Our study highlights the limitations of stable BMI as a marker of nutritional adequacy in advanced CKD, emphasizing the need for more comprehensive nutritional assessments in CKD management.
{"title":"Declining Serum Albumin With Stable Body Mass Index: A Mortality Indicator in Predialysis Chronic Kidney Disease","authors":"Menaka Sarav MD , Prabin Shrestha MD , Adnan Naseer MD , Fridtjof Thomas PhD , Keiichi Sumida MD, MPH, PhD, FASN , Kamyar Kalantar-Zadeh MD, MPH, PhD , Csaba P. Kovesdy MD","doi":"10.1053/j.jrn.2025.04.005","DOIUrl":"10.1053/j.jrn.2025.04.005","url":null,"abstract":"<div><h3>Objective</h3><div><span>This study aimed to investigate changes in nutritional markers in patients with predialysis chronic kidney disease (CKD) and stable </span>body mass index (BMI).</div></div><div><h3>Methods</h3><div><span><span>We analyzed data from a nationwide cohort of US Veterans with advanced CKD who transitioned to kidney replacement therapy from October 1, 2007, through March 31, 2015. We identified 20,164 U.S. veterans with stable BMI and multiple </span>serum albumin<span> measurements. We calculated intraindividual slopes of serum albumin<span> using mixed effects models for 3 years preceding dialysis. We examined the association of serum albumin slope with mortality after dialysis initiation using Cox proportional hazards models adjusted for demographic characteristics, comorbidities, and baseline estimated </span></span></span>glomerular filtration rate and serum albumin.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 64 years, with 98.3% male and 30% African American participants. Despite maintaining stable BMI, 81% of patients displayed a decline in serum albumin levels in the predialysis period (median slope: −0.09 g/dL/year, 25th and 75th percentile: −0.17, −0.02). A steeper decline in serum albumin over time was associated with significantly higher postdialysis mortality (multivariable-adjusted hazard ratio associated with −1 g/dL/year decline in serum albumin: 1.86, 95% confidence interval: 1.65-2.10, <em>P</em> < .001).</div></div><div><h3>Conclusion</h3><div>A large proportion of patients with advanced CKD display a clinically relevant decline in serum albumin despite maintaining a stable BMI. Our study highlights the limitations of stable BMI as a marker of nutritional adequacy in advanced CKD, emphasizing the need for more comprehensive nutritional assessments in CKD management.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 598-606"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2025.07.004
Allon N. Friedman MD
Obesity is arguably the premier global public health problem of our era. It is also an independent risk factor for the development and progression of chronic kidney disease (CKD) and adverse outcomes in persons with CKD. Fortunately, effective treatment options for obesity have proliferated in just the last few years. These newer therapies in conjunction with older treatments offer great potential in treating obesity and CKD, although many questions remain about their use, efficacy, and place within the overall therapeutic plan. This article will provide a discussion of the definition of obesity, its etiology, and its importance as a risk factor for CKD and other kidney-associated problems. It will then review current treatment options for obesity and the related evidence base. Finally, it will address major topics or controversies that remain unresolved and identify obstacles to effective treatment.
{"title":"Evaluation and Management of Obesity in Chronic Kidney Disease","authors":"Allon N. Friedman MD","doi":"10.1053/j.jrn.2025.07.004","DOIUrl":"10.1053/j.jrn.2025.07.004","url":null,"abstract":"<div><div>Obesity is arguably the premier global public health problem of our era. It is also an independent risk factor for the development and progression of chronic kidney disease (CKD) and adverse outcomes in persons with CKD. Fortunately, effective treatment options for obesity have proliferated in just the last few years. These newer therapies in conjunction with older treatments offer great potential in treating obesity and CKD, although many questions remain about their use, efficacy, and place within the overall therapeutic plan. This article will provide a discussion of the definition of obesity, its etiology, and its importance as a risk factor for CKD and other kidney-associated problems. It will then review current treatment options for obesity and the related evidence base. Finally, it will address major topics or controversies that remain unresolved and identify obstacles to effective treatment.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 578-588"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2025.01.005
Sophie Cornet MD , Kevin Quinonez MD , Xavier Warling MD , François Jouret MD, PhD , Antoine Lanot MD, PhD , Olivier Bruyère PhD , Etienne Cavalier EuSpLM, PhD , Pierre Delanaye MD, PhD
Objectives
Frailty is common among hemodialysis (HD) patients. Its assessment is usually based on clinical criteria. In the present work, we evaluated the interest of combining clinical frailty score and biomarkers to predict mortality of chronic HD patients. Four biomarkers were assessed: myostatin, insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEA-S), and serum creatinine-to-cystatin C ratio (SCr/SCys).
Methods
Prevalent HD patients were enrolled from September 2016 to October 2017 in 2 centers in this observational prospective study and followed up for 5 years. Serum levels of myostatin, IGF-1, DHEA-S, and SCr/SCys were measured at baseline. Frailty was assessed using Fried frailty score (≥ 3 indicates frailty). The ability to predict 5-year mortality was assessed by calculating Cox regression analyses and areas under the curve (AUCs).
Results
We included 125 HD patients with the following characteristics: median age of 67 (53; 78) years, 40% of women, 41% of diabetics, and median dialysis vintage of 30 (16; 54) months. Among them, 46% were classified as “Frail” according to Fried score. Mortality rate at 5 years was 56%. The median follow-up was 49 (19; 60) months. Cox univariate analysis showed that higher age, frailty phenotype, and decreased concentrations of myostatin, IGF-1, DHEA-S, and SCr/SCys were associated with higher mortality. In multivariate analysis, only myostatin remained significant among the biomarkers. The AUC of Fried score and myostatin to predict mortality was significant and comparable: 0.72 (95% confidence interval [CI]: 0.63-0.80) and 0.72 (95% CI: 0.64-0.80), respectively. Combining myostatin with Fried score improved significantly the AUC (AUC = 0.79, 95% CI: 0.71-0.86) compared to Fried score alone or myostatin alone (P = .0049 and P = .0035, respectively).
Conclusion
Decreased concentrations of myostatin seem to be independently associated with higher risk of mortality. Combining Fried frailty score with myostatin concentration could improve the prediction of 5-year mortality in chronic HD patients.
{"title":"Combination of Clinical Frailty Score and Myostatin Concentrations as Mortality Predictor in Hemodialysis Patients","authors":"Sophie Cornet MD , Kevin Quinonez MD , Xavier Warling MD , François Jouret MD, PhD , Antoine Lanot MD, PhD , Olivier Bruyère PhD , Etienne Cavalier EuSpLM, PhD , Pierre Delanaye MD, PhD","doi":"10.1053/j.jrn.2025.01.005","DOIUrl":"10.1053/j.jrn.2025.01.005","url":null,"abstract":"<div><h3>Objectives</h3><div><span><span>Frailty is common among </span>hemodialysis (HD) patients. Its assessment is usually based on clinical criteria. In the present work, we evaluated the interest of combining clinical frailty score and biomarkers to predict mortality of chronic HD patients. Four biomarkers were assessed: </span>myostatin<span>, insulin-like growth factor-1 (IGF-1), dehydroepiandrosterone sulfate (DHEA-S), and serum creatinine-to-cystatin C ratio (SCr/SCys).</span></div></div><div><h3>Methods</h3><div>Prevalent HD patients were enrolled from September 2016 to October 2017 in 2 centers in this observational prospective study and followed up for 5 years. Serum levels of myostatin<span>, IGF-1, DHEA-S, and SCr/SCys were measured at baseline. Frailty was assessed using Fried frailty score (≥ 3 indicates frailty). The ability to predict 5-year mortality was assessed by calculating Cox regression analyses and areas under the curve (AUCs).</span></div></div><div><h3>Results</h3><div><span><span>We included 125 HD patients with the following characteristics: median age of 67 (53; 78) years, 40% of women, 41% of diabetics, and median dialysis vintage of 30 (16; 54) months. Among them, 46% were classified as “Frail” according to Fried score. Mortality rate at 5 years was 56%. The median follow-up was 49 (19; 60) months. Cox </span>univariate analysis<span><span> showed that higher age, frailty phenotype, and decreased concentrations of myostatin, IGF-1, DHEA-S, and SCr/SCys were associated with higher mortality. In </span>multivariate analysis, only myostatin remained significant among the biomarkers. The AUC of Fried score and myostatin to predict mortality was significant and comparable: 0.72 (95% confidence interval [CI]: 0.63-0.80) and 0.72 (95% CI: 0.64-0.80), respectively. Combining myostatin with Fried score improved significantly the AUC (AUC = 0.79, 95% CI: 0.71-0.86) compared to Fried score alone or myostatin alone (</span></span><em>P =</em> .0049 and <em>P</em> = .0035, respectively).</div></div><div><h3>Conclusion</h3><div>Decreased concentrations of myostatin seem to be independently associated with higher risk of mortality. Combining Fried frailty score with myostatin concentration could improve the prediction of 5-year mortality in chronic HD patients.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 636-645"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2025.05.004
Liang-Chun Chen MD , Zih-Kai Kao MS , Chih-Yu Yang MD, PhD , Der-Cherng Tarng MD, PhD
Objective
Urine albumin-creatinine ratio (UACR) is widely used to estimate daily albuminuria. Despite efforts to improve the accuracy of the estimated albumin excretion rate, the individual contributions of age, sex, and body weight remain unexplored.
Methods
This hospital-based cohort study examined the explanatory power of various factors and compared total R2 values across different sets of factors to determine the optimal estimated albumin excretion rate model.
Results
An analysis of 304 24-hour urine samples revealed a median value of 0.538 g (interquartile range: 0.091-2.080 g), identifying UACR and body weight as significant factors with high partial R2 values in estimating daily albuminuria. A novel model using only UACR and body weight demonstrated performance comparable to previous models that included additional variables (total R2 values: ours 0.922 vs. 0.923, P = .893; ours 0.922 vs. 0.925, P = .727), and outperformed the model that excluded body weight (total R2 values: ours 0.922 vs. 0.855, P < .001). Receiver operating characteristic analysis identified 78.1 kg (body mass index [BMI] of 28.5 kg/m2) as the optimal cutoff for predicting underestimation of daily albuminuria by UACR in the heavier half of our patient cohort (area under the curve: 0.865). For individuals with body weight less than 78.1 kg (0th-75.4th percentile), daily albuminuria (g) could be estimated as: 0.033 + 0.999 × UACR (mg/mg) (total R2: 0.966). Conversely, for those weighing ≥78.1 kg (75.5th-100th percentile), the estimation formula was as follows: −3.885 + 1.538 × UACR (mg/mg) + 0.045 × body weight (kg) (total R2: 0.942).
Conclusions
For individuals with a BMI below 28.5 kg/m2, the UACR alone provides sufficient accuracy for estimating daily albuminuria (using the formula: daily albuminuria (g) = 0.033 + 0.999 × UACR (mg/mg)). However, for those with a BMI of 28.5 kg/m2 or higher, adding body weight as a single correction factor to UACR sufficiently improves the explanatory power, simplifying clinical practice by eliminating the need for age and sex as additional factors.
{"title":"Urine Albumin-creatinine Ratio Accurately Reflects Daily Albuminuria in Nonobese Patients but Requires Body Weight Correction in Obese","authors":"Liang-Chun Chen MD , Zih-Kai Kao MS , Chih-Yu Yang MD, PhD , Der-Cherng Tarng MD, PhD","doi":"10.1053/j.jrn.2025.05.004","DOIUrl":"10.1053/j.jrn.2025.05.004","url":null,"abstract":"<div><h3>Objective</h3><div>Urine albumin-creatinine ratio (UACR) is widely used to estimate daily albuminuria<span>. Despite efforts to improve the accuracy of the estimated albumin excretion rate, the individual contributions of age, sex, and body weight remain unexplored.</span></div></div><div><h3>Methods</h3><div><span>This hospital-based cohort study examined the explanatory power of various factors and compared total R</span><sup>2</sup> values across different sets of factors to determine the optimal estimated albumin excretion rate model.</div></div><div><h3>Results</h3><div><span>An analysis of 304 24-hour urine samples revealed a median value of 0.538 g (interquartile range: 0.091-2.080 g), identifying UACR and body weight as significant factors with high partial R</span><sup>2</sup><span> values in estimating daily albuminuria<span>. A novel model using only UACR and body weight demonstrated performance comparable to previous models that included additional variables (total R</span></span><sup>2</sup> values: ours 0.922 vs. 0.923, <em>P</em> = .893; ours 0.922 vs. 0.925, <em>P</em> = .727), and outperformed the model that excluded body weight (total R<sup>2</sup> values: ours 0.922 vs. 0.855, <em>P</em> < .001). Receiver operating characteristic analysis identified 78.1 kg (body mass index [BMI] of 28.5 kg/m<sup>2</sup><span>) as the optimal cutoff for predicting underestimation of daily albuminuria<span> by UACR in the heavier half of our patient cohort (area under the curve: 0.865). For individuals with body weight less than 78.1 kg (0th-75.4th percentile), daily albuminuria (g) could be estimated as: 0.033 + 0.999 × UACR (mg/mg) (total R</span></span><sup>2</sup>: 0.966). Conversely, for those weighing ≥78.1 kg (75.5th-100th percentile), the estimation formula was as follows: −3.885 + 1.538 × UACR (mg/mg) + 0.045 × body weight (kg) (total R<sup>2</sup>: 0.942).</div></div><div><h3>Conclusions</h3><div>For individuals with a BMI below 28.5 kg/m<sup>2</sup>, the UACR alone provides sufficient accuracy for estimating daily albuminuria (using the formula: daily albuminuria (g) = 0.033 + 0.999 × UACR (mg/mg)). However, for those with a BMI of 28.5 kg/m<sup>2</sup> or higher, adding body weight as a single correction factor to UACR sufficiently improves the explanatory power, simplifying clinical practice by eliminating the need for age and sex as additional factors.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 607-615"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2025.02.009
Ying Guo, Yizhe Xin, Rujia Wang, Bin Fu
{"title":"Does Protein Intake Have a Significant Impact on eGFR?","authors":"Ying Guo, Yizhe Xin, Rujia Wang, Bin Fu","doi":"10.1053/j.jrn.2025.02.009","DOIUrl":"10.1053/j.jrn.2025.02.009","url":null,"abstract":"","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 692-693"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2024.10.003
Mariana Mazzei Caiado Bressan MD , Elisa de Albuquerque Sampaio MD, PhD , Ricardo de Castro Cintra Sesso MD, PhD , Jocemir Ronaldo Lugon MD, PhD
Objectives
Mineral and bone disorders are frequent in patients in hemodialysis (HD) but a definite association of serum phosphate levels with mortality in this population is still an unmet issue. We assessed the association of three phosphate-level ranges with mortality in incident HD patients.
Methods
This national registry-based retrospective cohort study included 6214 incident adult patients on HD for >3 months. Data were collected from January 2011 to December 2018. The serum phosphate levels, represented by the median levels over the course of the entire HD treatment, were stratified into 3 ranges: <3.5 mg/dL, 3.5-5.5 mg/dL, and >5.5 mg/dL. The main outcome was 4-year all-cause mortality.
Results
The frequencies of cases in the lower, intermediate, and higher phosphate ranges were 5.8%, 64.6%, and 29.6%, respectively. In the fully adjusted multivariate model, the higher adopted phosphate range but not the lower one showed a significant association with mortality (hazard ratio [HR]: 1.54, 95% confidence interval [95% CI]: 1.21-1.95, P< .001). In the model, sevelamer, alone (HR: 0.44, 95% CI: 0.32-0.60, P< .001) or in combination with calcium-based phosphate binders (HR: 0.63, 95% CI: 0.40-0.98, P= .041), proved protective. In subgroup analyses, the lower adopted phosphate range was significantly associated with mortality only in patients <60 years. In a sensitivity analysis, we evaluated the effect of incremental intervals of 0.5 mg/dL across the phosphate distribution (from <2.0 mg/dL to ≥8.0 mg/dL), when serum phosphate <2.0 mg/dL was strongly associated with mortality (HR: 21.9, 95% CI: 2.99-160.66, P= .002).
Conclusion
The study reinforced the association of high phosphate levels with mortality in incident HD patients. The use of sevelamer was associated with a lower mortality rate when compared to the use of calcium-based phosphate binders. The lower adopted phosphate range was only associated with mortality in patients <60 years. In a sensitivity analysis though, phosphate levels below 2.0mg/dl were strongly associated with mortality.
{"title":"Serum Phosphate Levels and Mortality in Incident Hemodialysis Patients: A National Retrospective Cohort Study","authors":"Mariana Mazzei Caiado Bressan MD , Elisa de Albuquerque Sampaio MD, PhD , Ricardo de Castro Cintra Sesso MD, PhD , Jocemir Ronaldo Lugon MD, PhD","doi":"10.1053/j.jrn.2024.10.003","DOIUrl":"10.1053/j.jrn.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Mineral and bone disorders are frequent in patients in hemodialysis (HD) but a definite association of serum phosphate levels with mortality in this population is still an unmet issue. We assessed the association of three phosphate-level ranges with mortality in incident HD patients.</div></div><div><h3>Methods</h3><div>This national registry-based retrospective cohort study included 6214 incident adult patients on HD for >3 months. Data were collected from January 2011 to December 2018. The serum phosphate levels, represented by the median levels over the course of the entire HD treatment, were stratified into 3 ranges: <3.5 mg/dL, 3.5-5.5 mg/dL, and >5.5 mg/dL. The main outcome was 4-year all-cause mortality.</div></div><div><h3>Results</h3><div>The frequencies of cases in the lower, intermediate, and higher phosphate ranges were 5.8%, 64.6%, and 29.6%, respectively. In the fully adjusted multivariate model, the higher adopted phosphate range but not the lower one showed a significant association with mortality (hazard ratio [HR]: 1.54, 95% confidence interval [95% CI]: 1.21-1.95, <em>P</em>< .001). In the model, sevelamer, alone (HR: 0.44, 95% CI: 0.32-0.60, <em>P</em>< .001) or in combination with calcium-based phosphate binders (HR: 0.63, 95% CI: 0.40-0.98, <em>P</em>= .041), proved protective. In subgroup analyses, the lower adopted phosphate range was significantly associated with mortality only in patients <60 years. In a sensitivity analysis, we evaluated the effect of incremental intervals of 0.5 mg/dL across the phosphate distribution (from <2.0 mg/dL to ≥8.0 mg/dL), when serum phosphate <2.0 mg/dL was strongly associated with mortality (HR: 21.9, 95% CI: 2.99-160.66, <em>P</em>= .002).</div></div><div><h3>Conclusion</h3><div>The study reinforced the association of high phosphate levels with mortality in incident HD patients. The use of sevelamer was associated with a lower mortality rate when compared to the use of calcium-based phosphate binders. The lower adopted phosphate range was only associated with mortality in patients <60 years. In a sensitivity analysis though, phosphate levels below 2.0mg/dl were strongly associated with mortality.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 672-681"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemodialysis (HD) patients are at a high risk of frailty, falls, and fractures. The Kihon checklist (KCL) consists of physical function, cognitive function, oral function, nutritional status, depressed mood, activities of daily living, and social participation. This study aimed to clarify the association between falls in HD patients and frailty as assessed using the KCL, as well as scores and each domain.
Methods
A multicenter prospective cohort study was conducted across 9 facilities. Frailty was assessed using the KCL. Falls were then monitored for 1 year. Participants were classified into 3 groups based on their KCL scores: robust, prefrailty, and frailty. In the logistic regression analysis, the dependent variables were falls, severe falls, or fractures, whereas the independent variables were group classification, KCL score, or each domain.
Results
A total of 403 HD patients (70.0 [60.0-76.0] years, 170 [42.1%] women) were analyzed. During the 1-year follow-up period, 117 (29.0%) patients experienced falls. Prefrailty (odds ratio (OR) 3.00, 95% confidence interval (CI) 1.17-7.71, P < .001) and frailty (OR 6.79, 95% CI 2.69-17.16, P < .001) were independently associated with falls compared with robust patients. Additionally, the KCL score was associated with severe falls (OR 1.15, 95% CI 1.06-1.25, P = .001) and fracture (OR 1.13, 95% CI 1.01-1.28, P = .04). By KCL domain, physical function (OR 3.46, 95% CI 2.06-5.83, P < .001) and cognitive function (OR 1.74, 95% CI 1.09-2.77, P = .02) were independently associated with falls.
Conclusions
The KCL may be a useful screening tool for estimating fall and fracture risk in this population.
目的：血液透析（HD）患者易发生虚弱、跌倒和骨折。Kihon检查表（KCL）包括身体功能、认知功能、口腔功能、营养状况、抑郁情绪、日常生活活动和社会参与。本研究旨在通过使用KCL、评分和每个域来评估HD患者跌倒和虚弱之间的关系。方法：在9个机构进行了一项多中心前瞻性队列研究。使用KCL评估虚弱程度。然后对跌倒情况进行了一年的监测。参与者根据他们的KCL得分分为三组：健全性、虚弱前和虚弱。在logistic回归分析中，因变量为跌倒、严重跌倒或骨折，自变量为分组分类、KCL评分或各域。结果：共分析403例HD患者（70.0[60.0-76.0]岁，女性170例[42.1%]）。在1年的随访期间，117例（29.0%）患者出现跌倒。与健壮的患者相比，虚弱前（OR 3.00, 95%CI 1.17-7.71, p < 0.001）和虚弱（OR 6.79, 95%CI 2.69-17.16, p < 0.001）与跌倒独立相关。此外，KCL评分与严重跌倒（OR 1.15, 95%CI 1.06 - 1.25, p = 0.001）和骨折（OR 1.13, 95%CI 1.01-1.28, p = 0.04）相关。通过KCL域，身体功能（OR 3.46, 95%CI 2.06-5.83, p < 0.001）和认知功能（OR 1.74, 95%CI 1.09-2.77, p = 0.02）与跌倒独立相关。结论：KCL可能是评估这类人群跌倒和骨折风险的有用筛查工具。
{"title":"Relationship Between Frailty, as Assessed Using the Kihon Checklist, and Falls in Hemodialysis Patients: A Multicenter Prospective Cohort Study","authors":"Nobuyuki Shirai PT, PhD , Naoto Usui PT, PhD , Daisuke Okamura PT , Yoichi Sato PT, PhD , Sho Kojima PT, PhD , Kenta Mikami PT , Mizuki Nagashima PT , Yu Shimano PT , Nobuhito Shinozaki PT , Syun Hirukawa PT , Akihiro Sakuyama PT, PhD , Yoji Yamada PT, PhD , Masakazu Saitoh PT, PhD","doi":"10.1053/j.jrn.2025.03.006","DOIUrl":"10.1053/j.jrn.2025.03.006","url":null,"abstract":"<div><h3>Objectives</h3><div><span>Hemodialysis (HD) patients are at a high risk of </span>frailty<span>, falls, and fractures. The Kihon checklist (KCL) consists of physical function, cognitive function, oral function, nutritional status, depressed mood, activities of daily living, and social participation. This study aimed to clarify the association between falls in HD patients and frailty as assessed using the KCL, as well as scores and each domain.</span></div></div><div><h3>Methods</h3><div><span>A multicenter prospective cohort study was conducted across 9 facilities. Frailty was assessed using the KCL. Falls were then monitored for 1 year. Participants were classified into 3 groups based on their KCL scores: robust, prefrailty, and frailty. In the </span>logistic regression analysis, the dependent variables were falls, severe falls, or fractures, whereas the independent variables were group classification, KCL score, or each domain.</div></div><div><h3>Results</h3><div>A total of 403 HD patients (70.0 [60.0-76.0] years, 170 [42.1%] women) were analyzed. During the 1-year follow-up period, 117 (29.0%) patients experienced falls. Prefrailty (odds ratio (OR) 3.00, 95% confidence interval (CI) 1.17-7.71, <em>P</em> < .001) and frailty (OR 6.79, 95% CI 2.69-17.16, <em>P</em> < .001) were independently associated with falls compared with robust patients. Additionally, the KCL score was associated with severe falls (OR 1.15, 95% CI 1.06-1.25, <em>P</em> = .001) and fracture (OR 1.13, 95% CI 1.01-1.28, <em>P</em> = .04). By KCL domain, physical function (OR 3.46, 95% CI 2.06-5.83, <em>P</em> < .001) and cognitive function (OR 1.74, 95% CI 1.09-2.77, <em>P</em> = .02) were independently associated with falls.</div></div><div><h3>Conclusions</h3><div>The KCL may be a useful screening tool for estimating fall and fracture risk in this population.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 655-662"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1053/j.jrn.2025.05.003
Jeanette M. Andrade PhD, RDN, FAND , Katherine Mullis BS , Pablo Lamino PhD
Objective
Food and nutrition insecurity may contribute to the progression of chronic kidney disease (CKD). Current metrics to measure food and nutrition security (FANS) status may not capture the nuances associated with these concepts. The purpose of this mixed method study was to examine perceptions of FANS of adults with CKD, nondialysis.
Methods
A sequential explanatory mixed-method study was conducted from March to August 2024. Participants (n = 60) completed a survey that focused on the dimensions of FANS and diet quality. A sub-section of participants (n = 23) completed an interview that explored FANS. Frequencies and descriptives were analyzed using Statistical Package for Social Science (v28). Interviews were transcribed, and deductive and inductive coding was used to determine themes using NVivo (v14).
Results
Many participants (77%) were in stage 3 of CKD based on self-reported estimated Glomerular Filtration Rate, were considered Black (47.5%) or Hispanic/Latino (45.9%), did not receive any food/government assistance (55.7%), and self-reported annual household income of $50,000 or more (70.5%). The median diet quality score was 35.5 out of 60. The themes from the interviews focused on specific aspects of food security dimensions, such as availability and accessibility, with other themes present, such as affordability, health, and support.
Conclusion
Affordability of food, health, and support were of concern for adults with CKD, regardless of income level. Traditional food security instruments need to expand to include more in-depth questions about the food and nutrition dimensions in alleviating any potential burdens that adults with CKD face in obtaining and consuming foods.
{"title":"Perceptions of Food and Nutrition Security Among Adults With chronic kidney disease, Nondialysis: A Mixed Method Study","authors":"Jeanette M. Andrade PhD, RDN, FAND , Katherine Mullis BS , Pablo Lamino PhD","doi":"10.1053/j.jrn.2025.05.003","DOIUrl":"10.1053/j.jrn.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>Food and nutrition insecurity may contribute to the progression of chronic kidney disease (CKD). Current metrics to measure food and nutrition security (FANS) status may not capture the nuances associated with these concepts. The purpose of this mixed method study was to examine perceptions of FANS of adults with CKD, nondialysis.</div></div><div><h3>Methods</h3><div>A sequential explanatory mixed-method study was conducted from March to August 2024. Participants (n = 60) completed a survey that focused on the dimensions of FANS and diet quality. A sub-section of participants (n = 23) completed an interview that explored FANS. Frequencies and descriptives were analyzed using Statistical Package for Social Science (v28). Interviews were transcribed, and deductive and inductive coding was used to determine themes using NVivo (v14).</div></div><div><h3>Results</h3><div>Many participants (77%) were in stage 3 of CKD based on self-reported estimated Glomerular Filtration Rate, were considered Black (47.5%) or Hispanic/Latino (45.9%), did not receive any food/government assistance (55.7%), and self-reported annual household income of $50,000 or more (70.5%). The median diet quality score was 35.5 out of 60. The themes from the interviews focused on specific aspects of food security dimensions, such as availability and accessibility, with other themes present, such as affordability, health, and support.</div></div><div><h3>Conclusion</h3><div>Affordability of food, health, and support were of concern for adults with CKD, regardless of income level. Traditional food security instruments need to expand to include more in-depth questions about the food and nutrition dimensions in alleviating any potential burdens that adults with CKD face in obtaining and consuming foods.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 589-597"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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