Pub Date : 2025-09-01Epub Date: 2025-05-06DOI: 10.1053/j.jrn.2025.04.006
García-Cruz María Fernanda MSc , Rios-Rios Brenda Daniela MSc , Cárdenas Yolitzy PhD , Ríos-Silva Mónica PhD , Trujillo Xóchitl PhD , Huerta Miguel PhD , Bermúdez-Aceves Luis Antonio MD , Sánchez-Meza Karmina PhD , Bricio-Barrios Jaime Alberto PhD
Objective
Deterioration of cognitive status and malnutrition are very common in patients with hemodialysis; these patients usually have a greater decline in their cognitive performance than individuals of the same age in the general population. The objective of the study was to correlate cognitive function with nutritional risk indicators in adults receiving hemodialysis treatment in the state of Colima, Mexico.
Methods
Analytical, cross-sectional study, which included 63 people (aged >18 years) of both sexes, who attended the Colima State Hemodialysis Center. Each patient who agreed to participate signed an informed consent. Nutritional risk was measured with the Nutritional Control Scale. To evaluate cognitive status, the Brief Neuropsychological Test in Spanish was used.
Results
Overall, 38.1% of the participants were women and 61.9% were men, with a median age of 52 (interquartile range 24.5) years. In addition, 58.7% of the participants presented cognitive impairment, and 14.3% were at nutritional risk. Albumin presented a positive correlation with the recall and encoding domains, the latter being stronger in the group of patients with moderate to severe nutritional risk, and lymphocytes were strongly and negatively correlated with the encoding domain.
Conclusion
No association was found between cognitive status and nutritional status in this study. However, a positive correlation of albumin and lymphocytes with some domains of cognitive function was found, especially in patients with nutritional risk.
{"title":"Correlation of Nutritional Risk Indicators and Cognitive Function on Mexican Hemodialysis Patients: Cross-Sectional Study","authors":"García-Cruz María Fernanda MSc , Rios-Rios Brenda Daniela MSc , Cárdenas Yolitzy PhD , Ríos-Silva Mónica PhD , Trujillo Xóchitl PhD , Huerta Miguel PhD , Bermúdez-Aceves Luis Antonio MD , Sánchez-Meza Karmina PhD , Bricio-Barrios Jaime Alberto PhD","doi":"10.1053/j.jrn.2025.04.006","DOIUrl":"10.1053/j.jrn.2025.04.006","url":null,"abstract":"<div><h3>Objective</h3><div>Deterioration of cognitive status and malnutrition are very common in patients with hemodialysis<span>; these patients usually have a greater decline in their cognitive performance than individuals of the same age in the general population. The objective of the study was to correlate cognitive function with nutritional risk indicators in adults receiving hemodialysis treatment in the state of Colima, Mexico.</span></div></div><div><h3>Methods</h3><div><span>Analytical, cross-sectional study, which included 63 people (aged >18 years) of both sexes, who attended the Colima State Hemodialysis Center. Each patient who agreed to participate signed an informed consent. Nutritional risk was measured with the Nutritional Control Scale. To evaluate cognitive status, the Brief </span>Neuropsychological Test in Spanish was used.</div></div><div><h3>Results</h3><div>Overall, 38.1% of the participants were women and 61.9% were men, with a median age of 52 (interquartile range 24.5) years. In addition, 58.7% of the participants presented cognitive impairment, and 14.3% were at nutritional risk. Albumin presented a positive correlation with the recall and encoding domains, the latter being stronger in the group of patients with moderate to severe nutritional risk, and lymphocytes were strongly and negatively correlated with the encoding domain.</div></div><div><h3>Conclusion</h3><div>No association was found between cognitive status and nutritional status in this study. However, a positive correlation of albumin and lymphocytes with some domains of cognitive function was found, especially in patients with nutritional risk.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 663-671"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044769","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}
Protein-energy wasting (PEW) is the chronic kidney disease-specific diagnosis encompassing malnutrition. PEW is associated with adverse outcomes, including those receiving peritoneal dialysis (PD). Identifying PEW requires accurate methods to improve diagnosis. The Global Leadership Initiative on Malnutrition (GLIM) criteria is focused on validating a global consensus for malnutrition diagnosis in adults in clinical settings. While the GLIM criteria has been extensively studied in other clinical populations, there is limited evidence about the agreement with PEW in the PD setting. The aim of this study was to assess the agreement, accuracy, sensitivity, and specificity of GLIM criteria in comparison to the malnutrition inflammation score (MIS), a widely used tool to diagnose PEW in patients on dialysis.
Methods
This was a cross-sectional study of patients undergoing PD. PEW was diagnosed using MIS score. Nutritional assessment was performed to identify malnutrition using GLIM criteria. Phenotypic criteria were assessed using low body mass index, low fat-free mass index, or low muscle strength. Etiology criteria were evaluated using high serum C-reactive protein or reduced food intake. The concordance between GLIM and MIS was evaluated by the Kappa test. A receiver operating characteristic curve was used for identifying area under curve, sensitivity, and specificity of GLIM.
Results
Patients undergoing PD (n = 154) were included in the study. Participants had a median age of 40 (29-51) years and 46.7% were male. PEW/malnutrition was diagnosed using MIS score in 35.3% and in 27.3% using the GLIM criteria. In comparison with MIS (used as the diagnostic reference), the sensitivity of GLIM was 65.8%, specificity 61.6%, and area under curve was 0.63. The weighted Kappa coefficient was (k 0.15, P = .02.).
Conclusion
GLIM criteria did not perform better than MIS in diagnosing PEW/malnutrition in patients in PD. Future research to assess the association of GLIM criteria with clinical outcomes is needed.
{"title":"Comparison Between Global Leadership Initiative on Malnutrition Criteria and Protein-Energy Wasting in Patients With Kidney Failure Undergoing Peritoneal Dialysis","authors":"Gabriela Leal-Escobar MNA , Annabel Biruete PhD , Karla Berenice Cano-Escobar MD , Magdalena Madero MD , Ivan Armando Osuna-Padilla PhD","doi":"10.1053/j.jrn.2025.01.006","DOIUrl":"10.1053/j.jrn.2025.01.006","url":null,"abstract":"<div><h3>Objective</h3><div>Protein-energy wasting (PEW) is the chronic kidney disease-specific diagnosis encompassing malnutrition. PEW is associated with adverse outcomes<span>, including those receiving peritoneal dialysis (PD). Identifying PEW requires accurate methods to improve diagnosis. The Global Leadership Initiative on Malnutrition (GLIM) criteria is focused on validating a global consensus for malnutrition diagnosis in adults in clinical settings. While the GLIM criteria has been extensively studied in other clinical populations, there is limited evidence about the agreement with PEW in the PD setting. The aim of this study was to assess the agreement, accuracy, sensitivity, and specificity of GLIM criteria in comparison to the malnutrition inflammation score (MIS), a widely used tool to diagnose PEW in patients on dialysis.</span></div></div><div><h3>Methods</h3><div>This was a cross-sectional study of patients undergoing PD. PEW was diagnosed using MIS score. Nutritional assessment<span> was performed to identify malnutrition using GLIM criteria. Phenotypic criteria were assessed using low body mass index, low fat-free mass index, or low muscle strength. Etiology criteria were evaluated using high serum C-reactive protein or reduced food intake. The concordance between GLIM and MIS was evaluated by the Kappa test. A receiver operating characteristic curve was used for identifying area under curve, sensitivity, and specificity of GLIM.</span></div></div><div><h3>Results</h3><div><span>Patients undergoing PD (n = 154) were included in the study. Participants had a median age of 40 (29-51) years and 46.7% were male. PEW/malnutrition was diagnosed using MIS score in 35.3% and in 27.3% using the GLIM criteria. In comparison with MIS (used as the diagnostic reference), the sensitivity of GLIM was 65.8%, specificity 61.6%, and area under curve was 0.63. The weighted Kappa coefficient was (k 0.15, </span><em>P</em> = .02.).</div></div><div><h3>Conclusion</h3><div>GLIM criteria did not perform better than MIS in diagnosing PEW/malnutrition in patients in PD. Future research to assess the association of GLIM criteria with clinical outcomes is needed.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 5","pages":"Pages 682-689"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069215","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}
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 : 2025-09-01Epub Date: 2025-07-17DOI: 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 : 2025-09-01Epub Date: 2025-05-13DOI: 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 : 2025-09-01Epub Date: 2025-05-22DOI: 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 : 2025-09-01Epub Date: 2025-01-25DOI: 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 : 2025-09-01Epub Date: 2024-11-04DOI: 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}
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