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Handheld Dynamometry Testing During Dialysis: Intrarater and Interrater Reliability Study 透析期间的手持式测力测试:内部和内部可靠性研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2025.01.002
Eva Segura-Ortí PhD, PT , Anna Junqué-Jiménez PhD, RN , Valentin Dubuis PT , Maycon M. Reboredo PhD, PT , Vicente Benavent-Caballer PhD, PT , Noemi Valtueña-Gimeno PhD, PT , Fabricio Sciammarella Barros MSc, PT , Daniela Thomé Silva PT , Francisco J. Martinez-Olmos PhD, PT

Objectives

The aim was to assess the intrarater and interrater reliability of the handheld dynamometry testing of lower limb muscles during hemodialysis.

Methods

This is a cross-sectional study including subjects undertaking hemodialysis for at least 3 months. Handheld dynamometer measurements of hip and ankle muscle strength (N) were registered on 4 different occasions, 2 trials by raters A and 2 by raters B, to evaluate the intrarater and interrater reliability. Bland-Altman plots were constructed to examine the agreement between raters by scoring the difference between raters against the mean of both raters’ scores. The intraclass correlation coefficient was used to assess relative intrarater and interrater reliability. Absolute reliability was assessed with the minimal detectable change.

Results

Fifty-six participants (median age, 67 years) data showed high to very high relative reliability (intraclass correlation coefficients 0.75-0.98). Regarding the intrarater absolute reliability, minimal detectable change score 90% confidence interval values ranged from 27.0 to 41.6.5 N (0.14-0.26 N/kg m2) for hip muscles but increased for ankle muscles. Interrater values were wider. The mean difference between trials ranged narrowly across the two-time points for raters A (1.0-19.3 N) and for raters B (1.3 - 11.4 N). The mean difference between raters ranged from 2.4 to 13.5 N. The Bland-Altman plot revealed a systematic bias for raters A in ankle plantar flexion.

Conclusions

The assessment of the hip flexion and abduction strength during dialysis with a handheld dynamometer is reliable and safe. Normalized data provides more reliable results.
目的目的是评估血液透析期间下肢肌肉手持式测力计测试的内部和相互之间的可靠性:这是一项横断面研究,研究对象包括血液透析至少 3 个月的受试者。手持式测力计对髋部和踝部肌肉力量(N)的测量在4个不同场合进行登记,其中2次由评分者A进行,2次由评分者B进行,以评估评分者内部和评分者之间的可靠性。通过将评分者之间的差异与两位评分者评分的平均值进行比较,绘制布兰德-阿尔特曼图来检验评分者之间的一致性。类内相关系数(ICC)用于评估评分者内部和评分者之间的相对可靠性。绝对信度用最小检测变化(MDC)进行评估:56 名参与者(中位年龄 67 岁)的数据显示出较高至非常高的相对可靠性(ICC 为 0.75 至 0.98)。关于评分者内部的绝对可靠性,髋部肌肉的 MDC90 值在 27.0 至 41.6.5 N(0.14 至 0.26 N/Kg m2)之间,但踝部肌肉的 MDC90 值有所增加。评定者之间的差异值更大。评定者 A 和评定者 B 在两个时间点之间的试验平均差异范围较小(分别为 1.0 - 19.3 N 和 1.3 - 11.4 N)。布兰-阿尔特曼曲线图显示,在踝关节跖屈方面,评分员 A 存在系统性偏差。.结论在透析过程中使用手持式测力计评估髋关节屈曲和外展力量是可靠和安全的。归一化数据可提供更可靠的结果。
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引用次数: 0
The Effect of Egg White Meal on Anemia in Patients on Hemodialysis Taking Erythropoietin and Iron Infusion 蛋白餐对服用促红细胞生成素和输注铁剂的血液透析患者贫血的影响
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2024.06.003
Jalal Azmandian MD , Najmeh Shamspour MD , Ali Azmandian MD , Habibeh Ahmadipour MD , Tahereh Alinaghi Langari MD

Objective

Eggs are a useful and cheap food source. We evaluated the effects of egg white meal on anemia in dialysis patients.

Methods

In an open-label, clinical trial, conducted in dialysis centers, 107 hemodialysis patients aged ≥ 18 years with hemoglobin levels below 12 g/dL and requiring treatment with artificial erythropoietin and iron infusion were included in the study. They were divided into a control and an intervention group. The participants in the intervention group consumed an egg white pack (containing 6 egg whites, 96 calories, 24 g protein) as a substitute for meat products 3 days a week for 8 weeks. Finally, changes in serum albumin, hemoglobin, ferritin and iron/total iron-binding capacity, erythropoietin dose, and iron infusion dose were measured.

Results

A total of 107 dialysis patients were studied (55 patients in egg white and 52 in control groups) with the mean age of 54.31 ± 16.35 years and male majority (57.90%). The mean of hemoglobin concentration had no statistically significant difference at baseline (P = .13) and after 4 weeks (P = .48), while after 8 weeks, the mean hemoglobin concentration in the intervention group was significantly higher than the control group (P = .03). Mean of synthetic erythropoietin dose after 4 and 8 weeks was significantly lower in the intervention group compared to the control group (P = .30, P = .001). Lower Erythropoietin Resistance Index values in intervention group were significantly higher than the control group (P = .02).

Conclusion

We observed that consumption of egg whites led to an increase in mean hemoglobin concentration, serum iron, and albumin levels. These results suggest that egg whites could be a useful dietary intervention for dialysis patients with anemia.
物品:鸡蛋是一种有用且廉价的食物来源。我们评估了蛋白粉对透析患者贫血的影响:在透析中心进行的一项开放标签临床试验中,107 名年龄≥18 岁、血红蛋白水平低于 12 g/dL、需要使用人工促红细胞生成素和输注铁剂治疗的血液透析患者参与了研究。他们被分为对照组和干预组。干预组的参与者每周 3 天食用蛋白包(含 6 个蛋白,96 卡路里,24 克蛋白质),以替代肉制品,持续 8 周。最后,测量了血清白蛋白、血红蛋白、铁蛋白和铁/TIBC、促红细胞生成素剂量和铁输注剂量的变化:共有 107 名透析患者接受了研究(蛋白组 55 人,对照组 52 人),平均年龄(54.31±16.35)岁,男性占多数(57.90%)。血红蛋白浓度的平均值在基线(P=0.13)和四周后无显著统计学差异(P=0.48)。(P=0.48),而八周后,干预组的平均血红蛋白浓度明显高于对照组。(4周和8周后,干预组合成促红细胞生成素的平均剂量明显低于对照组(P=0.03)。(P=0.30,P=0.001)干预组的 ERI 值明显低于对照组。(P=0.02)结论:我们观察到,食用蛋清会导致平均血红蛋白浓度、血清铁和白蛋白水平的增加。这些结果表明,蛋清可作为贫血透析患者的有效饮食干预。
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引用次数: 0
Association of Protein Intake With Discordance Between Cystatin C- and Creatinine-Based Estimated Glomerular Filtration Rates in Community-dwelling Japanese Adults 在日本社区居住的成年人中,蛋白质摄入与胱抑素C和肌酐为基础的eGFR不一致的关系
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2024.12.007
Keiko Kabasawa MD, MPH, PhD , Ribeka Takachi PhD, RD , Michihiro Hosojima MD, PhD , Tomoyo Komata RD , Kazutoshi Nakamura MD , Norie Sawada MD, PhD , Shoichiro Tsugane MD, PhD , Yumi Ito MD, PhD , Junta Tanaka MD, PhD , Ichiei Narita MD, PhD , Kunihiro Matsushita MD, PhD

Objective

Recent studies have reported the prognostic implications of the discordance between creatinine-based and cystatin C-based estimated glomerular filtration rates (eGFRcr and eGFRcys, respectively); however, the associations of protein intake with the eGFR discordance have not been investigated. The present study investigated whether protein intake was associated with the discordance between eGFRcr and eGFRcys.

Design and Methods

We cross-sectionally analyzed data from a Japanese community-based cohort including 6,143 participants (50.7% women; age range, 40-97 years). Protein intake was estimated by food groups derived from a validated food frequency questionnaire. As a measure of discordance, we modeled the ratio of eGFRcys and eGFRcr (eGFRcys divided by eGFRcr) continuously in multivariable linear regression models and categorically (<0.8, 0.8-1.1, and ≥1.2) in multinomial logistic regression models. We analyzed men and women separately given their distinct dietary patterns.

Results

The mean eGFR ratio was 1.15 in men and 1.19 in women. In multivariable linear regression analysis, total protein was positively associated with the eGFR ratio in men (regression coefficient, 0.005 [95% confidence interval, 0.003, 0.007]). When animal and plant proteins were analyzed separately, a significant positive association was seen for animal protein only in men (0.005 [0.003, 0.007]). The results were similar when we modeled protein intake categorically by multinomial logistic regression.

Conclusion

This study suggests intake of dietary protein, especially animal protein in men, as a determinant of eGFR discordance. Future studies exploring eGFR discordance and health outcomes should consider simultaneously assessing dietary protein intake.
目的:最近的研究报道了基于肌酐和基于胱抑素c的估计肾小球滤过率(分别为eGFRcr和eGFRcys)之间不一致的预后意义;然而,蛋白质摄入与eGFR不一致的关系尚未被调查。本研究调查了蛋白质摄入是否与eGFRcr和eGFRcys之间的不一致有关。设计和方法:我们横断面分析来自日本社区队列的数据,包括6143名参与者(50.7%为女性;年龄范围:40-97岁。蛋白质的摄入量是根据一份经过验证的食物频率问卷,通过食物组来估计的。作为不一致性的度量,我们在多变量线性回归模型和分类模型中连续建模eGFRcys和eGFRcr的比率(eGFRcys除以eGFRcr)(结果:男性的平均eGFR比率为1.15,女性为1.19)。在多变量线性回归分析中,男性总蛋白与eGFR呈正相关(回归系数为0.005 [95% CI, 0.003, 0.007])。当分别分析动物蛋白和植物蛋白时,仅在男性中发现动物蛋白有显著的正相关(0.005[0.003,0.007])。当我们用多项逻辑回归对蛋白质摄入量进行分类建模时,结果是相似的。结论:本研究提示膳食蛋白质,尤其是动物蛋白的摄入是eGFR不一致的决定因素。未来探索eGFR不一致和健康结果的研究应考虑同时评估膳食蛋白质摄入量。
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引用次数: 0
Diet Quality, Self-Efficacy, and Health Literacy in Adults With Chronic Kidney Disease: A Cross-Sectional Study 慢性肾病成人的饮食质量、自我效能感和健康素养:一项横断面研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2024.06.005
Erynn A. McAuley BNutDiet(Hons) , Lynda A. Ross PhD , Mary T. Hannan-Jones PhD , Helen L. MacLaughlin PhD

Objective

Adherence to high-quality dietary patterns is associated with lower risk of disease progression and all-cause mortality in chronic kidney disease (CKD). Self-efficacy and health literacy are recognized as factors that may lead to better adherence to high-quality diets. However, these associations are not well studied in CKD. This study aims to explore the relationship between health literacy, self-efficacy, and diet quality in CKD.

Methods

Participants with CKD stages 3a-5 recruited from 3 large tertiary hospitals were assessed using the Self-Efficacy for Managing Chronic Disease 6-item scale, the Health Literacy Questionnaire, and the Australian Eating Survey Food Frequency Questionnaire. Diet quality was measured using the Australian Recommended Food Score. Associations were examined using multivariable linear regression models, adjusted for sex and type 2 diabetes diagnosis.

Results

Sixty participants were included in the analysis. Mean age of participants was 74.5 years and 58% were male. The mean Australian Recommended Food Score was poor (mean = 29.9 ± 9.1/73) and characterized by high intake of Processed foods and animal protein, and low intake of fruit and vegetables. Mean Self-Efficacy for Managing Chronic Disease 6-item scale was high (7.12 ± 2.07/10). Self-efficacy and health literacy domains 6 - Actively engage with healthcare providers and 7 - Navigating healthcare system independently predicted diet quality in the adjusted model for sex and type 2 diabetes.

Conclusion

Adults with CKD report suboptimal diet quality. The results suggest that self-efficacy and aspects of health literacy should be considered when designing interventions aimed at improving diet quality in people with CKD.
目的:坚持优质饮食模式与降低慢性肾脏病(CKD)的疾病进展风险和全因死亡率有关。自我效能感和健康素养被认为是可能导致更好地坚持优质饮食的因素。然而,这些关联在 CKD 中并没有得到很好的研究。本研究旨在探讨 CKD 患者的健康素养、自我效能感和饮食质量之间的关系:从三家大型三甲医院招募的 CKD 3a-5 期患者使用管理慢性疾病自我效能 6 项量表 (SEMCD-6)、健康素养问卷 (HLQ) 和澳大利亚饮食调查 (AES) 食物频率问卷进行评估。饮食质量采用澳大利亚推荐食物评分(ARFS)进行测量。采用多变量线性回归模型对相关性进行了研究,并对性别和2型糖尿病(T2D)诊断进行了调整:60名参与者参与了分析。参与者的平均年龄为 74.5 岁,58% 为男性。平均ARFS较差(Mean=29.9±9.1/73),特点是加工食品和动物蛋白摄入量高,水果和蔬菜摄入量低。SEMCD-6平均值较高(7.12±2.07/10)。在性别和 T2D 调整模型中,自我效能和健康素养领域 6 - 积极与医疗保健提供者接触和 7 - 医疗保健系统导航可独立预测饮食质量:结论:患有慢性肾脏病的成年人的饮食质量欠佳。结果表明,在设计旨在改善慢性肾脏病患者饮食质量的干预措施时,应考虑自我效能和健康素养的各个方面。
{"title":"Diet Quality, Self-Efficacy, and Health Literacy in Adults With Chronic Kidney Disease: A Cross-Sectional Study","authors":"Erynn A. McAuley BNutDiet(Hons) ,&nbsp;Lynda A. Ross PhD ,&nbsp;Mary T. Hannan-Jones PhD ,&nbsp;Helen L. MacLaughlin PhD","doi":"10.1053/j.jrn.2024.06.005","DOIUrl":"10.1053/j.jrn.2024.06.005","url":null,"abstract":"<div><h3>Objective</h3><div>Adherence to high-quality dietary patterns is associated with lower risk of disease progression and all-cause mortality in chronic kidney disease (CKD). Self-efficacy and health literacy are recognized as factors that may lead to better adherence to high-quality diets. However, these associations are not well studied in CKD. This study aims to explore the relationship between health literacy, self-efficacy, and diet quality in CKD.</div></div><div><h3>Methods</h3><div>Participants with CKD stages 3a-5 recruited from 3 large tertiary hospitals were assessed using the Self-Efficacy for Managing Chronic Disease 6-item scale, the Health Literacy Questionnaire, and the Australian Eating Survey Food Frequency Questionnaire. Diet quality was measured using the Australian Recommended Food Score. Associations were examined using multivariable linear regression models, adjusted for sex and type 2 diabetes diagnosis.</div></div><div><h3>Results</h3><div>Sixty participants were included in the analysis. Mean age of participants was 74.5 years and 58% were male. The mean Australian Recommended Food Score was poor (mean = 29.9 ± 9.1/73) and characterized by high intake of Processed foods and animal protein, and low intake of fruit and vegetables. Mean Self-Efficacy for Managing Chronic Disease 6-item scale was high (7.12 ± 2.07/10). Self-efficacy and health literacy domains 6 - Actively engage with healthcare providers and 7 - Navigating healthcare system independently predicted diet quality in the adjusted model for sex and type 2 diabetes.</div></div><div><h3>Conclusion</h3><div>Adults with CKD report suboptimal diet quality. The results suggest that self-efficacy and aspects of health literacy should be considered when designing interventions aimed at improving diet quality in people with CKD.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 3","pages":"Pages 410-418"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428129","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}
引用次数: 0
The Development and Testing of an Educational Video for Patients With End Stage Kidney Disease Receiving Dialysis in Two Tertiary Hospitals in Cape Town 为开普敦两家三级医院接受透析治疗的终末期肾病患者制作和测试教育视频。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2024.12.008
Hannelise Rademan BSc Diet, MSc (Therapeutic Nutrition) (RDSA) , Zarina Ebrahim BSc Diet, MSc (Dietetics and Nutrition), PhD (Nutrition) (SA) , Nazeema Esau MSc (Dietetics and Nutrition) (SA)

Objectives

Medical nutrition therapy plays a crucial role in managing end-stage kidney disease. Nutrition education should be comprehensible, positive, and actionable. Storytelling can provide context, aid comprehension and retention of new information, and foster a sense of connection among patients. The study aimed to develop a video based on the “Healthy Eating in Kidney Disease” infographic and to test the knowledge of patients before and after watching the video. The study investigated the association between factors such as the number of years receiving dialysis, income, and education level on pre- and postvideo scores.

Methods

This experimental before–after study developed an animated nutrition education video based on the South African–based infographic “Healthy Eating for Kidney Disease” in collaboration with an animator and the researchers. The video was designed in animated format in English, Afrikaans, and isiXhosa. The developed video was used to test participants’ knowledge by using the same questionnaire before and after watching the video.

Results

The developed video was tested on 125 participants undergoing peritoneal dialysis or hemodialysis. Participants had a mean age of 42.06 (±standard deviation 10.99) years. Predominantly, participants used isiXhosa (n = 62, 50.8%) as their primary language, followed by Afrikaans and English. Most participants (65.6%; n = 82) exhibited adequate prevideo knowledge scores, with a mean score of 67.73%. Postvideo, the majority (59.2%; n = 74) achieved good knowledge scores with a mean of 82.32%. Noteworthy improvements were observed in knowledge categories postintervention, reflecting a significant positive change (P < .001), with a mean increase of 14.59%.

Conclusion

The educational animated video for end-stage kidney disease patients was successfully developed and tested. The results indicated the video's effectiveness in enhancing participants' knowledge. Although no correlations emerged between knowledge scores and demographic factors, the study suggests that video-based education holds promise in encouraging behavioural changes and improving health outcomes.
目的:医学营养治疗在治疗终末期肾脏疾病中起着至关重要的作用。营养教育应该是可理解的、积极的和可操作的。讲故事可以提供背景,帮助理解和保留新信息,并培养患者之间的联系感。本研究的目的是根据“肾脏疾病的健康饮食”信息图制作视频,并测试患者在观看视频前后的知识水平。该研究调查了接受透析治疗的年数、收入和教育水平等因素对视频前后评分的影响。方法:与动画师和研究人员合作,这项实验前后研究开发了一个动画营养教育视频,该视频基于南非的信息图表“健康饮食治疗肾病”。该视频以动画形式设计,使用英语、南非荷兰语和南非语。制作的视频被用来测试参与者在观看视频之前和之后使用相同的问卷。结果:开发的视频在125名接受腹膜透析或血液透析的参与者中进行了测试。参与者的平均年龄为42.06岁(±标准差10.99)岁。参与者主要使用伊西科萨语(n = 62, 50.8%)作为主要语言,其次是南非荷兰语和英语。大多数参与者(65.6%;N = 82)表现出足够的视频前知识得分,平均得分为67.73%。后视频,占多数(59.2%);N = 74)知识得分较好,平均为82.32%。干预后的知识类别有显著改善,反映出显著的正变化(P < 0.001),平均增加14.59%。结论:研制成功了终末期肾病患者教育动画视频。结果表明,视频在提高参与者的知识方面是有效的。虽然知识得分和人口因素之间没有相关性,但研究表明,基于视频的教育在鼓励行为改变和改善健康结果方面有希望。
{"title":"The Development and Testing of an Educational Video for Patients With End Stage Kidney Disease Receiving Dialysis in Two Tertiary Hospitals in Cape Town","authors":"Hannelise Rademan BSc Diet, MSc (Therapeutic Nutrition) (RDSA) ,&nbsp;Zarina Ebrahim BSc Diet, MSc (Dietetics and Nutrition), PhD (Nutrition) (SA) ,&nbsp;Nazeema Esau MSc (Dietetics and Nutrition) (SA)","doi":"10.1053/j.jrn.2024.12.008","DOIUrl":"10.1053/j.jrn.2024.12.008","url":null,"abstract":"<div><h3><strong>Objectives</strong></h3><div>Medical nutrition therapy plays a crucial role in managing end-stage kidney disease. Nutrition education should be comprehensible, positive, and actionable. Storytelling can provide context, aid comprehension and retention of new information, and foster a sense of connection among patients. The study aimed to develop a video based on the “Healthy Eating in Kidney Disease” infographic and to test the knowledge of patients before and after watching the video. The study investigated the association between factors such as the number of years receiving dialysis, income, and education level on pre- and postvideo scores.</div></div><div><h3><strong>Methods</strong></h3><div>This experimental before–after study developed an animated nutrition education video based on the South African–based infographic “Healthy Eating for Kidney Disease” in collaboration with an animator and the researchers. The video was designed in animated format in English, Afrikaans, and isiXhosa. The developed video was used to test participants’ knowledge by using the same questionnaire before and after watching the video.</div></div><div><h3><strong>Results</strong></h3><div>The developed video was tested on 125 participants undergoing peritoneal dialysis or hemodialysis. Participants had a mean age of 42.06 (±standard deviation 10.99) years. Predominantly, participants used isiXhosa (n = 62, 50.8%) as their primary language, followed by Afrikaans and English. Most participants (65.6%; n = 82) exhibited adequate prevideo knowledge scores, with a mean score of 67.73%. Postvideo, the majority (59.2%; n = 74) achieved good knowledge scores with a mean of 82.32%. Noteworthy improvements were observed in knowledge categories postintervention, reflecting a significant positive change (<em>P</em> &lt; .001), with a mean increase of 14.59%.</div></div><div><h3>Conclusion</h3><div>The educational animated video for end-stage kidney disease patients was successfully developed and tested. The results indicated the video's effectiveness in enhancing participants' knowledge. Although no correlations emerged between knowledge scores and demographic factors, the study suggests that video-based education holds promise in encouraging behavioural changes and improving health outcomes.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 3","pages":"Pages 425-432"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967378","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}
引用次数: 0
Nutritional Status Modifies the Association Between Hemoglobin Level and Mortality in Older Patients Undergoing Hemodialysis: A Nationwide Dialysis Registry in Japan 营养状况改变了接受血液透析的老年患者血红蛋白水平和死亡率之间的关系:日本全国透析登记
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2025.01.003
Takaaki Kosugi MD, PhD , Takeshi Hasegawa MD, MPH, PhD , Takahiro Imaizumi MD, PhD , Hiroki Nishiwaki MD, MPH, PhD , Hirokazu Honda MD, PhD , Yasuhiko Ito MD, PhD , Kazuhiko Tsuruya MD, PhD , Masanori Abe MD, PhD , Norio Hanafusa MD, PhD , Takahiro Kuragano MD, PhD

Objectives

Anemia is a common complication associated with adverse outcomes in older patients undergoing hemodialysis (HD). They also tend to experience malnutrition, which can affect the course of anemia. We hypothesized that the optimal hemoglobin (Hb) level varies depending on nutritional status in older patients undergoing HD and aimed to investigate the association between Hb levels and mortality according to nutritional status.

Methods

This is an observational study utilizing a nationwide Japanese database from 2019 to 2021. This study included 95,771 patients aged ≥75 years undergoing HD thrice a week. The nutritional risk index for Japanese hemodialysis patients (NRI-JH) was calculated. The association between Hb levels and mortality was investigated using Cox regression analysis stratified by NRI-JH. A nonlinear relationship was investigated using restricted cubic spline analysis.

Results

During a median follow-up period of 24 months, 27,611 patients died. In the low-risk NRI-JH group, the risk of all-cause mortality was higher in the Hb categories of <9.0, 9.0-9.9, and ≥13 g/dL compared to the reference Hb category of 10-10.9 g/dL, with the adjusted hazard ratios and 95% confidence intervals of 1.45 (1.32-1.59), 1.15 (1.08-1.22), and 1.18 (1.07-1.29), respectively. In contrast, the impact of Hb levels on mortality was significantly attenuated in the high-risk NRI-JH group, with a mild increased risk in the <9.0 g/dL category (adjusted hazard ratio, 1.07; 95% confidence interval, 1.01-1.15).

Conclusion

Among older patients undergoing HD, the impact of Hb levels on mortality was attenuated in the high-risk NRI-JH group.
目的:贫血是老年血液透析(HD)患者的常见并发症。他们还容易出现营养不良,这可能会影响贫血的病程。我们假设老年HD患者的最佳血红蛋白(Hb)水平取决于营养状况,并旨在根据营养状况调查Hb水平与死亡率之间的关系。方法:这是一项观察性研究,利用2019年至2021年日本全国数据库。这项研究包括95,771例年龄≥75岁的患者,每周接受三次HD治疗。计算日本血透患者营养风险指数(NRI-JH)。采用NRI-JH分层的Cox回归分析研究Hb水平与死亡率之间的关系。利用限制三次样条分析研究了两者之间的非线性关系。结果:在24个月的中位随访期间,27,611例患者死亡。结论:在老年HD患者中,高危NRI-JH组Hb水平对死亡率的影响减弱。
{"title":"Nutritional Status Modifies the Association Between Hemoglobin Level and Mortality in Older Patients Undergoing Hemodialysis: A Nationwide Dialysis Registry in Japan","authors":"Takaaki Kosugi MD, PhD ,&nbsp;Takeshi Hasegawa MD, MPH, PhD ,&nbsp;Takahiro Imaizumi MD, PhD ,&nbsp;Hiroki Nishiwaki MD, MPH, PhD ,&nbsp;Hirokazu Honda MD, PhD ,&nbsp;Yasuhiko Ito MD, PhD ,&nbsp;Kazuhiko Tsuruya MD, PhD ,&nbsp;Masanori Abe MD, PhD ,&nbsp;Norio Hanafusa MD, PhD ,&nbsp;Takahiro Kuragano MD, PhD","doi":"10.1053/j.jrn.2025.01.003","DOIUrl":"10.1053/j.jrn.2025.01.003","url":null,"abstract":"<div><h3>Objectives</h3><div>Anemia is a common complication associated with adverse outcomes in older patients undergoing hemodialysis (HD). They also tend to experience malnutrition, which can affect the course of anemia. We hypothesized that the optimal hemoglobin (Hb) level varies depending on nutritional status in older patients undergoing HD and aimed to investigate the association between Hb levels and mortality according to nutritional status.</div></div><div><h3>Methods</h3><div>This is an observational study utilizing a nationwide Japanese database from 2019 to 2021. This study included 95,771 patients aged ≥75 years undergoing HD thrice a week. The nutritional risk index for Japanese hemodialysis patients (NRI-JH) was calculated. The association between Hb levels and mortality was investigated using Cox regression analysis stratified by NRI-JH. A nonlinear relationship was investigated using restricted cubic spline analysis.</div></div><div><h3>Results</h3><div>During a median follow-up period of 24 months, 27,611 patients died. In the low-risk NRI-JH group, the risk of all-cause mortality was higher in the Hb categories of &lt;9.0, 9.0-9.9, and ≥13 g/dL compared to the reference Hb category of 10-10.9 g/dL, with the adjusted hazard ratios and 95% confidence intervals of 1.45 (1.32-1.59), 1.15 (1.08-1.22), and 1.18 (1.07-1.29), respectively. In contrast, the impact of Hb levels on mortality was significantly attenuated in the high-risk NRI-JH group, with a mild increased risk in the &lt;9.0 g/dL category (adjusted hazard ratio, 1.07; 95% confidence interval, 1.01-1.15).</div></div><div><h3>Conclusion</h3><div>Among older patients undergoing HD, the impact of Hb levels on mortality was attenuated in the high-risk NRI-JH group.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 3","pages":"Pages 443-453"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048762","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}
引用次数: 0
Effects of Ketoanalogue Supplements on Patients Receiving Continuous Ambulatory Peritoneal Dialysis: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Study 酮类补充剂对接受连续动态腹膜透析的患者的影响:一项多中心、随机、双盲、安慰剂对照研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-05-01 DOI: 10.1053/j.jrn.2024.11.010
Sixiu Chen , Li Fan , Yagui Qiu , Nan Chen , Jianghua Chen , Zhangsuo Liu , Fei Xiong , Qingfeng Han , Haiping Mao , Jianxiong Lin , Wei Chen , Xueqing Yu

Objectives

Evidence of the effects of ketoanalogue supplements on residual kidney function (RKF) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is limited. This study aimed to evaluate the efficacy and safety of ketoanalogues in preserving RKF in CAPD patients.

Methods

This 1-year multicenter, randomized, double-blinded, placebo (PBO)-controlled trial involved 153 CAPD patients across 6 centers. Patients were randomly assigned to either the keto acid (KA, 100 mg/kg per day) or PBO group, both with a protein intake of 1.0 g/kg ideal body weight. The primary outcome was the changes in RKF, evaluated based on 24-hour creatinine and urea clearance, and secondary outcomes included dialysis adequacy, peritoneal function, nutritional status, and quality-of-life scores.

Results

The decline in RKF was 1.89 (0.44, 2.98) and 1.56 (0.35, 3.14) mL/min/1.73 m2 in the KA and PBO groups, respectively, with no difference observed (P = .89). There were no differences in dialysis adequacy, peritoneal function, nutritional status, or quality-of-life scores between the groups. In subgroup analyses, for patients with early peritoneal dialysis (PD) initiation, patients in the KA group had a significantly lower decline in RKF compared with the PBO group (1.34 vs. 4.79 mL/min/1.73 m2, P = .02); however, there is no significant difference between the groups in patients with late PD initiation (1.89 vs. 1.23 mL/min/1.73 m2, P = .17).

Conclusions

Ketoanalogues did not reduce the decline in RKF on the basis of a protein-restricted diet in patients receiving CAPD; however, its effect on patients with early PD initiation needs further investigation.
背景:酮类补充剂对持续动态腹膜透析(CAPD)患者残余肾功能(RKF)影响的证据有限。本研究旨在评估酮类药物在CAPD患者中保存RKF的有效性和安全性。方法:这项为期1年的多中心、随机、双盲、安慰剂对照试验涉及6个中心的153名CAPD患者。患者被随机分配到酮酸组(KA,每天100 mg/kg)或安慰剂组(PBO),两组的蛋白质摄入量均为1.0 g/kg理想体重。主要结局是RKF的变化,基于24小时肌酐和尿素清除率进行评估,次要结局包括透析充分性、腹膜功能、营养状况和生活质量评分。结果:KA组和PBO组RKF分别下降1.89(0.44,2.98)和1.56 (0.35,3.14)mL/min/1.73 m2,差异无统计学意义(p = 0.89)。两组之间在透析充分性、腹膜功能、营养状况或生活质量评分方面没有差异。在亚组分析中,对于早期腹膜透析(PD)开始的患者,KA组患者的RKF下降明显低于PBO组(1.34 vs. 4.79 mL/min/1.73 m2, p = 0.02);然而,PD起始时间较晚的患者,两组间无显著差异(1.89 vs 1.23 mL/min/1.73 m2, p = 0.17)。结论:在接受CAPD的患者中,酮类似物并没有减少基于蛋白质限制饮食的RKF下降;然而,其对早期PD患者的影响有待进一步研究。
{"title":"Effects of Ketoanalogue Supplements on Patients Receiving Continuous Ambulatory Peritoneal Dialysis: A Multicenter, Randomized, Double-Blinded, Placebo-Controlled Study","authors":"Sixiu Chen ,&nbsp;Li Fan ,&nbsp;Yagui Qiu ,&nbsp;Nan Chen ,&nbsp;Jianghua Chen ,&nbsp;Zhangsuo Liu ,&nbsp;Fei Xiong ,&nbsp;Qingfeng Han ,&nbsp;Haiping Mao ,&nbsp;Jianxiong Lin ,&nbsp;Wei Chen ,&nbsp;Xueqing Yu","doi":"10.1053/j.jrn.2024.11.010","DOIUrl":"10.1053/j.jrn.2024.11.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Evidence of the effects of ketoanalogue supplements on residual kidney function (RKF) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is limited. This study aimed to evaluate the efficacy and safety of ketoanalogues in preserving RKF in CAPD patients.</div></div><div><h3>Methods</h3><div>This 1-year multicenter, randomized, double-blinded, placebo (PBO)-controlled trial involved 153 CAPD patients across 6 centers. Patients were randomly assigned to either the keto acid (KA, 100 mg/kg per day) or PBO group, both with a protein intake of 1.0 g/kg ideal body weight. The primary outcome was the changes in RKF, evaluated based on 24-hour creatinine and urea clearance, and secondary outcomes included dialysis adequacy, peritoneal function, nutritional status, and quality-of-life scores.</div></div><div><h3>Results</h3><div>The decline in RKF was 1.89 (0.44, 2.98) and 1.56 (0.35, 3.14) mL/min/1.73 m<sup>2</sup> in the KA and PBO groups, respectively, with no difference observed (<em>P</em> = .89). There were no differences in dialysis adequacy, peritoneal function, nutritional status, or quality-of-life scores between the groups. In subgroup analyses, for patients with early peritoneal dialysis (PD) initiation, patients in the KA group had a significantly lower decline in RKF compared with the PBO group (1.34 vs. 4.79 mL/min/1.73 m<sup>2</sup>, <em>P</em> = .02); however, there is no significant difference between the groups in patients with late PD initiation (1.89 vs. 1.23 mL/min/1.73 m<sup>2</sup>, <em>P</em> = .17).</div></div><div><h3>Conclusions</h3><div>Ketoanalogues did not reduce the decline in RKF on the basis of a protein-restricted diet in patients receiving CAPD; however, its effect on patients with early PD initiation needs further investigation.</div></div>","PeriodicalId":50066,"journal":{"name":"Journal of Renal Nutrition","volume":"35 3","pages":"Pages 463-471"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803130","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}
引用次数: 0
Low Skeletal Muscle Density Assessed by Abdominal Computerized Tomography Predicts Outcome in Children With Chronic Kidney Disease 腹部计算机断层扫描评估的低骨骼肌密度可预测慢性肾病患儿的预后。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-03-01 DOI: 10.1053/j.jrn.2024.11.003
Meiqiu Wang MD , Zijian Chen BS , Tingting Yu MS , Lianghui You MD , Yingchao Peng MD , Huangyu Chen MS , Pei Zhang MD , Zhuo Shi MS , Xiang Fang MD , LiLi Jia BS , Zhengkun Xia MD , Chenbo Ji PhD, MD , Hao Tang MS , Chunlin Gao MD

Objectives

Skeletal muscle loss and abnormal fat distribution are predictors of poor clinical outcomes in adults with chronic kidney disease (CKD). However, the relationship between body composition (muscle mass and adipose tissue) and prognosis in children with CKD has not been well elucidated.

Methods

The retrospective single-center study enrolled children with CKD and healthy group who underwent an abdominal computerized tomography examination and compared the body composition of the third lumbar spine (L3) between the 2 groups. We defined the primary outcome as hemodialysis, peritoneal dialysis, kidney transplantation, or death. Logistic regression analysis was applied to assess the connection between low skeletal muscle density (SMD) and clinical and demographic variables. Multivariate Cox regression analysis was used to evaluate the risk factors for progression to the primary outcome. Kaplan-Meier survival analysis was performed to compare the effect of different body composition on event-free survival rate.

Results

Thirty-two patients with CKD [estimated glomerular filtration rate: 14.89 (8.86, 29.88) (mL/min/1.73 m2)] and 66 heathy subjects [estimated glomerular filtration rate: 135.72 (121.70, 161.29) (mL/min/1.73 m2)] were recruited in our study. From the assessment of body composition assessed by computerized tomography, skeletal muscle area, SMD, and skeletal muscle index in the CKD group was lower than those in the healthy group (P < .05). On the other hand, visceral fat area and visceral fat index in the CKD group were significantly higher than those in the healthy group (P < .05). In logistic regression analysis, triglyceride (odds ratio: 8.635, 95% confidence interval (CI): 1.153-64.687) was independently associated with low SMD. After adjusting clinical data and body composition, high serum albumin (hazard ratio: 0.873, 95% CI: 0.798-0.955) and high SMD (hazard ratio: 0.895, 95% CI: 0.822-0.974) were protective factors for delaying renal failure. Based on the Kaplan-Meier analysis, only the group with low SMD had lower event-free survival in comparison to the reference group (P < .05).

Conclusions

These findings suggest that there is significant skeletal muscle loss and decrease in SMD in CKD children. Notably, low SMD is indicative of poor prognosis in CKD children.
目的:骨骼肌减少和脂肪分布异常是慢性肾脏病(CKD)成人不良临床预后的预测因素。然而,儿童慢性肾脏病患者的身体成分(肌肉质量和脂肪组织)与预后之间的关系尚未得到很好的阐明:这项回顾性单中心研究招募了接受腹部计算机断层扫描(CT)检查的 CKD 患儿和健康组患儿,并比较了两组患儿第三腰椎(L3)的身体成分。我们将主要结果定义为血液透析、腹膜透析、肾移植或死亡。我们采用逻辑回归分析来评估低骨骼肌密度(SMD)与临床和人口统计学变量之间的联系。多变量 Cox 回归分析用于评估进展为主要结果的风险因素。卡普兰-梅耶生存分析用于比较不同身体成分对无事件生存率的影响:研究共招募了 32 名慢性肾脏病患者[eGFR:14.89(8.86, 29.88) (mL/min/1.73m2)] 和 66 名健康人[eGFR:135.72(121.70, 161.29) (mL/min/1.73m2)] 。通过 CT 对身体成分进行评估,CKD 组的骨骼肌面积、SMD 和骨骼肌指数(SMI)均低于健康组(PConclusions:这些研究结果表明,CKD 儿童的骨骼肌明显减少,SMD 也有所下降。值得注意的是,低SMD表明慢性肾脏病儿童预后不良。
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引用次数: 0
Application of ChatGPT to Support Nutritional Recommendations for Dialysis Patients: Comment 应用 ChatGPT 支持透析患者的营养建议:评论。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-03-01 DOI: 10.1053/j.jrn.2024.11.006
Hinpetch Daungsupawong, Viroj Wiwanitkit
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引用次数: 0
Author's Reply to the Letter to the Editor: Is the “Nutritional Risk Index for Japanese Hemodialysis” Validated as a Nutritional and Prognostic Indicator? 日本血液透析营养风险指数 "作为营养和预后指标是否有效?
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2025-03-01 DOI: 10.1053/j.jrn.2024.12.004
Katsuhito Mori MD, PhD, Yosuke Yamamoto MD, PhD, Norio Hanafusa MD, PhD, Suguru Yamamoto MD, PhD, Shingo Fukuma MD, PhD, Yoshihiro Onishi PhD, Masanori Emoto MD, PhD, Masaaki Inaba MD, PhD
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引用次数: 0
期刊
Journal of Renal Nutrition
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