Markers In Hemodialysis Patients Research Articles

The impact of flaxseed oil on lipid profiles, weight loss, and inflammatory markers in hemodialysis patients: A systematic review and meta-analysis of randomized controlled trials.

Studies investigating the effects of flaxseed oil on lipid profiles, weight loss, and inflammatory markers have produced inconsistent results. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to explore the impact of flaxseed oil on these parameters in hemodialysis patients. The study protocol was registered online (PROSPERO number: CRD42023484076). The meta-analyses showed a significant decrease in triglyceride (TG) levels (WMD = -85.78 mg/dL, 95% CI: -155.24 to -16.32, I2 = 98.32%) and C-reactive protein (CRP) levels (WMD = -2.66 mg/L, 95% CI: -4.07 to -1.24, I2 = 92.26%) following consumption of flaxseed oil. Subgroup analyses revealed significant changes in LDL-C, HDL-C, and TC levels only in trials utilizing a dosage higher than 10 g per day and using ground flaxseed oil. Based on the results, flaxseed oil improves CRP and TG levels, and higher doses positively affect lipid profiles. However, it has no significant effect on anthropometric measures.

Transferrin levels are associated with malnutrition markers in hemodialysis patients in KwaZulu-Natal, South Africa

Introduction Malnutrition is a global phenomenon and may be contributing to the increasing size of the hemodialysis (HD) population in South Africa and is affecting morbidity and clinical outcomes. Our study assessed whether transferrin could be a possible marker for malnutrition in the HD population. Methods Clinical parameters (including skinfold thickness and mid-upper arm circumference [MUAC]) and laboratory markers (including transferrin and hemoglobin) were measured during a six-month period in a sample of 59 HD patients. Results Linear regression analysis showed that MUAC (p = 0.027) as well as skinfold thickness (p = 0.021) had a significant association with transferrin levels within the HD participants. There was no significant association between transferrin levels or MUAC with hemoglobin levels (p = 0.075). Furthermore, the study found that decreased transferrin levels (< 2.15 g/dL to 3.80 g/dL) were closely related to malnutrition in the malnutrition distribution groups within the study, with 97.7% of HD participants being classified in one of the malnutrition groups. Conclusion Thus, transferrin levels are a valuable marker for malnutrition within the HD patient population and can be included along with clinical assessment parameters such as MUAC and skinfold thickness as primary indicators for malnutrition.

The Effect of the Holy Quran Recitation on Inflammatory Markers in Hemodialysis Patients in Iran: A Randomized Clinical Trial.

Increased inflammation is a common complication in chronic hemodialysis (HD) patients. Addressing the psychological symptoms of patients may help reduce inflammation and its negative impact on the body. Considering the calming effects of listening to the Holy Quran, this may help reduce mental, psychological, and physical problems in Muslim patients. The present study sought to examine the effects of listening to Holy Quran recitation on the level of inflammatory markers in HD patients. This was a randomized controlled trial involving 50 HD patients at Kowsar Hospital in Semnan, Iran, in 2019-2020. The participants were divided into experimental and control groups using simple randomization by sealed envelopes. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and interleukin-6 (IL-6) levels in blood were measured before the intervention. The participants in the experimental group listened by headphones to the Holy Quran being recited three times a week, 20 min each time, for one month. For those in the control group, headphones were placed but on silent mode. At the end of the intervention one month later, inflammatory markers were measured again for participants in both groups. Data were analyzed in SPSS-16 using descriptive and inferential statistics (t test, Wilcoxon, and Mann-Whitney U). Mean IL-6 level decreased by 20.2pg/ml, mean ESR level by 16.8mm/hr, and mean CRP level by 19.9mg/dl in the experimental group, while these values increased in the control group. The between-group differences in the intervention and control groups at follow-up were significant for all three inflammatory markers (p < 0.05). Listening to the Holy Quran being recited is recommended as a complementary therapy for reducing systemic inflammation (as indicated by inflammatory markers) in Muslim HD patients.Trial registration: Iranian Registry of Clinical Trials, Trial No: IRCT20120109008665N9. Registered 4 Nov 2019.

Effects of microcapsules with turmeric and green propolis supplementation on inflammatory markers in hemodialysis patients

Effects of microcapsules with turmeric and green propolis supplementation on inflammatory markers in hemodialysis patients

The Association of Neutrophil Lymphocyte Ratio and Glycemic Markers in Hemodialysis Patients

Background/aims: Neutrophil lymphocyte ratio was found to be as an inflammation marker in the preceding decade and recently related with glycemic indices in patients with diabetes mellitus. The target of this research was to explore the association of neutrophil lymphocyte ratio and glycemic indices in hemodialysis population. Methods: 177 hemodialysis patients (98 diabetic and 79 non-diabetic) aged 56.08±16.06 years were enrolled in this research. Neutrophil lymphocyte ratio was calculated and its association with predialysis glucose and HbA1c was studied. Results: NLR was positively correlated with predialysis glucose (p=0.000, r=0.338), body mass index (p=0.029, r=0.220), white blood cell (p=0.000, r=0.430), platelet (p=0.034, r=0.159), neutrophil (p=0.000, r=0.656) and C-reactive protein (p=0.00, r=0.377) levels. In non-diabetic hemodialysis group, predialysis glucose was still correlated with neutrophil lymphocyte ratio (p=0.047, r=0.224). Diabetics had higher predialysis glucose (185.94±81.11 vs 111.24±25.59, p=0.000) and neutrophil lymphocyte ratio (4.99±4.17 vs 2.82±1.23, p=0.000) compared to non-diabetics. Conclusion: This study revealed that predialysis glucose levels in hemodialysis patients are correlated with neutrophil lymphocyte ratio and hemodialysis patients with diabetes have higher neutrophil lymphocyte ratio levels. Neutrophil lymphocyte ratio should be recognized as a glycemic control marker along with traditional glycemic indices in HD patients.

Pulmonary Artery Pressure Status in Hemodialysis Patients and Its Association with Nutritional and Biochemical Markers

Background: The prevalence of pulmonary hypertension (PH) is reported between 17% and 56% in hemodialysis patients. The pathogenesis of PH in hemodialysis patients is still unclear. Malnutrition may be associated with impaired pulmonary function in hemodialysis patients. Objectives: The present study aimed to investigate the association between PH and nutritional and biochemical markers in hemodialysis patients. Methods: In this cross-sectional study, 80 patients undergoing hemodialysis at the Kowsar Medical Center, Semnan, Iran, from 1 March 2016 to 31 August 2016 were enrolled by complete enumeration. Pulmonary artery pressure was determined by echocardiography between hemodialysis sessions. Arm circumference, triceps fat mass, and body mass index (BMI) were determined. Other laboratory tests included transferrin, serum albumin, cholesterol, triglyceride, and hemoglobin. The source of receiving protein was recorded in a questionnaire. The data were analyzed by the chi-square test and logistic regression analysis at a significance level of less than 0.05. Results: Pulmonary hypertension ( &gt; 25 mmHg) was found in 32 (40%) of the 80 patients studied. The mean of pulmonary pressure in patients with PH was 34.66 ± 5.6 mmHg compared to 16.85 ± 3.7 mmHg in patients without PH. Age, gender, arm circumference, frequency of dialysis per year, and serum levels of albumin, transferrin, triglyceride, and total cholesterol were not significantly different between patients with and without PH. There was a significant difference in the mean hemoglobin level between patients with and without PH (P = 0.003). The likelihood of developing PH was reduced by 0.3 in those with hemoglobin ≥ 11 g/dL compared to patients with hemoglobin levels below 11 g/dL (OR = 0.400, P = 0.003). The likelihood of developing PH in patients with albumin ≥ 3.8 g/L decreased by 0.126 compared to those with albumin less than 3.8 (OR = 0.126, P = 0.003). Conclusions: The results of our study indicated a higher incidence of PH in patients with lower levels of hemoglobin and albumin. So, patients undergoing hemodialysis are recommended to be regularly screened for these two variables.

Effect of Coenzyme Q10 Supplementation on Middle Molecules in Hemodialysis Patients: A Randomized Clinical Trial

Background: Middle molecules, including some cytokines such as IL-6 and TNF-α, parathyroid hormone, etc., are types of uremic toxins having roles in the development of inflammation in hemodialysis patients. Different studies evaluating effects of coenzyme Q10 (CoQ10) on different inflammation markers in hemodialysis patients have controversial results. Moreover, no study determined the effect of CoQ10 on plasma concentration of IL-6, the most powerful predictor of poor outcomes and mortality, in hemodialysis patients. Therefore, a study was designed to examine the effects of CoQ10 supplementation on IL-6, TNF-α, and intact parathyroid hormone (iPTH) in chronic hemodialysis patients.&#x0D; Methods: In this single-blind randomized controlled trial, patients undergoing hemodialysis were randomly assigned to CoQ10 (100 mg/day) or control group. The duration of the study was 12 weeks. The plasma concentrations of IL-6, as the primary outcome, and TNF-α and iPTH, as the secondary outcomes, were measured at baseline and week 12.&#x0D; Results: Of 73 enrolled patients, 68 completed the study. At the end of the study, there were no significant differences in the concentrations of IL-6 (p=0.570), TNF-α (p=0.301), and iPTH (p=0.642) between the two groups. The standardized mean difference (CoQ10 vs. control) was -0.13 (95% CI -0.60; 0.35) for IL-6, -0.25 (95% CI -0.73; 0.22) for TNF-α, and 0.11 (95% CI -0.36; 0.59) for iPTH.&#x0D; Conclusion: This study showed a trivial effect of CoQ10 supplementation on the concentrations of IL-6 and iPTH and a small effect on the level of TNF-α in hemodialysis patients.

Association of miR-21-5p with routine biochemical markers and inflammatory cytokines in hemodialysis patients

BackgroundAlthough the role of miR-21-5p in some kidney diseases is relatively documented, the relationship of miR-21-5p with markers of bone metabolism and inflammation in patients receiving hemodialysis (HD) remains unclear. Here, we aim to explore the relationship of miR-21-5p with routine biochemical parameters, mineral bone disorders, and inflammatory markers in HD patients. MethodsSerum miR-21-5p expressions from 60 HD patients and 20 healthy controls were analyzed with qPCR. Bone metabolism-related parameters such as receptor activator of nuclear factor-kappa B ligand (RANKL), osteocalcin, calcium, phosphorus, and parathormone; inflammation-related markers such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, IL-10, and C-reactive protein (CRP); and oxidative stress markers such as total antioxidant status (TAS) and total oxidant status (TOS) were measured in serum samples of HD patients. ResultsWe showed for the first time that miR-21-5p expressions were increased in patients receiving HD. In addition, miR-21-5p expressions showed a significantly positive correlation with bone metabolism markers, i.e. RANKL, osteocalcin, phosphorus, and parathormone, and inflammation markers, i.e. TNF-α, IL-6, and CRP. We detected that areas under the receiver operating characteristic curve for miR-21-5p, RANKL, osteocalcin, TNF-a, IL-6, and oxidative stress index in HD patients were 0.9317, 0.7742, 0.9038, 0.7319, 0.7063, and 0.7738, respectively. ConclusionElevated miR-21-5p expressions are associated with routine biochemical and inflammatory markers in HD patients, suggesting that miR-21-5p might have diagnostic and/or therapeutic importance in the treatment of chronic kidney diseases.

The effect of omega-3 fatty acids and vitamin E supplementation on lipid profiles and inflammatory markers in hemodialysis patients: A systematic review of current literature

&lt;p align="center"&gt;&lt;strong&gt;ABSTRAK &lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Latar Belakang: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Kebutuhan terapi hemodialisis (HD) masih terus berkembang. Di Indonesia, HD mewakili 82% dari pelayanan cuci darah di Puskesmas Indonesia.&lt;/em&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Namun, HD menyebabkan peningkatan penanda inflamasi serta perubahan profil lipid. Kombinasi vitamin E dan asam lemak omega-3 dapat membantu mengurangi indikator inflamasi dan meningkatkan profil lipid.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Tujuan: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Penelitian ini bertujuan untuk mengetahui pengaruh co-suplementasi vitamin E dan omega-3 terhadap profil lipid dan indikator inflamasi.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Metode: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Penelitian ini dilakukan di PubMed dan Google Scholar untuk mencari artikel-artikel secara sistematis, Kriteria inklusi yang digunakan adalah artikel bahasa Inggris dengan uji coba terkontrol acak (RCT) dan uji coba terkontrol (CT) yang menyelidiki efek vitamin E dan omega-3 pada profil lipid dan penanda inflamasi pasien hemodialisis. Semua artikel harus diterbitkan antara September 2013 - September 2022.&lt;/em&gt; &lt;em&gt;AM dan AA melakukan seluruh proses penelitian sebagai reviewer dan seluruh ketidaksetujuan diselesaikan bersama NH sebagai penulis ketiga.&lt;/em&gt;&lt;strong&gt;&lt;em&gt;&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Hasil: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;1020 studi diidentifikasi dari database dan 12 artikel terpilih berdasarkan kriteria inklusi. Asam lemak omega-3 meningkatkan profil lipid, seperti kolesterol, LDL, HDL, dan trigliserida. Namun, studi ini hanya menemukan satu penelitian tentang efek vitamin E pada profil lipid. Asam lemak Omega-3 dan suplementasi vitamin E tidak memiliki efek signifikan pada penanda inflamasi, tetapi dampak suplementasi vitamin E pada tingkat IL-6 telah dilaporkan.&lt;/em&gt;&lt;strong&gt;&lt;em&gt;&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Kesimpulan: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Co-suplementasi&lt;/em&gt;&lt;strong&gt;&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Omega-3 dan vitamin E berpengaruh pada penurunan level indikator inflamasi dan profil lipid pasien hemodialisis. Kami merekomendasikan bahwa studi berikutnya harus berfokus pada penelitian uji klinis mengenai pengaruh suplementasi kombinasi ini terhadap indikator inflamasi dan profil lipid pasien hemodialisis.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;KATA KUNCI&lt;/strong&gt;&lt;strong&gt;&lt;em&gt;: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;hemodialisis; indikator inflamasi; omega-3; profil lipid; vitamin E&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;p align="center"&gt;&lt;strong&gt;ABSTRACT&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Hemodialysis therapy (HD) demands is still growing. In Indonesia, HD represents 82% of dialysis services in Indonesian health centers.&lt;/em&gt;&lt;em&gt; However, HD causes an increase in inflammatory markers as well as lipid profile changes. The combination of vitamin E and omega-3 fatty acids can assist to decrease inflammatory indicators and enhance lipid profiles.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study aims to investigate the effect of co-supplementation of vitamin E and omega-3 on lipid profiles and indicators of inflammation.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;This study was conducted on PubMed and Google Scholar to search articles systematically. The inclusion criteria used were English articles of randomized controlled trials (RCTs) and controlled trials (CT) that investigated the effects of vitamin E and omega-3 on lipid profiles and inflammatory markers of hemodialysis patients. All articles must be published between September 2013 - September 2022.&lt;/em&gt; &lt;em&gt;AM and AA conducted the entire research process as reviewers and all disagreements were finalized with NH as a third author.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;1020 studies were identified from databases. Afterward, this study included 12 articles based on the inclusion criteria. Omega-3 fatty acids improve lipid profiles, such as cholesterol, LDL, HDL, and triglyceride. While we only found a single study about the effect of vitamin E on lipid profile. Furthermore, &lt;/em&gt;&lt;em&gt;omega-3 fatty acids and vitamin E supplementation have no significant effect on inflammatory markers, but the &lt;/em&gt;&lt;em&gt;impact of vitamin E supplementation on IL-6 levels &lt;/em&gt;&lt;em&gt;was&lt;/em&gt;&lt;em&gt; reported&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Co-supplementation of omega-3 and vitamin E decrease levels of inflammatory indicators and lipid profiles in hemodialysis patients. We recommend that future studies should focus on clinical trials to investigate the effect of this co-supplementation on lipid profiles and inflammatory markers of hemodialysis patients.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;KEYWORD&lt;/strong&gt;&lt;strong&gt;&lt;em&gt;: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;hemodialysis; inflammatory markers; lipid profiles; omega-3, vitamin E&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Serum Levels of α-Klotho, Inflammation-Related Cytokines, and Mortality in Hemodialysis Patients.

It has been hypothesized that α-Klotho deficiency might contribute to chronic inflammation in patients with end-stage renal disease (ESRD), especially those on hemodialysis (HD). Serum Klotho levels by some authors are considered a potential predictor of cerebrovascular events. Therefore, we analyzed serum levels of α-Klotho with ELISA and inflammation-related cytokines in HD patients. Sixty-seven HD patients and 19 healthy people were recruited between November 2017 and June 2021. A Cytometric Bead Array (CBA) was used to determine the level of different cytokines: IL-12p70, TNF, IL-10, IL-6, IL-1β, and IL-8. A human Klotho ELISA kit was used to determine the level of α-Klotho in the plasma samples of HD patients. There was no difference in serum levels of α-Klotho between HD patients and healthy people. Patients had increased serum IL-6 and IL-8. Significant positive correlations existed between the concentration of α-Klotho and the serum concentrations of IL-12p70, IL-10, and IL-1β. However, in a multivariable linear regression analysis, only patients' age was associated independently with α-Klotho level. Serum α-Klotho was not associated with higher mortality risk in HD patients. While these results draw attention to potential relationships between α-Klotho proteins and inflammatory markers in HD patients, our cross-sectional study could not confirm the pathogenic link between α-Klotho, inflammation, and cardiovascular mortality.

Serum Intact and Total Fibroblast Growth Factor 23 Levels and Iron-related Parameters in Hemodialysis Patients

Objective: Fibroblast growth factor (FGF)23 suppresses erythropoiesis and is implicated in iron metabolism. It was investigated whether high levels of FGF23 was associated with hepcidin levels of iron metabolism markers in hemodialysis patients. Methods: The serum hepcidin, erythroferrone, and intact-FGF23 or total-FGF23 level as well as iron-related parameters at pre-dialysis in 70 hemodialysis (HD) patients was measured and performed a regression analysis. Results: Each measurement for FGF23, including the intact-/total-FGF23 ratio, correlated strongly with both serum inorganic phosphate and calcium-phosphate product concentrations. Serum hepcidin levels showed a positive correlation with TSAT or serum ferritin concentration. In addition, a negative correlation was found between serum of hepcidin and erythroferrone levels, but no correlation was found between FGF23-related measurements and serum hepcidin levels. Both serum FGF23 levels and erythroferrone levels correlated with erythropoietin-stimulating agent treatment. Conclusion: It was strongly suggested that both serum phosphate concentrations and calcium-phosphate products were associated with FGF23 production in HD patients. As previously reported, the association between hepcidin and iron metabolism markers was reconfirmed, but a simple linear relationship between hepcidin and FGF23 was not observed even after adjusting FGF23. However, a significant negative correlation between erythroferrone and serum hepcidin levels was confirmed in HD patients.

The Extracellular Mass to Body Cell Mass Ratio as a Predictor of Mortality Risk in Hemodialysis Patients.

The extracellular mass/body cell mass ratio (ECM/BCM ratio) is a novel indicator of nutritional and hydration status in hemodialysis (HD) patients. This study aimed to explore the ECM/BCM ratio as a predictor of mortality risk with nutritional-inflammatory markers in HD patients. A prospective observational study was conducted in 90 HD patients (male: 52.2%; DM: 25.60%). Clinical and biochemical parameters [serum albumin, serum C-reactive protein (s-CRP), interleukine-6 (IL-6)] were analysed and bioelectrical impedance analysis (BIA) was performed. Protein-energy wasting syndrome (PEW) was diagnosed using malnutrition-inflammation score (MIS). Based on BIA-derived measurements, the ECM/BCM ratio with a cut-off point of 1.20 was used as a PEW-fluid overload indicator. Comorbidity by Charlson index and hospital admissions were measured. Out of 90 HD patients followed up for 36 months, 20 patients (22.22%) died. PEW was observed in 24 survivors (34.28%) and all non-survivors. The ECM/BCM ratio was directly correlated with MIS, s-CRP, Charlson index and hospital admissions but was negatively correlated with phase angle and s-albumin (all, p < 0.001). Values of the ECM/BCM ratio ≥ 1.20 were associated with higher probability of all-cause mortality (p = 0.002). The ECM/BCM ratio ≥ 1.20, IL-6 ≥ 3.1 pg/mL, s-CRP and s-albumin ≥ 3.8 g/dL and Charlson index were significantly associated with all-cause mortality risk in multivariate adjusted analysis. This study demonstrates that the ECM/BCM ratio ≥ 1.20 as a nutritional marker and/or fluid overload indicator had a significant prognostic value of death risk in HD patients.

The use of predialysis glucose as long term glycemic marker in hemodialysis patients

Aim: The major cause of chronic renal disease (CRD) is diabetes mellitus (DM). Although there are some other long term glycemic markers available, HbA1c remains the gold standart in CRD. In this study we aimed to explore the relation between average predialysis glucose and HbA1c levels. &#x0D; Material and Method: 101 diabetic hemodialysis patients from two centers were included in this study. Last 2 and 3 months’ average predialysis glucose levels were obtained. After 3 months, HbA1c levels were also studied. &#x0D; Results: A significant and strong correlation between HbA1c and both 2 and 3 months’ average predialysis glucose levels were found (p

Total iron binding capacity is a predictor for muscle loss in maintenance hemodialysis patients.

Protein-energy wasting in hemodialysis (HD) patients is characterized by decreased skeletal muscle mass and plasma protein. Some previous studies reported relationships between skeletal muscle dysfunction and iron deficiency. Dialysis patients with malnutrition may have a functional iron deficiency (FID) because of inflammation. Serum total iron binding capacity (TIBC), correlated with transferrin, is a nutritional status marker in HD patients and a biomarker of iron status. The relationship between muscle loss and iron status is unknown. The aim of the present study was to assess the relationship between iron status and change in skeletal muscle mass. A prospective cohort of 267 HD patients was examined for 12months. Blood samples were obtained at baseline to measure TIBC, ferritin, transferrin saturation (TSAT), and hepcidin-25. Nutritional status and changes in muscle mass were assessed by subjective global assessment, albumin, creatinine index, and percentage creatinine generation rate. At baseline, lower tertiles of TIBC were significantly related to lower muscle mass and albumin levels; they were also significantly correlated with high ferritin, hepcidin-25, and TSAT levels, as well as a higher proportion of use of erythropoiesis-stimulating agents. Multiple regression analysis adjusted with confounders showed TIBC was an independent biomarker for decreased muscle mass and albumin. Change in muscle mass remained significantly decreased in the lower tertile of TIBC and in malnourished patients. The present study demonstrated relationships between FID and muscle loss. TIBC was an independent biomarker of muscle loss in HD patients, considering iron status, inflammation, oxidative stress, and malnutrition.

Role of Soluble Transferrin Receptor - An Iron Marker in Hemodialysis Patients.

Iron status assessment is crucial in end-stage renal disease hemodialysis (ESRD-HD) patients because iron deficiency may cause unresponsiveness to erythropoiesis-stimulating agent. Soluble transferrin receptor (sTfR) is a potential iron marker that is not influenced by inflammation, and the results among studies are still conflicting. This study evaluated the role of sTfR in determining iron deficiency in ESRD-HD patients. This cross-sectional study was conducted at the Hemodialysis Unit in Cipto Mangunkusumo Hospital, Indonesia, from August to September 2018 and included 127 ESRD-HD patients. The sTfR level, sTfR index (sTfR/log ferritin), iron status, ferritin level, and complete blood count were assessed. Transferrin saturation (TSAT) was used as a reference. The role of sTfR was analyzed using the Chi-square test and receiver operating characteristic curve analysis. The median sTfR was 3.0 (range, 1.0-8.5) mg/l, and the median TSAT was 23% (4.0%-100%). The sTfR level in ESRD-HD patients with absolute iron deficiency was 3.9 (1.9-8.5) mg/l, in those with functional iron deficiency was 3.5 (1.9-5.4) mg/l, and in those with no iron deficiency was 2.6 (1.0-6.4) mg/l. The previous sTfR cut-off value of 2.5 mg/l had a sensitivity of 83.3%, specificity of 48.2%, positive predictive value (PPV) of 44.3%, and negative predictive value (NPV) of 85.4%, whereas the new sTfR cut-off value of 2.71 mg/l had a sensitivity of 83.3%, specificity of 56.5%, PPV of 48.6%, and NPV of 87.3%. TSAT and index TSAT were not influenced by inflammation. The cut-off sTfR value of 2.71 mg/l is better than 2.5 mg/l to determine the iron status in ESRD-HD patients.

The effect of intradialytic exercise on inflammatory markers in hemodialysis patients

BackgroundChronic low-grade inflammation is a feature of chronic kidney disease associated with increased risk of multiple morbidities and mortalities. Hemodialysis (HD) patients lead a sedentary life style which may aggravate their inflammatory state and practicing exercise may improve this condition. The aim of this work was to study the effect of intradialytic exercise (IDE) on inflammatory markers in HD patients.ResultsThis prospective cohort study included 40 HD patients, divided into 2 groups: exercise group completed IDE for 3 months and non-exercise group matched in age and sex as controls. At baseline, there was no difference between both groups regarding physical performance assessed using short physical performance battery test (SPBT) or inflammatory markers C-reactive protein (CRP) and interleukin 6 (IL-6) P > 0.05. After 3 months, SPBT significantly improved in exercise group (P < 0.001). Also, both serum CRP and IL-6 levels showed significant decrease in exercise group compared to baseline (P < 0.001), while no similar change was noticed in non-exercise group.ConclusionsRegular intradialytic aerobic exercise program can improve physical function and inflammation in hemodialysis patients. Further studies on larger number of patients are warranted.

Creatinine index as a predictive marker of sarcopenia in patients under hemodialysis.

Sarcopenia is a clinical condition that comprises declined skeletal muscle (SM) mass and SM strength, and is a risk factor for physical disability, impaired quality of life, and advanced morbidity and mortality in patients on hemodialysis (HD). The existing difficulty in evaluating SM mass and consequently of sarcopenia, with affordable and practical methods in clinical practice, is well established. The purpose of this study is to examine the creatinine index (CrI), a surrogate of SM mass, as a potential predictive marker of sarcopenia. In this cross-sectional study, we included 130 patients on HD with a mean age of 66.17 ± 12.47years. SM mass and SM strength were evaluated with CrI and hand grip strength, respectively. Anthropometric, adiposity, nutritional, and biochemical assessments were also performed. Partial correlation and multivariate regression analyses were applied to investigate the association between CrI and SM strength. Correlation analysis showed that mid-arm circumference, calf circumference, Geriatric nutritional index, and albumin-to-total protein ratio were positively associated with SM strength. Multivariate model indicated that CrI (β = 2.05, p < 0.001) and dialysis duration (β =-0.53, p = 0.001) were independently related to SM strength. The significant positive correlation between CrI and SM strength remained unaffected even after adjusting for potential confounders. Creatinine Index was significantly associated with SM strength highlighting its value as a new emerging practical in clinical setting sarcopenia predictive marker in HD patients.

Serum growth differentiation factor-15 analysis as a malnutrition marker in hemodialysis patients

Background/aim Growth differentiation factor (GDF)-15 is related to inflammation and mortality in many conditions. We aimed to determine if an elevated serum GDF-15 level is related to nutritional status of patients on hemodialysis (HD) and mortality.Materials and methodsRoutine HD patients (n = 158) were included in the study and followed for 18 months. Some malnutrition/inflammation scoring indexes (malnutrition/inflammation score (MIS), controlling nutritional status (CONUT) score, and prognostic nutritional index (PNI)), biochemical parameters, and GDF-15 were used to build Cox regression multivariate models to study the association with mortality. Results Among the patients, 90 (57 %) had a high MIS (≥8), which associates with worse status. The serum GDF-15 level was higher in the same group (p = 0.003). The serum GDF-15 level differentiated malnutrition/inflammation according to the MIS (p = 0.031). Age, GDF15, and C-reactive protein (CRP) were significantly associated with higher all-cause mortality risk. Patients with both age and GDF-15 above the mean had a hazard ratio of 2.76 (p = 0.006) when compared with those both < mean.Conclusion In HD patients, the GDF-15 level is increased in worse nutritional status. Beyond the MIS, age, GDF-15 and CRP would be used together to estimate the worse clinical outcome in these patients.

Etelcalcetide Utilization, Dosing Titration, and Chronic Kidney Disease–Mineral and Bone Disease (CKD-MBD) Marker Responses in US Hemodialysis Patients

Clinical trial data have demonstrated the efficacy of etelcalcetide for reducing parathyroid hormone (PTH) levels in hemodialysis (HD) patients. We provide a real-world summary of etelcalcetide utilization, dosing, effectiveness, and discontinuation since its US introduction in April2017. New-user design within prospective cohort. 2,596 new users of etelcalcetide from April 2017 through August 2019 in a national sample of adult maintenance HD patients in the US Dialysis Outcomes and Practice Patterns Study (DOPPS). Baseline PTH, prior cinacalcet use, initial etelcalcetide dose. Trajectories of etelcalcetide dose, chronic kidney disease-mineral and bone disease (CKD-MBD) medications, and levels of PTH, serum calcium, and phosphorus in the 12 months after etelcalcetide initiation. Cumulative incidence methods for etelcalcetide discontinuation and linear generalized estimating equations for trajectory analyses. By August 2019, etelcalcetide prescriptions increased to 6% of HD patients from their first use in April 2017. Starting etelcalcetide dose was 15 mg/wk in 70% of patients and 7.5 mg/wk in 27% of patients; 49% of new users were prescribed cinacalcet in the prior 3 months. Etelcalcetide discontinuation was 9%, 17%, and 27% by 3, 6, and 12 months after initiation. One year after etelcalcetide initiation, mean PTH levels declined by 40%, from 948 to 566 pg/mL, and the proportion of patients with PTH within target (150-599 pg/mL) increased from 33% to 64% overall, from 0 to 60% among patients with baseline PTH≥ 600 pg/mL, and from 30% to 63% among patients with prior cinacalcet use. The proportion of patients with serum phosphorus > 5.5 mg/dL decreased from 55% to 45%, while the prevalence of albumin-corrected serum calcium< 7.5 mg/dL remained at 1%-2%. There were increases in use of active vitamin D (from 77% to 87%) and calcium-based phosphate binders (from 41% to 50%) in the 12 months after etelcalcetide initiation. Data are unavailable for provider dosing protocols, dose holds, or reasons for discontinuation. In the 12 months after etelcalcetide initiation, patients had large and sustained reductions in PTH levels. These results support the utility of etelcalcetide as an effective therapy to achieve the KDIGO-recommended guidelines for CKD-MBD markers in HD patients.

Serum fetuin-A levels and its relationship with biochemical parameters in hemodialysis patients

Introduction: Cardiovascular events are the most important complications of end-stage renal disease (ESRD). The role of fetuin-A and vascular calcification inhibitors in cardiovascular complications, dysregulated biochemical markers, and mortality is uncertain in patients under hemodialysis. Objectives: The aim of this study was to investigate the relationship of fetuin-A with cardiovascular complications and biochemical markers in hemodialysis patients. Patients and Methods: In this cross-sectional study, 65 patients undergoing hemodialysis were enrolled. Blood samples were taken at pre-dialysis to determine serum fetuin-A, calcium, phosphorus, intact parathyroid hormone (iPTH), C-reactive protein (CRP), albumin, triglyceride, total cholesterol, as well as blood hemoglobin, and hematocrit. The data was analyzed considering the statistical significance level of 0.05. Results: Out of 65 patients, seven patients died during the study, and 58 patients were finally evaluated. Mean (±SD) serum fetuin-A level was 1268.71 ± 1229.4 μg/mL. There was no significant difference in the mean fetuin-A level between genders (P=0.904). There were no significant correlations between the serum level of fetuin-A and age, duration of dialysis, heart diseases, serum levels of calcium, phosphorus, PTH, albumin, CRP, cholesterol and finally blood hemoglobin. However, significant relationships were found between fetuin-A level and serum triglyceride (TG) level (P=0.019) and body mass index (BMI) (P=0.024). Conclusion: Fetuin-A level was significantly associated with serum TG level and BMI. Regarding the links of obesity and hypertriglyceridemia with cardiovascular diseases (CVDs), controlling serum TG level and body weight can reduce the risk of vascular atherosclerosis in patients undergoing dialysis.