Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease.

BackgroundReducing dietary sodium has potential to benefit patients with chronic kidney disease (CKD). Little research is available defining dietary sodium knowledge gaps in patients with pre-dialysis CKD. We designed a brief screening tool to rapidly identify patient knowledge gaps related to dietary sodium for patients with CKD not yet on dialysis.MethodsA Short Sodium Knowledge Survey (SSKS) was developed and administered to patients with pre-dialysis CKD. We also asked patients if they received counseling on dietary sodium reduction and about recommended intake limits. We performed logistic regression to examine the association between sodium knowledge and patient characteristics. Characteristics of patients who answered all SSKS questions correctly were compared to those who did not.ResultsOne-hundred fifty-five patients were surveyed. The mean (SD) age was 56.6 (15.1) years, 84 (54%) were men, and 119 (77%) were white. Sixty-seven patients (43.2%) correctly identified their daily intake sodium limit. Fifty-eight (37.4%) were unable to answer all survey questions correctly. In analysis adjusted for age, sex, race, education, health literacy, CKD stage, self-reported hypertension and attendance in a kidney education class, women and patients of non-white race had lower odds of correctly answering survey questions (0.36 [0.16,0.81]; p = 0.01 women versus men and 0.33 [0.14,0.76]; p = 0.01 non-white versus white, respectively).ConclusionsOur survey provides a mechanism to quickly identify dietary sodium knowledge gaps in patients with CKD. Women and patients of non-white race may have knowledge barriers impeding adherence to sodium reduction advice

Energy Balance in Advanced Chronic Kidney Disease and End-Stage Renal Disease

Energy intake, resting energy expenditure, and energy expended for physical activity (EEPA) are components of energy balance that may be disrupted by a number of disorders and clinical conditions commonly present in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Energy intake of patients with CKD has been consistently lower than the recommended intake in multiple reports. On the other hand, while reduced energy intake due to anorexia may be applicable for ESRD patients with overt protein-energy wasting, it is potentially unrealistic for overweight or obese subjects who are able to maintain their body weight. Studies on resting energy expenditure have provided mixed results, most likely as a consequence of differences in the population characteristics, clinical conditions, and stage of the disease. Finally, although there is lack of specific studies on EEPA, there is evidence that ESRD patients, particularly those undergoing hemodialysis are in general less active than sedentary healthy individuals. These observations may raise questions regarding the accuracy of dietary reports and the uncertainties related to the energy requirements, optimal dietary energy intake, and recommendations for physical activity in these patients.Universidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilVanderbilt Univ, Med Ctr, Div Nephrol, Nashville, TN USAUniversidade Federal de São Paulo, Div Nephrol, BR-04039000 São Paulo, BrazilWeb of Scienc

Scientific American Nephrology, Dialysis and Transplantation

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KETOACID SUPPLEMENTATION PARTIALLY IMPROVES METABOLIC PARAMETERS IN PATIENTS ON PERITONEAL DIALYSIS

Background: A low protein diet supplemented with ketoacids has been shown to improve the metabolic profile, including insulin resistance, in patients with chronic kidney disease (CKD), but whether ketoacids alone exert similar effects is unknown. In this prospective randomized controlled trial, we aimed to evaluate the effects of ketoacid supplementation on insulin resistance, systemic inflammation, oxidative stress and endothelial dysfunction among 100 CKD patients undergoing peritoneal dialysis (PD). Methods: Patients from one Chinese PD center were randomly assigned to take ketoacids (12 tablets per day) (n = 50) versus a control group (n = 50) for 6 months in an open-label parallel-arm design. Daily protein intake of 0.8 - 1.2 g/kg/d and daily energy intake of 25 - 35 kcal/kg/d was prescribed to both groups. Insulin resistance was evaluated using homeostatic model assessment (HOMA-IR) index as the primary outcome. We assessed systemic inflammation using high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6), oxidative stress using plasma oxidized low density lipoprotein (oxLDL), adipokines using leptin and adiponectin and endothelial dysfunction using serum soluble intercellular adhesion molecule-1 (sICAM) and soluble vascular adhesion molecule-1 (sVCAM) as secondary outcomes. Results: There were no significant differences in baseline characteristics between the 2 groups except a slightly higher age in patients assigned to the intervention. A total of 89% of participants completed the 6-month intervention. There was no significant difference in the change of HOMA-IR values from baseline between groups after adjusting for baseline age, gender, body mass index and HOMA-IR. For secondary outcomes, hs-CRP varied significantly between groups (p = 0.02), increasing over time for the control group while remaining stable for the ketoacid group. Similarly, the leptin/adiponectin ratio (LAR) differed between groups (p &lt; 0.001), remaining stable in the ketoacid group but increasing in the control group. Conclusion: Ketoacid therapy administered for 6 months had no effect on HOMA-IR but resulted in improvements in hs-CRP and LAR, suggesting metabolic benefit. Future studies are needed to confirm these results and any potential benefit in vascular health of PD patients.Ketosteril Research Award, Fresenius Kabi Deutschland GmbH, Germany; National Institute of Diabetes and Digestive and Kidney Diseases [K24 DK062849]; National Center for Research Resources [1UL-1RR024975]; New Century Excellent Talents from Education Department, ChinaSCI(E)[email protected]

SERUM CREATININE TO BODY WEIGHT RATIO-A SIMPLE MEAUSRE OF BODY COMPOSITION

Body composition is not routinely measured in clinical practice in HD pts. Therefore, we examined whether serum creatinine (SCr) (a muscle mass marker in HD pts) to weight (wt) ratio is associated with measures of body composition and functional ability. 116 HD pts from an longitudinal study of nutritional status underwent at least one DEXA scan for measurement of body composition. Height, wt and 6-min walk distance were measured on a non-HD day. Intra-abdominal fat at the L4-L5 level and muscle area at mid thigh level were measured with MRI. Generalized estimating equations (GEE) were used to fit a pooled cross-sectional regression model relating outcomes to concurrently measured SCr/Wt across 4 study visits.SCr/wt0.140.10-0.140.10SCr, mg/dL12.0±3.09.6 ± 1.76.9±1.9Wt, kg65±1683 ± 1589±8Age,yr43±1651 ± 1458±15Men, %*585559DM, %115562BMI, kg/m23.2±4.529.0±4.730.8±5.7Intra-abdominal fat, cm79±43140±68167±65Muscle area, cm109 29108 28104 26DEXA fat mass/wt ,%25±934±939±186-min walk distance, m372±109313±110244±78In a multivariable GEE regression, adjusted for age, gender, race and DM, compared to the highest tertile of Scr/Wt, the lowest tertile was associated with lower 6min walk distance (β -61, 95% CI -94 to -29m). Results were similar when these models were further adjusted for wt. SCr/Wt is associated with direct measures of body composition and correlates with physical function. The specific functional form of SCr/ Wt which scales optimally with body composition needs to be determined

Results of a novel screening tool measuring dietary sodium knowledge in patients with chronic kidney disease.

BackgroundReducing dietary sodium has potential to benefit patients with chronic kidney disease (CKD). Little research is available defining dietary sodium knowledge gaps in patients with pre-dialysis CKD. We designed a brief screening tool to rapidly identify patient knowledge gaps related to dietary sodium for patients with CKD not yet on dialysis.MethodsA Short Sodium Knowledge Survey (SSKS) was developed and administered to patients with pre-dialysis CKD. We also asked patients if they received counseling on dietary sodium reduction and about recommended intake limits. We performed logistic regression to examine the association between sodium knowledge and patient characteristics. Characteristics of patients who answered all SSKS questions correctly were compared to those who did not.ResultsOne-hundred fifty-five patients were surveyed. The mean (SD) age was 56.6 (15.1) years, 84 (54%) were men, and 119 (77%) were white. Sixty-seven patients (43.2%) correctly identified their daily intake sodium limit. Fifty-eight (37.4%) were unable to answer all survey questions correctly. In analysis adjusted for age, sex, race, education, health literacy, CKD stage, self-reported hypertension and attendance in a kidney education class, women and patients of non-white race had lower odds of correctly answering survey questions (0.36 [0.16,0.81]; p = 0.01 women versus men and 0.33 [0.14,0.76]; p = 0.01 non-white versus white, respectively).ConclusionsOur survey provides a mechanism to quickly identify dietary sodium knowledge gaps in patients with CKD. Women and patients of non-white race may have knowledge barriers impeding adherence to sodium reduction advice

Validation of an automated segmentation algorithm for lower leg MR images, applied to sodium quantification

AbstractObjectiveTo develop and validate an automated segmentation algorithm for the lower leg using a multi-parametric magnetic resonance imaging protocol.MethodsAn automated algorithm combining active contour and intensity-based thresholding methods was developed to identify skin and muscle regions from proton Dixon MR images of the lower leg. Tissue sodium concentration was then computed using contemporaneously acquired sodium images with calibrated phantoms in the field of view. Resulting sodium concentration measurements were compared to a gold standard manual segmentation in 126 scans.ResultsMost cases had no observable errors in segmentation of muscle and skin. Six cases had minor errors that were not expected to affect quantification; in the worst, 126 mm2 (2%) of a muscle area of 8,042 mm2 was misclassified. In one case the algorithm failed to separate the tibia from the muscle compartment. Correlation between automated and manual measurements of sodium concentration was R2 = 0.84 for skin, R2 = 0.99 for muscle. Additionally, the RMSE was 2.4mM for skin and 0.5mM for muscle; the observed physiological range was 8.5 to 37.4mM.ConclusionFor the purpose of estimating sodium concentrations in muscle and skin compartments, the automated segmentations provided equally accurate results compared to the more time-intensive manual segmentations. Sodium quantification serves as a biomarker for disease progression, which would assist with early diagnostic treatments. The proposed algorithm will improve workflow, reproducibility, and consistency in such studies.</jats:sec