Utility of Phase Angle to Identify Cachexia and Assess Mortality in End-Stage Renal Disease

© 2020 American Society for Nutrition. Published by Elsevier Inc. This is an Open access article under the CC-BY-NC-ND license. https://creativecommons.org/licenses/by-nc-nd/4.0/Objectives This cross-sectional analysis sought to identify cachexia and assess survival using phase angle (PA) in patients with end-stage renal disease (ESRD) receiving haemodialysis. Methods Patients receiving haemodialysis (n = 87, mean age 65.9 +/– 13.0) completed a Phase Angle (PA; 50 khz) measurement using bioelectrical impedance analysis. Cachexia variables were recorded according to Evans et al. definition (2008) including nutritional and functional measures (weight, Body Mass Index (BMI), Hand Grip Strength (HGS), Lean Tissue Mass (LTM), C-Reative Protein (CRP), serum albumin, haemoglobin, appetite (Functional Assessment of Anorexia/Cachexia Treatment (FAACT)) and fatigue (Functional Assessment of Chronic Illness Therapy (FACIT)). Survival was assessed at 12 months. Mann Whitney-U and Spearman correlation coefficient were conducted. Results The majority of patients completed follow up (n = 76). Eleven patients had died. Mean PA was not statistically different between those identified as cachectic and non-cachectic according to Evans et al. (2008) definition or between those patients that survived and died. However, patients that survived had better mean scores of weight, BMI, HGS, CRP, serum albumin and fatigue (FACIT). In addition, LTM scores were significantly better in patients that survived (P < .01). Appetite scores were also significantly better in patients that survived (P < .01) and those without cachexia (P = .01). Conclusions This study was part of a larger effort to clarity a phenotype of cachexia in ESRD. Unlike previous research, this study did not find PA useful in identifying patients at a higher risk of cachexia or death. However overall these patients had a very low mean PA. FAACT did discriminate between groups indicating self-reporting measurement tools of nutritional status were useful in identifying patients at a higher risk of cachexia and death. A larger sample and longer follow up is required to balance the limitations of this small study. Timing the administration of PA also requires consideration in future studies. Funding Sources Public Health Agency; Northern Ireland Kidney Research Fund.Peer reviewe

Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

International audienceBACKGROUND: Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. OBJECTIVE: The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. METHOD: This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. RESULTS: A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.2 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. \textgreater5% for \textgreater6 months) or BMI \textless20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). The FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. CONCLUSION: Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD

Establishing a clinical phenotype for cachexia in end stage kidney disease - study protocol.

BACKGROUND: Surveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD. METHODS: A longitudinal study which will recruit adult patients with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12 months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia. DISCUSSION: Cachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education

Establishing a clinical phenotype for cachexia in end stage kidney disease - study protocol.

BackgroundSurveys using traditional measures of nutritional status indicate that muscle wasting is common among persons with end-stage kidney disease (ESKD). Up to 75% of adults undergoing maintenance dialysis show some evidence of muscle wasting. ESKD is associated with an increase in inflammatory cytokines and can result in cachexia, with the loss of muscle and fat stores. At present, only limited data are available on the classification of wasting experienced by persons with ESKD. Individuals with ESKD often exhibit symptoms of anorexia, loss of lean muscle mass and altered energy expenditure. These symptoms are consistent with the syndrome of cachexia observed in other chronic diseases, such as cancer, heart failure, and acquired immune deficiency syndrome. While definitions of cachexia have been developed for some diseases, such as cardiac failure and cancer, no specific cachexia definition has been established for chronic kidney disease. The importance of developing a definition of cachexia in a population with ESKD is underscored by the negative impact that symptoms of cachexia have on quality of life and the association of cachexia with a substantially increased risk of premature mortality. The aim of this study is to determine the clinical phenotype of cachexia specific to individuals with ESKD.MethodsA longitudinal study which will recruit adult patients&nbsp;with ESKD receiving haemodialysis attending a Regional Nephrology Unit within the United Kingdom. Patients will be followed 2 monthly over 12&nbsp;months and measurements of weight; lean muscle mass (bioelectrical impedance, mid upper arm muscle circumference and tricep skin fold thickness); muscle strength (hand held dynamometer), fatigue, anorexia and quality of life collected. We will determine if they experience (and to what degree) the known characteristics associated with cachexia.DiscussionCachexia is a debilitating condition associated with an extremely poor outcome. Definitions of cachexia in chronic illnesses are required to reflect specific nuances associated with each disease. These discrete cachexia definitions help with the precision of research and the subsequent clinical interventions to improve outcomes for patients suffering from cachexia. The absence of a definition for cachexia in an ESKD population makes it particularly difficult to study the incidence of cachexia or potential treatments, as there are no standardised inclusion criteria for patients with ESKD who have cachexia. Outcomes from this study will provide much needed data to inform development and testing of potential treatment modalities, aimed at enhancing current clinical practice, policy and education

Erratum to: Using a generic definition of cachexia to understand clinical characteristics and mortality in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study

International audienc

Erratum.

In the originally published version of thismanuscript, amendments made during the proofing stage were not applied and have been listed in this erratum. Upon the original publication, there was an error in the spelling of author Kamyar Kalantar-Zadeh’s surname. Upon the original publication, the ORCID ID for authors Andrew Davenport and Helen Noble were incorrectly added to the author list. These have now been deleted. Upon the original publication, the Twitter handle of some authors were added to the Corresponding author information in error. These have now been deleted. Upon the original publication, the following sentence in the “Results” line in the Abstract should read: “A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.6 years.”. Upon the original publication, the “Materials andMethods” section had the following errors: In the first paragraph, the following sentence should read: “...between September 2017 and April 2019.”. In the second paragraph, the following sentence should read: “A single researcher carried out all assessments.”. Under the “Musclemass (MUAMC)” heading, the following sentence should read: “Suitable cut-point values designated the 5th percentile as an appropriate cut-point for lowMUAMC using normative values (i.e. &lt;23.8cmfor males and &lt;18.4cm for females) [11, 12].”. Under the “Analysis” heading, the following sentence should read: “Dichotomized values were compared using the X2 test.”. Upon the original publication, the following text in the Results section, under the “Longitudinal results” heading should read: “showed a significant main effect of time on HGS (P&lt;0.001)”. Upon the original publication, the following sentence in the Discussion section, under the “Cachectic phenotype” heading should read: “Therefore the cut-off value for CRP levels in an ESRD population needs to be revised to a level &gt;5mg/L.”. Upon the original publication, the following text in the Funding section should read: “Public Health Agency Northern Ireland”. Upon the original publication, within the reference section, the following citation (11) should refer to: “StosovicM, StanojevicM, Sanja Simic-Ogrizovic S, et al. The predictive value of anthropometric parameters onmortality in haemodialysis patients. Nephrol Dial Transplant 2011; 26: 1367–1374.”. These errors have now been corrected online. The publisher apologizes for the errors

A neuroethics framework for the Australian Brain Initiative

Neuroethics is central to the Australian Brain Initiative’s aim to sustain a thriving and responsible neurotechnology industry. Diverse and inclusive community and stakeholder engagement and a trans-disciplinary approach to neuroethics will be key to the success of the Australian Brain Initiative

Erratum: A Neuroethics Framework for the Australian Brain Initiative (Neuron (2019) 101(3) (365–369), (S0896627319300054), (10.1016/j.neuron.2019.01.004))

(Neuron 101, 365–369; February 6, 2019) In the original publication of this NeuroView, the member list for the Australian Brain Alliance was omitted. This has now been corrected online. Neuron apologizes for the error.</p