Body cell mass measured by bioimpedance spectroscopy as a nutritional marker.

Body Cell Mass (BCM) is a sum of all metabolically active cells of the body. Aim of the study was to compare BCM with other nutritional and inflammatory markers in patients with chronic kidney disease (CKD) stage 4-5 (NKF) without dialysis treatment and in hemodialysis patients(HD). We included 45 adult patients with CKD and eGFR<30 ml/min not treated with dialysis (26 male, age: 59,7±16,8) and 39 adults treated with HD three times a week, for more than three months (26 male, 5 diabetics, age: 59,8 ±16). Body composition was measured using multifrequency biopimpedance spectroscopy: Body Composition Monitor - FMC. We used BCM index (BCMI) defined as BCM divided by height to the power of 2. To measure hand grip strength (HGS) we used dynamometr Jamar. In statistics analysis we used Pearson correlations (SPSS v18). Predialysis group: BCMI: 7,1 ±1,6 kg/m², Lean Tissue Index (LTI): 12,9 ±2,4 kg/m², Fat Tissue Index (FTI): 14,7 ±5,4 kg/m², BMI: 28,2 ±5 kg/m², serum creatinine level (SCr): 3,9 ±2,1 mg/dl, eGFR: 18,3 ±7,0034 ml/min/1,73 m², albumin (SA): 3,9 ±0,3 g/dl, prealbumin (PA): 32,8 ±8,8 mg/dl, CRP: 0,5 ±0,3 mg/dl. A positive correlation was found with BCMI and HGS (r = 0,55; p=0,001), PA (r = 0,41; p=0,004) and SCr (r =0,37; p=0,012). A negative correlation was found between BCMI and age (r = -0,48; p=0,006), CRP (r = -0,33; p=0,028). We do not observed correlation with BMI and SA. HD group: BCMI: 6,4±1,7 kg/m², LTI: 12,1±2,3 kg/m², FTI: 12 ±6 kg/m², BMI: 24,8 ±4,8, SCr: 8,9 ±2,6 mg/dl, TP: 6,7 ±0,6 g/dl, SA: 3,9 ±0,47 g/dl, PA 33,8 ±11,4 g/dl, CRP: 1,1 ±1,4 mg/dl. A positive, significant correlation was found between BCMI and HGS (r = 0,47; p=0,003). A negative correlation was found with BCMI and age (r = -0,55; p=0,0005) and with CRP (r = -0,31), but not statistically significant. We do not observed correlation between BCMI and BMI, SCr, TP, SA, PA, hemodialysis vintage, Kt/V. Assessment of body compartments is important tool in estimation nutritional status in patients with stage IV-V CKD and hemodialysis patients. Analysis of body composition in association with other markers worth to be studied, especially in larger groups of patients

Clinical Study Impact of Cardiovascular Organ Damage on Cortical Renal Perfusion in Patients with Chronic Renal Failure

Introduction. Properly preserved renal perfusion is the basic determinant of oxygenation, vitality, nutrition, and organ function and its structure. Perfusion disorders are functional changes and are ahead of the appearance of biochemical markers of organ damage. The aim of this study was to evaluate a relationship between the renal cortex perfusion and markers of cardiovascular organ damage in patients with stable chronic renal failure (CKD). Methods. Seventeen patients (2 F; 15 M; age 47 ± 16) with stable CKD at 2-4 stages and hypertension or signs of heart failure were enrolled in this study. Blood tests with an estimation of renal and cardiac functions, echocardiographic parameters, intima-media thickness (IMT), renal resistance index (RRI), and total (TPI), proximal (PPI), and distal (DPI) renal cortical perfusion intensity measurements were collected. Results. DPI was significantly lower than PPI. TPI significantly correlated with age, Cys, CKD-EPI (cystatin), and IMT, whereas DPI significantly depended on Cystain, CKD-EPI (cystatin; cystatin-creatinine), IMT, NT-proBNP, and troponin I. In multiple stepwise regression analysis model only CKD-EPI (cystatin) independently influenced DPI. Conclusions. Cardiovascular and kidney damage significantly influences renal cortical perfusion. Ultrasound measurement of renal perfusion could be a sensitive method for early investigation of cardiovascular and renal injuries

Impact of Cardiovascular Organ Damage on Cortical Renal Perfusion in Patients with Chronic Renal Failure

Introduction. Properly preserved renal perfusion is the basic determinant of oxygenation, vitality, nutrition, and organ function and its structure. Perfusion disorders are functional changes and are ahead of the appearance of biochemical markers of organ damage. The aim of this study was to evaluate a relationship between the renal cortex perfusion and markers of cardiovascular organ damage in patients with stable chronic renal failure (CKD). Methods. Seventeen patients (2 F; 15 M; age 47±16) with stable CKD at 2–4 stages and hypertension or signs of heart failure were enrolled in this study. Blood tests with an estimation of renal and cardiac functions, echocardiographic parameters, intima-media thickness (IMT), renal resistance index (RRI), and total (TPI), proximal (PPI), and distal (DPI) renal cortical perfusion intensity measurements were collected. Results. DPI was significantly lower than PPI. TPI significantly correlated with age, Cys, CKD-EPI (cystatin), and IMT, whereas DPI significantly depended on Cystain, CKD-EPI (cystatin; cystatin-creatinine), IMT, NT-proBNP, and troponin I. In multiple stepwise regression analysis model only CKD-EPI (cystatin) independently influenced DPI. Conclusions. Cardiovascular and kidney damage significantly influences renal cortical perfusion. Ultrasound measurement of renal perfusion could be a sensitive method for early investigation of cardiovascular and renal injuries

First year survival of patients on maintenance dialysis treatment in Poland

Retrospective analysis of demographic and clinical data of all patients starting dialysis over two years in our Department (n = 105) has been conducted. Factors such as type of dialysis treatment, reason of end-stage renal disease, Body Mass Index (BMI), laboratory tests results, number and cause of death during first year of dialysis were taken under consideration. Five patients have been excluded from the analysis of mortality (four received renal transplantation, one changed dialysis center). Twenty tree deaths have been noted during first year of dialysis treatment. Nine of them occurred during the first three months of therapy. The leading cause of death was cardio-vascular events (n = 14, 60.9%), the second was malignancy (8, 34,8%), one patient died due to catheter associated infection. Malignancy as a cause of end-stage renal disease, lack of outpatient nephrology care, acute mode of beginning renal replacement therapy and lack of erythropoiesis stimulating agents therapy were associated with higher risk of all-cause mortality during first year of dialysis. Being under the outpatient nephrology care, etiology of ESRD other than malignancy and erythropoiesis stimulating agents therapy were independently associated with better survival during this period of time. Other independent variables did not reach statistical significance. To conclude, in order to improve one year survival of dialysis patients, outpatient nephrology care with adequate amount of visits and associated dialysis therapy should be employed

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed