A wide prevalence of sarcopenia is observed depending on the method and cutoff limit applied. This may limit extrapolate on to clinical practice. BIA and SKF were the surrogate methods to assess muscle mass with the best concordance with DXA in elderly MHD patients.

No abstract

Up to now, there is no single method that provides complete and unambiguous assessment of the nutritional status in chronic kidney disease (CKD). Therefore, it has been recommended the use of many nutritional markers. The subjective global assessment (SGA) contains questions regarding the clinical history and physical examination. Subsequently, other versions of the SGA were developed. The malnutrition inflammation score (MIS) was also developed from the original version of the SGA and consists of 70% of the items common to SGA in addition to objective questions. Since many modifications were proposed in the original form of SGA, the use of these questionnaires in CKD patients has increased substantially in clinical practice. Therefore, this paper aims to review the applicability of the SGA and MIS when applied to assess the nutritional status of CKD patients.

A wide prevalence of sarcopenia is observed depending on the method and cutoff limit applied. This may limit extrapolate on to clinical practice. BIA and SKF were the surrogate methods to assess muscle mass with the best concordance with DXA in elderly MHD patients.

The 7p-SGA and MIS translated into Portuguese can be applied for assessing the nutritional status of elderly patients on HD. Studies testing the applicability of these instruments in adult patients on HD and in peritoneal dialysis should yet be performed.

The composite indices of nutritional status have been largely applied to assess protein energy wasting (PEW) in hemodialysis (HD) patients, but the applicability in elderly HD patients remains unknown. We aimed to assess whether the prevalence of PEW differs depending on the composite indice applied and, to evaluate the concurrent concordance between the composite indices and objective methods of nutritional status. Sixty-four elderly HD patients (male 72%; 7073, 4 years old) were included. The indices chosen were those validated for HD and/or with high applicability in clinical practice: 7 points subjective global assessment (7p-SGA), malnutrition inflammation score (MIS), the criteria proposed by the International Society in Renal Nutrition and Metabolism (ISRNM) and the mini-nutrition assessment (MNA). For 7p-SGA and MIS, PEW was defined as score r5 and 4 6, respectively. The objective parameters used to evaluate the concurrent concordance were BMI, body fat % (B Fat; skinfold thicknesses), phase angle (P Angle; BIA), handgrip strength (HGS; dynamometer) and serum albumin. The prevalence of PEW and the objective methods which values differed significantly between wellnourished (WN) x PEW patients across the 4 composite indices are described below: 7p-SGA MIS IRSNM MNA PEW (%) 53% 81% 28% 20% WN x PEW WN x PEW WN x PEW WN x PEW BMI NS NS o0.05 NS B fat % o 0.05 2 o 0.05 1,2 o0.05 1,2 o 0.05 2 P Angle NS o 0.05 1 o0.05 1 NS HGS NS NS NS NS Albumin NS NS NS NS NS: not significant; 1 for male; 2 for female A large variation in the prevalence of PEW was observed among the composite indices. No composite indice agreed concurrently with all objectives methods. The IRSNM, followed by the MIS had the greater concordance with the objective methods in elderly HD patients.http://dx.We aimed to validate the translation of the 7 point subjective global assessment (7 p-SGA) and malnutrition inflammation score (MIS) from English to Portuguese to be applied for elderly patients on hemodialysis (HD). For the translation, the back-translation method was used. First, two independent bilinguals renal dietitians (Portuguese native speakers) worked independently to translate the 7 p-SGA and MIS to Portuguese. After that, the final version was back translated to English by a bilingual English teacher (Portuguese native speaker). In order to investigate the conceptual and semantic equivalence of the translated version, a renal dietitian (English native speaker) compared each item of the original English version of the 7 p-SGA and MIS to the back translated English version by rating the similarity between both questionnaires from 1 to 100 (being 100 the highest degree of similarity). The degree of similarity was 96.8 77.8 for 7p-SGA and 99.6 71.4 for MIS, indicating that the Portuguese versions had equivalent meaning to the original English version. We then performed the validation of the Portuguese version by assessing the concurrent concordance of both nutritional composite indices with objective methods (BMI, body fat %, phase angle...

The composite indices of nutritional status have been largely applied to assess protein energy wasting (PEW) in hemodialysis (HD) patients, but the applicability in elderly HD patients remains unknown. We aimed to assess whether the prevalence of PEW differs depending on the composite indice applied and, to evaluate the concurrent concordance between the composite indices and objective methods of nutritional status. Sixty-four elderly HD patients (male 72%; 7073, 4 years old) were included. The indices chosen were those validated for HD and/or with high applicability in clinical practice: 7 points subjective global assessment (7p-SGA), malnutrition inflammation score (MIS), the criteria proposed by the International Society in Renal Nutrition and Metabolism (ISRNM) and the mini-nutrition assessment (MNA). For 7p-SGA and MIS, PEW was defined as score r5 and 4 6, respectively. The objective parameters used to evaluate the concurrent concordance were BMI, body fat % (B Fat; skinfold thicknesses), phase angle (P Angle; BIA), handgrip strength (HGS; dynamometer) and serum albumin. The prevalence of PEW and the objective methods which values differed significantly between wellnourished (WN) x PEW patients across the 4 composite indices are described below: 7p-SGA MIS IRSNM MNA PEW (%) 53% 81% 28% 20% WN x PEW WN x PEW WN x PEW WN x PEW BMI NS NS o0.05 NS B fat % o 0.05 2 o 0.05 1,2 o0.05 1,2 o 0.05 2 P Angle NS o 0.05 1 o0.05 1 NS HGS NS NS NS NS Albumin NS NS NS NS NS: not significant; 1 for male; 2 for female A large variation in the prevalence of PEW was observed among the composite indices. No composite indice agreed concurrently with all objectives methods. The IRSNM, followed by the MIS had the greater concordance with the objective methods in elderly HD patients.http://dx.We aimed to validate the translation of the 7 point subjective global assessment (7 p-SGA) and malnutrition inflammation score (MIS) from English to Portuguese to be applied for elderly patients on hemodialysis (HD). For the translation, the back-translation method was used. First, two independent bilinguals renal dietitians (Portuguese native speakers) worked independently to translate the 7 p-SGA and MIS to Portuguese. After that, the final version was back translated to English by a bilingual English teacher (Portuguese native speaker). In order to investigate the conceptual and semantic equivalence of the translated version, a renal dietitian (English native speaker) compared each item of the original English version of the 7 p-SGA and MIS to the back translated English version by rating the similarity between both questionnaires from 1 to 100 (being 100 the highest degree of similarity). The degree of similarity was 96.8 77.8 for 7p-SGA and 99.6 71.4 for MIS, indicating that the Portuguese versions had equivalent meaning to the original English version. We then performed the validation of the Portuguese version by assessing the concurrent concordance of both nutritional composite indices with objective methods (BMI, body fat %, phase angle...

body mass index (LBMI, kg of LBM/m 2 ; r¼ -0.37; po0.01) and % body fat (r¼-0.33; p¼ 0.02); stair climb time correlated negatively with lean leg mass (r¼-0.32, p¼0.03) and total leg mass (r¼-0.29, p¼0.045).). Sit-to-stand did not correlate with any body composition measure. 6-MW adjusted for age and gender correlated negatively with LBMI (r¼-0.29; p¼0.04).There were no associations between BMI (range, 19.8-44.2 kg/m 2 ) and physical performance. Conclusions: These findings indicate that adult MHD pts had a higher % body fat. Measures of physical performance were markedly reduced in MHD pts as compared to Normals. Physical performance in MHD, measured especially by 6-MW, correlated negatively with some measures of body composition, particularly with LBMI.http://dx.and the Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy, JapanBetter nutritional status and early initiation of dialysis had been considered one of the most important methods for better prognosis of dialysis patients. In this study, we analyzed the effects of nutritional status, renal function at the start of renal replacement therapy (RRT), and co morbidity on 12-month survival of ESRD patients. The subjects in this study were 9695 new ESRD patients who started RRT in 2007 in Japan. The average age of the subjects was 67.5 years, 64.1% of the subjects were male, and 42.9% had diabetes. During the 12-month period after the start of RRT, 1546 patients died, and 35 patients received renal transplantation. Average estimated glomerular filtration rate (eGFR) at the initiation of dialysis was 6.52 þ 4.20 mL/min/1.73 m2. Average serum albumin was significantly higher (P o0.001) in survivor (3.3 þ0.6 g/dl in survivor and 2.9 þ0.7 g/dl in expired patients) at the initiation of RRT. One-year odds ratio (OR) of mortality in patients with eGFR more than 4-6 ml/min/1.73 m 2 was increased with increased eGFR at dialysis initiation, but OR was identical among the groups with eGFR less than 4 ml/min/1.73 m 2 . Not only patients with sufficient residual renal function at the initiation of dialysis, but also patients with low nutritional status at the initiation of dialysis showed poor survival.