Creatinine Excretion as a Measure of Protein Nutrition in Adults of Varying Age

Walser, Mackenzie

doi:10.1177/014860718701100510

Cited by 147 publications

(103 citation statements)

References 39 publications

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“…[13][14][15] Similar reverse epidemiologic observations have also been found for serum creatinine and PTH levels. 13,16,17 Reduced intake of calcium, phosphorous and bPEP/bET predicts mortality in hemodialysis S-C Chen et al protein might lead to low serum creatinine and PTH levels, which usually reflect poor nutritional status and might contribute to high mortality. 13,18 In this study, patients in the mortality group had lower creatinine and PTH levels and their serum creatinine level was a predictor of overall and cardiovascular mortality (HR, 0.733; P¼0.029 and HR, 0.610; P¼0.004, respectively) in multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients

et al. 2010

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Impaired left ventricular systolic function is an important cause of mortality in hemodialysis patients. An increase in the ratio of pre-ejection period (PEP) to ejection time (ET) is associated with a decrease in left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study was to investigate whether bPEP/bET was a useful predictor for overall and cardiovascular mortality in hemodialysis patients. We enrolled 212 hemodialysis patients in one regional hospital. The bPEP and bET were measured using an ABI-form device. The mean follow-up period was 28.3 ± 5.7 months. The relative mortality risk was analyzed by Cox-regression methods. Twenty-two deaths were recorded in 212 patients (10.4%). In a multivariate analysis, the bPEP/bET (hazard ratio [HR], 1.055; P¼0.047) and serum creatinine level (P¼0.029) were positively and negatively associated with overall mortality, respectively. In addition, increased bPEP/bET (HR, 1.080; P¼0.017), increased fasting glucose (P¼0.046) and decreased serum creatinine level (P¼0.004) were independent predictors for cardiovascular mortality. Our findings show that bPEP/bET, a surrogate of left ventricular systolic function, is a useful predictor for overall and cardiovascular mortality in hemodialysis patients. Screening hemodialysis patients by means of bPEP/bET may help to identify a high-risk group for increased mortality.

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Section: Discussionmentioning

confidence: 99%

A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients

et al. 2010

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“…59, 60 Nevertheless, variation in residual renal function or recent intake of meats may substantially change serum creatinine levels independently of the patient's muscle mass. [61][62][63] However, the effect of meat intake on circulating creatinine varies with day-to-day diet, and our use of 3-month averaged pre-HD serum creatinine concentrations will likely mitigate their association with diet. Another limitation is the lack of comprehensive data on comorbid conditions and changes in residual renal function over time.…”

Section: Gained Muscle Mass Referencementioning

confidence: 99%

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Kalantar-Zadeh

Streja

Kövesdy

et al. 2010

Mayo Clinic Proceedings

282

235

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Objective: To determine whether dry weight gain accompanied by an increase in muscle mass is associated with a survival benefit in patients receiving maintenance hemodialysis (HD). Patients and MethOds:In a nationally representative 5-year cohort of 121,762 patients receiving HD 3 times weekly from July 1, 2001, through June 30, 2006, we examined whether body mass index (BMI) (calculated using 3-month averaged post-HD dry weight) and 3-month averaged serum creatinine levels (a likely surrogate of muscle mass) and their changes over time were predictive of mortality risk.Results: In the cohort, higher BMI (up to 45) and higher serum creatinine concentration were incrementally and independently associated with greater survival, even after extensive multivariate adjustment for available surrogates of nutritional status and inflammation. Dry weight loss or gain over time exhibited a graded association with higher rates of mortality or survival, respectively, as did changes in serum creatinine level over time. Among the 50,831 patients who survived the first 6 months and who had available data for changes in weight and creatinine level, those who lost weight but had an increased serum creatinine level had a greater survival rate than those who gained weight but had a decreased creatinine level. These associations appeared consistent across different demographic groups of patients receiving HD.cOnclusiOn: In patients receiving long-term HD, larger body size with more muscle mass appears associated with a higher survival rate. A discordant muscle gain with weight loss over time may confer more survival benefit than weight gain while losing muscle. Controlled trials of muscle-gaining interventions in patients receiving HD are warranted. Mayo Clin Proc. 2010;85(11):991-1001From the harold simmons center for chronic disease Research and epidemiology (K.K.-Z., e.s., j.j., n.n.) and division of nephrology and hypertension (K.K.-Z., j.d.K., R.M.), los angeles biomedical Research institute at harborucla Medical center, torrance, ca; ucla david Geffen school of Medicine (K.K.-Z., a.R.n., j.d.K., R.M.); department of Family health and/or epidemiology, ucla school of Public health, los angeles, ca (K.K.-Z., e.s., j.d.K.); salem veterans affairs Medical center, salem, va (c.P.K.); davita, el segundo, ca (a.R.n, M.K.); university of alberta, edmonton, alberta, canada (a.O.); and charité university school of Medicine, berlin, Germany and centre for clinical and basic Research, iRccs san Raffaele, Rome, italy (s.d.a.) the study was supported by dr Kalantar-Zadeh's research grants from the national institute of diabetes and digestive and Kidney diseases of the national institutes of health (R01 dK078106), the american heart association (0655776Y), and davita clinical Research (dcR), as well as a philanthropic grant from Mr harold simmons and an additional dcR grant for the division of nephrology & hypertension at harbor-ucla Medical center. drs nissenson and Krishnan are employees of davita. dr Kalantar-Zadeh is the medical director ...

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“…The prevalence (95% confidence interval [CI]) of reduced GFR was determined for the screened population. Estimated creatinine excretion was compared with age-and gender-matched expected values using the formulas derived by Walser using two-tailed t test (20). The association between measured Ccr and estimated GFR on the basis of the CG and MDRD Study GFR equations was assessed by ordinary linear regression and Passing and Bablok regression analyses.…”

Section: Statistical Analysesmentioning

confidence: 99%

Serum Creatinine as Marker of Kidney Function in South Asians

Jafar¹,

Schmid²,

Levey³

2005

Journal of the American Society of Nephrology

104

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Migrant populations of South Asian origin have a higher risk for chronic kidney disease than the native whites. Several formulas have been developed to estimate kidney function from serum creatinine concentration. However, none of these has been validated in the South Asian population, which generally has different muscle mass composition than whites. A population-based cross-sectional study was performed on 262 individuals who were aged >40 yr in Karachi, Pakistan. Reduced GFR was defined as creatinine clearance (Ccr) measured in 24-h urine collection of <60 ml/min per 1.73 m 2 . Creatinine excretion was compared with age-and gender-matched white individuals by comparison of observed versus expected results on the basis of a formula using t test. The agreement among Cockcroft Gault (CG) Ccr and Modification of Diet in Renal Disease (MDRD) Study GFR equations was assessed by regression analyses, and the degree of accuracy of estimated versus measured GFR was determined. Mean (95% confidence interval) creatinine excretion was 1.7 (1.0 to 2.4) mg/kg per d lower than expected for age-and gender-matched white individuals (P < 0.001). The coefficient of determination for measured Ccr on the logarithmic scale was 66.7 and 55.6% for the CG and MDRD Study equations, respectively. The proportion of estimates within 20, 30, and 50% of measured Ccr values was 47.7 versus 32.8% (P < 0.001), 64.9 versus 49.6% (P < 0.001), and 79.4 versus 72.9 (P ‫؍‬ 0.07) for CG versus MDRD Study equations, respectively. Lower mean creatinine excretion in these individuals may explain, in part, suboptimal agreement between estimated versus measured GFR. Inclusion of terms for ethnic and racial groups other than white and black might improve the performance of GFR estimating equations.

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Creatinine Excretion as a Measure of Protein Nutrition in Adults of Varying Age

Cited by 147 publications

References 39 publications

A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients

A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

Serum Creatinine as Marker of Kidney Function in South Asians

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