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İkizler, T. Alp

doi:10.1681/asn.2007090983

Cited by 48 publications

(38 citation statements)

References 47 publications

(15 reference statements)

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“…26 However, it remains unclear which type of nutritional store, in particular fat or muscle, is more protective and the extent to which a lower body mass is detrimental in patients with CKD. 29 For personal use. Mass reproduce only with permission from Mayo Clinic Proceedings a .…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Whether that finding is associated with lower body mass index, triglycerides, and energy intake in those patients needs to be explored. Given the strong epidemiologic data already showing lower survival with declining body mass index and lower serum lipids in maintenance dialysis patients (25)(26)(27), estimation of the health effects of silent peritonitis episodes should take the harmful consequences of deficient energy stores into account. However, we could not draw a conclusion about the relationship between silent peritonitis and malnutrition, given that lean body mass and DPI did not really vary between the silent and non-silent peritonitis groups.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of “Silent” and “Non-Silent” Peritonitis in Patients on Peritoneal Dialysis

Dong

Luo

et al. 2013

Perit Dial Int

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♦ Objectives: We compared the clinical characteristics and outcomes of "silent" peritonitis (meaning episodes without fever and abdominal pain) and "non-silent" peritonitis in patients on peritoneal dialysis (PD). ♦ Methods: Our cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis. ♦ Results: Of 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older (p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes (p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33). ♦ Conclusions: Silent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.Perit Dial Int 2013; 33(1):28-37 www.PDIConnect.com epub ahead of print:

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“…Discrepancy exists even regarding the upper BMI limit for survival advantage, with some studies reporting a positive effect even at BMI values .35 kg/m 2 and others indicating an upper limit of 25 kg/m 2 (7,8). Postulated reasons for improved survival with high BMI include potential benefits of adipose tissue per se, for example as a source of TNF-a-soluble receptors and lipoproteins that counteract the effects of TNF-a itself or the inflammatory effects of circulating endotoxins (8-10) or as a vital energy source in undernourished patients (10). In health, aging is associated with loss of muscle mass in the range of 2-4 kg over 10 years (11).…”

Section: Introductionmentioning

confidence: 99%

“…Studies with surrogate markers of FTM and LTM suggest a dominant protective role of LTM over FTM (7,17,19,20). However, other studies concluded that survival is dependent more on FTM than LTM (10,21). Recently, multifrequency bioimpedance spectroscopy (MF-BIS) devices have been introduced to assess body composition in HD patients.…”

Section: Introductionmentioning

confidence: 99%

Body Composition and Survival in Dialysis Patients

Marcelli

Usvyat

Kotanko

et al. 2015

Clinical Journal of the American Society of Nephrology

137

115

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Background and objectives High body mass index appears protective in hemodialysis patients, but uncertainty prevails regarding which components of body composition, fat or lean body mass, are primarily associated with survival. (FTIs), which are the respective tissue masses normalized to height squared, relative to an age-and sex-matched healthy population. The relationship between LTI and FTI and all-cause mortality was studied by Kaplan-Meier analysis, multivariate Cox regression, and smoothing spline ANOVA logistic regression.Results In 37,345 hemodialysis patients, median (25th-75th percentile) LTI and FTI were 12.2 (10.3-14.5) and 9.8 (6.6-12.4) kg/m 2 , respectively. Median (25th-75th percentile) follow-up time was 266 (132-379) days; 3458 (9.2%) patients died during follow-up. Mortality was lowest with both LTI and FTI in the 10th-90th percentile (reference group) and significantly higher at the lower LTI and FTI extreme (hazard ratio [HR], 3.37; 95% confidence interval [95% CI], 2.94 to 3.87; P,0.001). Survival was best with LTI between 15 and 20 kg/m 2 and FTI between 4 and 15 kg/m 2 (probability of death during follow-up: ,5%). When taking the relation between both compartments into account, the interaction was significant (P=0.01). Higher FTI appeared protective in patients with low LTI (HR, 3.37; 95% CI, 2.94 to 3.87; P,0.001 at low LTI-low FTI, decreasing to HR, 1.79; 95% CI, 1.47 to 2.17; P,0.001 at low LTI-high FTI).Conclusions This large international study indicates best survival in patients with both LTI and FTI in the 10th-90th percentiles of a healthy population. In analyses of body composition, both lean tissue and fat tissue compartments and also their relationship should be considered.

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Resolved

Cited by 48 publications

References 47 publications

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

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

Clinical Characteristics and Outcomes of “Silent” and “Non-Silent” Peritonitis in Patients on Peritoneal Dialysis

Body Composition and Survival in Dialysis Patients

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