Total Iron-Binding Capacity–Estimated Transferrin Correlates With the Nutritional Subjective Global Assessment in Hemodialysis Patients

Kalantar-Zadeh, Kamyar; Kleiner, Morton; Dunne, Eileen F.; Ahern, Kathleen; Nelson, Monica; Koslowe, Rama; Luft, Friedrich C.

doi:10.1053/ajkd.1998.v31.pm9469497

Cited by 143 publications

(114 citation statements)

References 33 publications

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“…The current analysis confirms previous reports describing a statistical association between hemodialysis dose, hematocrit, and EPO dose (29,42,47). These relationships may reflect direct or indirect benefits of better solute clearance, such as enhanced removal of putative soluble erythropoietic inhibitors (48,49) and/or improved nutrition and substrate availability for erythropoiesis (41,42). Alternatively, improved anemia correction with increased dialysis doses may be reflective of diligence to other components of patient care that could improve EPO responsiveness, diminish blood losses, and/or enhance erythrocyte survival.…”

Section: Discussionsupporting

confidence: 89%

“…This contention is supported by the demonstration of the inverse relationship between EPO dose and hematocrit. The cause of the heterogeneity on EPO responsiveness is unclear and may be a consequence of other comorbid conditions like overt or covert inflammatory processes (35)(36)(37), hyperparathyroidism (38), trace mineral toxicity such as aluminum (39,40), protein-calorie and malnutrition (41), and inadequate hemodialysis (29,42).…”

Section: Discussionmentioning

confidence: 99%

“…This relationship may be a consequence of patient-specific variables, such as better compliance and subsequent fewer missed EPO injections, and/or survival bias giving rise to a patient subgroup with fewer EPOresistant comorbid conditions. Patient weight is a surprising finding in view of the adjustment for EPO dose by weight and may reflect an interaction between patients' nutritional state and EPO responsiveness (41). Care processes, such as prescribed EPO dose, the prescribed route of EPO and iron administration, and laboratory surrogates of marrow iron stores, demonstrated associations in the anticipated manner.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Anemia Management among US Hemodialysis Patients

Coladonato¹,

Frankenfield²,

Reddan³

et al. 2002

Journal of the American Society of Nephrology

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Abstract. This study was undertaken to describe the relationship between hematocrit (Hct) and changes in the prescribed dose of erythropoietin (EPO) as well as selected patient and process care measures across annual national samples of hemodialysis patients from 1994 to 1998. This study uses the cohorts identified in the ESRD Core Indicators Project, random samples of 6181, 6241, 6364, 6634, and 7660 patients, stratified by ESRD Networks drawn for each year from 1994 to 1998. Patient demographic and clinical information was collected from October to December for each year. Surrogates of iron stores and patterns of iron and EPO administration were profiled from 1996 to 1998. Multivariable stepwise linear regression analyses were performed to adjust for potential confounding variables and to identify independent variables associated with Hct and EPO dose. Mean Hct and EPO dose increased each year from 31.1 Ϯ 5.2% to 34.1 Ϯ 3.7% and from 58.2 Ϯ 41.8 U/kg to 68.2 Ϯ 55.0 U/kg, respectively (P ϭ 0.0001). Increasing Hct was positively associated with male gender, more years on dialysis, older age, higher urea reduction ratio and transferrin saturation, prescription of intravenous iron, and lower ferritin and EPO dose in multivariable models (all P ϭ 0.0001). Male gender, older age, diabetes, higher Hct, and increasing weight, urea reduction ration, and transferrin saturation were associated with lower EPO doses (all P Ͻ 0.01). Conversely, intravenous EPO and iron were associated with higher prescribed EPO doses (all P ϭ 0.0001). Although increasing Hct is associated with decreasing EPO dose at the patient level, the increase in Hct seen across years among the cohorts of hemodialysis patients in the United States has been associated with increasing doses of EPO at the population level.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trends in Anemia Management among US Hemodialysis Patients

Coladonato¹,

Frankenfield²,

Reddan³

et al. 2002

Journal of the American Society of Nephrology

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“…The single-pool Kt/V was used to represent the weekly dialysis dose, and the normalized protein equivalent of total nitrogen appearance (nPNA), also known as normalized protein catabolic rate (nPCR), was calculated to estimate the daily protein intake (30). Total iron binding capacity (TIBC) represented serum transferrin (31). All routine laboratory measurements were performed by DaVita Laboratories (Deland, FL) using automated methods, and the average values for each laboratory test within the 13-wk study period were calculated and used for data analyses in this study.…”

Section: Laboratory Evaluationmentioning

confidence: 99%

A Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis Patients

Kalantar-Zadeh

Block

Humphreys

et al. 2004

Journal of the American Society of Nephrology

153

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Abstract. An increased level of total plasma homocysteine (tHcy) is a risk factor for poor cardiovascular outcome in the general population. However, a decreased, rather than an increased, tHcy concentration may predict poor outcome in maintenance hemodialysis (MHD) patients, a phenomenon referred to as reverse epidemiology. Associations were examined between tHcy level and markers of malnutrition-inflammation complex syndrome and 12-mo prospective hospitalization and mortality in 367 MHD patients, aged 54.5 Ϯ 14.7 (mean Ϯ SD) years, who included 199 men and 55% individuals with diabetes. tHcy was 24.4 Ϯ 11.8 mol/L, and 94% of the patients had hyperhomocysteinemia (tHcy Ͼ13.5 mol/L). tHcy had weak to moderate but statistically significant bivariate and multivariate correlations with some laboratory markers of nutrition (serum albumin, prealbumin, creatinine, and urea nitrogen) but no significant correlation with serum C-reactive protein or two proinflammatory cytokines (IL-6 and TNF-␣).During 12 mo of follow-up, 191 MHD patients were hospitalized, 37 died, nine underwent renal transplantation, and 38 transferred out. Hospitalization rates were significantly higher in patients with lower tHcy levels. Mortality rate in the lowest tHcy quartile (17.4%) was significantly higher compared with other three quartiles (6.5 to 9.8%; Kaplan-Meier P ϭ 0.04). Relative risk of death for the lowest tHcy quartile, even after adjustment for case-mix and serum albumin, was 2.27 (95% confidence interval, 1.14 to 4.53; P ϭ 0.02). Hence, tHcy may be a more exclusive nutritional marker in MHD patients with no association with inflammatory measures. Despite a very high prevalence of hyperhomocysteinemia in MHD patients, lower values of tHcy are paradoxically associated with increased hospitalization and mortality. The lowest tHcy quartile confers a twofold increase in risk of death independent of hypoalbuminemia. The nutritional feature of tHcy in MHD patients may explain its reverse association with outcome.In the general population, an increased level of total plasma homocysteine (tHcy) is a risk factor for increased cardiovascular events and mortality (1-4). In maintenance hemodialysis (MHD) outpatients, however, the association between tHcy and clinical outcome is inconsistent and even paradoxical. Some studies have shown a poor outcome in MHD patients with hyperhomocysteinemia (5-9). However, a few recent studies have suggested that a decreased, not an increased, tHcy concentration is related to a higher prevalence of cardiovascular disease and poor outcome in these individuals (10 -12). This seems to be due to the empirical association between a low tHcy and protein-energy malnutrition, which is per se a known risk factor for poor clinical outcome in dialysis patients (11,13,14). This recently described paradoxical association between tHcy and clinical outcome in dialysis patients has now been referred to as a possible component of the reversal of the cardiovascular risks (15-17). It is believed that both inflammation and protei...

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“…Em pacientes com insuficiência renal crônica, foi encontrada correlação entre o diagnóstico de desnutrição realizado pela ANS e métodos objetivos tanto bioquímicos, como a dosagem de transferrina (20) , quanto os de composição corporal (12,19) . ABDULLAH et al…”

Section: Pacientes Nefropatasunclassified

Avaliação nutricional subjetiva: Parte 2 - Revisão de suas adaptações e utilizações nas diversas especialidades clínicas

Barbosa-Silva

Barros

2002

Arq. Gastroenterol.

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RESUMO -Racional -A avaliação nutricional subjetiva é método clínico de avaliação do estado nutricional, que considera não apenas alterações da composição corporal, mas também alterações funcionais do paciente. É processo simples, de baixo custo e não-invasivo, podendo ser realizado à beira do leito. Embora tenha sido desenvolvida para avaliar pacientes cirúrgicos, vários estudos mostram seu uso em outras situações clínicas, como pacientes com insuficiência renal, pacientes oncológicos, hepatopatas, geriátricos e HIV positivos. Objetivo -Revisar o uso da avaliação nutricional subjetiva em outras situações clínicas e estudos de intervenção. Métodos -Foi realizada revisão sistemática no MEDLINE utilizando o descritor "subjective global assessment" e selecionados os trabalhos mais relevantes. Resultados -Foram encontradas adaptações da avaliação nutricional subjetiva para seu uso em pacientes com insuficiência renal, pacientes oncológicos e hepatopatas, com bons resultados neste grupo de pacientes. Em estudos de intervenção em pacientes oncológicos, a avaliação nutricional subjetiva tem sido utilizada para identificar pacientes de maior risco nutricional e que necessitam de terapia nutricional agressiva. Poucos estudos de intervenção de pacientes cirúrgicos utilizaram a avaliação nutricional subjetiva como método para identificação do paciente de risco nutricional. Conclusão -A avaliação nutricional subjetiva tem se mostrado boa opção na avaliação nutricional de pacientes cirúrgicos e algumas modificações têm sido sugeridas para o uso do método também em outras especialidades. A experiência do observador é de extrema importância, uma vez que dela depende a precisão do método. DESCRITORES -Avaliação nutricional. Transtornos nutricionais. INTRODUÇÃOA avaliação nutricional subjetiva (ANS) é método clínico de avaliação do estado nutricional, desenvolvido por BAKER et al.(2) e DETSKY et al. (9) . Diferencia-se dos demais métodos de avaliação nutricional utilizados na prática clínica por englobar não apenas alterações da composição corporal, mas também alterações funcionais do paciente. Trata-se de método simples, de baixo custo e não-invasivo, podendo ser realizado à beira do leito. Apesar de possibilitar a participação de todos os membros da equipe multidisciplinar de terapia nutricional na realização da avaliação nutricional, é indispensável o treinamento adequado de todos os observadores que desejam praticá-la, pois sua precisão depende da capacidade do observador em detectar as alterações nutricionais significativas através da avaliação subjetiva. Por ser de fácil execução e boa repetibilidade, a ANS vem se tornando o método de escolha também em outras situações clínicas, seja na sua forma original ou após adaptações. Serão discutidos a seguir seu uso e resultado em diversas situações clínicas, assim como estudos de intervenção. Uso do método em diversas situações clínicasOriginariamente, a ANS foi desenvolvida e validada para pacientes cirúrgicos (2,8) , sendo posteriormente utilizada como método de avaliação nutri...

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Total Iron-Binding Capacity–Estimated Transferrin Correlates With the Nutritional Subjective Global Assessment in Hemodialysis Patients

Cited by 143 publications

References 33 publications

Trends in Anemia Management among US Hemodialysis Patients

Trends in Anemia Management among US Hemodialysis Patients

A Low, Rather than a High, Total Plasma Homocysteine Is an Indicator of Poor Outcome in Hemodialysis Patients

Avaliação nutricional subjetiva: Parte 2 - Revisão de suas adaptações e utilizações nas diversas especialidades clínicas

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