Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Tufan, Fatih; Yıldız, Abdülmecit; Doğan, İbrahim; Yıldız, Demet; Sevinir, Şeniz

doi:10.3109/13685538.2014.908281

Cited by 19 publications

(25 citation statements)

References 30 publications

(31 reference statements)

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“…A high fever and high CRP level might reflect the extent of inflammation . Meanwhile, the value of BUN is not clear, but we presume that it indicates dehydration, renal dysfunction and increased catabolism, which might have the negative impact of aggravating the infection.…”

Section: Discussionmentioning

confidence: 89%

“…13,14 A high fever and high CRP level might reflect the extent of inflammation. 15 Meanwhile, the value of BUN is not clear, but we presume that it indicates dehydration, 16 renal dysfunction and increased catabolism, 17 which might have the negative impact of aggravating the infection. The CURB-65 pneumonia severity score is one of the main scoring systems for evaluating the risk of mortality with CAP.…”

Section: Discussionmentioning

confidence: 91%

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Novel algorithm for management of acute epididymitis

et al. 2016

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Abbreviations & Acronyms BP = blood pressure BPH = benign prostatic hyperplasia BT = body temperature BUN = blood urea nitrogen CAP = community-acquired pneumonia CRP = C-reactive protein DBP = diastolic blood pressure DM = diabetes mellitus Hb = hemoglobin HR = heart rate LDH = lactate dehydrogenase LUTS = lower urinary tract symptoms PLT = platelet SBP = systolic blood pressure SIRS = systemic inflammatory response syndrome TUR-P = transurethral resection of the prostate WBC = white blood cell Objectives: To identify predictive factors for the severity of epididymitis and to develop an algorithm guiding decisions on how to manage patients with this disease. Methods: A retrospective study was carried out on 160 epididymitis patients at Keio University Hospital. We classified cases into severe and non-severe groups, and compared clinical findings at the first visit. Based on statistical analyses, we developed an algorithm for predicting severe cases. We validated the algorithm by applying it to an external cohort of 96 patients at Tokyo Medical Center. The efficacy of the algorithm was investigated by a decision curve analysis. Results: A total of 19 patients (11.9%) had severe epididymitis. Patient characteristics including older age, previous history of diabetes mellitus and fever, as well as laboratory data including a higher white blood cell count, C-reactive protein level and blood urea nitrogen level were independently associated with severity. A predictive algorithm was created with the ability to classify epididymitis cases into three risk groups. In the Keio University Hospital cohort, 100%, 23.5%, and 3.4% of cases in the high-, intermediate-, and low-risk groups, respectively, became severe. The specificity of the algorithm for predicting severe epididymitis proved to be 100% in the Keio University Hospital cohort and 98.8% in the Tokyo Medical Center cohort. The decision curve analysis also showed the high efficacy of the algorithm. Conclusions: This algorithm might aid in decision-making for the clinical management of acute epididymitis.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Novel algorithm for management of acute epididymitis

et al. 2016

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“…While obesity is a risk factor for the progression of disease in hemodialysis patients, malnutrition is related to increased morbidity and mortality rates. Hemodialysis is associated with increased energy and protein requirements [8]. Hemodialysis patients are often exposed to a number of dietary restrictions related to dietary phosphorus, potassium, sodium, fluid intake, and macronutrients, including carbohydrate and fat [10].…”

Section: Discussionmentioning

confidence: 99%

“…Adverse changes in fluid-electrolyte balance (hyperkalemia, hyperphosphatemia, peripheral and pulmonary edema) can be seen in patients who do not comply with their diet. The purpose of dietary therapy for patients undergoing hemodialysis treatment is to provide an optimal nutritional status and prevent malnutrition without disturbing the fluid-electrolyte balance or increasing uremic symptoms [8]. Consumptions of excessive fat, excessive salt or insufficient fiber may lead to atherogenic results in dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Nutritional Status of Hemodialysis Patients in Istanbul/Turkey

2019

AJUN

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Background: This study aims to determine protein, sodium, potassium, phosphorus consumptions and energy intake in endstage renal disease (ESRD) patients undergoing hemodialysis 3 times a week and compare these quantities with recommended requirements. Methods: This study was conducted with 198 end-stage renal disease patients between the ages of 20 and 65 who underwent hemodialysis 3 times a week. Data were obtained via a survey form and Food Frequency Questionnaire. Results: No significant relationship was identified between gender and protein consumption (p>0.05). However, a significant relationship was found between the body mass indices (BMI) and protein consumption of the patients (p<0.05); when groups were compared, protein consumption reduced while the BMI increased (p<0.01). When age and protein consumption were examined, protein consumption was found to be higher in patients aged 20-44 as compared to patients aged 56-65 (p<0.05). Conclusion: The protein consumption and energy intake of hemodialysis patients appears to be below the recommended level. This suggests that hemodialysis patients are receiving insufficient nutrition in Istanbul/Turkey. Hemodialysis patients should be given better nutritional education and their nutritional status should be optimized.

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“…Of note, we did not assess fluid/volume status in our cohort and therefore could not differentiate which stimulus may have been most important in increasing copeptin levels in patients with elevated NRS scores [18] . A study conducted by Tufan et al [19] found that in addition to routinely used markers of malnutrition, the urea/creatinine ratio may provide additional information on malnutrition in a population of hemodialysis patients. Our findings indicating significant association of malnutrition with urea but not with creatinine support that hypothesis.…”

Section: Perspectives From Other Studiesmentioning

confidence: 99%

Unraveling the Link between Malnutrition and Adverse Clinical Outcomes: Association of Acute and Chronic Malnutrition Measures with Blood Biomarkers from Different Pathophysiological States

Felder¹,

Braun²,

Stanga

et al. 2016

Ann Nutr Metab

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Background and Aims: Malnutrition is associated with poor clinical outcomes. Whether there is a causal relationship or it merely mirrors a severe patient condition remains unclear. We examined the association of malnutrition with biomarkers characteristic of different pathophysiological states to better understand the underlying etiological mechanisms. Methods: We prospectively followed consecutive adult medical inpatients. Multivariable regression models were used to investigate the associations between malnutrition - as assessed using the Nutritional Risk Screening (NRS 2002) - and biomarkers linked to inflammation, stress, renal dysfunction, nutritional status and hematologic function. Results: A total of 529 patients were included. In a fully adjusted model, malnutrition was significantly associated with the inflammatory markers procalcitonin (0.20, 95% CI 0.03-0.37), proadrenomedullin (0.28, 95% CI 0.12-0.43) and albumin (-0.39, 95% CI -0.57 to -0.21), the stress marker copeptin (0.34, 95% CI 0.17-0.51), the renal function marker urea (0.23, 95% CI 0.07-0.38), the nutritional markers vitamin D25 (-0.22, 95% CI -0.41 to -0.02) and corrected calcium (0.29, 95% CI 0.10-0.49) and the hematological markers hemoglobin (-0.27, 95% CI -0.43 to -0.10) and red blood cell distribution width (0.26, 95% CI 0.07-0.44). Subgroup analysis suggested that acute malnutrition rather than chronic malnutrition was associated with elevated biomarker levels. Conclusion: Acute malnutrition was associated with a pronounced inflammatory response and an alteration in biomarkers associated with different pathophysiological states. Interventional trials are needed to prove causality.

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Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Abstract: In addition to routinely used markers of malnutrition UCR may provide additional information regarding malnutrition in this population.

Cited by 19 publications

References 30 publications

Novel algorithm for management of acute epididymitis

Novel algorithm for management of acute epididymitis

Investigation of Nutritional Status of Hemodialysis Patients in Istanbul/Turkey

Unraveling the Link between Malnutrition and Adverse Clinical Outcomes: Association of Acute and Chronic Malnutrition Measures with Blood Biomarkers from Different Pathophysiological States

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