Validation of formulas calculating normalized protein catabolic rate in patients undergoing home hemodialysis

Casino, Francesco Gaetano; Deira, Javier; Roblero, María Fernanda Slon; Sanchidrián, Silvia González; Domínguez, Sandra Gallego; Bilbao, Itziar Castaño; Vega, Cristina García de la; Aguilar, José Carlos Aguilar; Rocha, Anastácia Guimarães; Basile, Carlo

doi:10.1007/s40620-023-01674-0

Cited by 2 publications

(5 citation statements)

References 12 publications

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“…The protein catabolic rate (PCR) was calculated from the pre-dialysis BUN concentration (C 0 ; mg/dl) and the Kt/V [ 20 ], based on a two-BUN measurement, single-pool, variable-volume model by the following formula, for patients dialysed thrice weekly and especially for a C 0 measured after the long dialysis-free interval at the beginning of the week:…”

Section: Methodsmentioning

confidence: 99%

Sex hormone binding globulin (SHBG) serum levels and insulin resistance in men on chronic hemodialysis

Nikolaou,

Tziastoudi,

Gougoura

et al. 2024

Diabetol Metab Syndr

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Background In males with end stage renal disease biochemical hypogonadism is a frequent finding. Testosterone and sex hormone binding globulin (SHBG) have been associated with insulin resistance, a well-known condition in uremia. The aim of the present study was to investigate in males on chronic hemodialysis the relationship of testosterone and SHBG serum levels with insulin resistance. Methods In a cross-sectional study we enrolled men treated with chronic hemodialysis who did not suffer from an acute illness or other endocrinopathy, as well as primary hypogonadism, and were not hospitalised. Diabetes mellitus, diabetic nephropathy or previous transplantation were not exclusion criteria. As controls we used a community-based group of healthy males matched for age and Body Mass Index (BMI). We assessed the BMI (kg/m2) from body weight and height, the body fat content (%) by bioelectrical impedance and serum testosterone (ng/ml), SHBG (nmol/L) and estradiol (pg/ml) by standard methods. Testosterone < 3.25 ng/ml defined biochemical hypogonadism. In non-diabetic males, we calculated the homeostasis model assessment index (HOMA-R), an estimate of insulin resistance, from serum fasting insulin and glucose. Results 27 men (age 54.4 ± 19 years) on chronic hemodialysis (treatment duration 29.1 ± 14.4 months) and 51 healthy men (age 47.1 ± 9.6 years) were included. In men on hemodialysis vs. healthy men there were increased serum levels of SHBG (40.9 ± 26.9 vs. 27.6 ± 11.9 nmol/L; p = 0.031) and a significantly enhanced frequency of biochemical hypogonadism (22.2 vs. 3.9%; p = 0.011). In cases without diabetes (n = 22) a significant correlation was observed between the HOMA-R (r = -0.586, p = 0.004) and the fasting insulin levels (r = -0.650, p = 0.001) on the one hand and the serum SHBG levels on the other. Conclusions Our findings confirm enhanced prevalence of biochemical hypogonadism in males on chronic hemodialysis. In non-diabetic cases the serum levels of SHBG correlated with serum insulin and insulin resistance.

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Section: Methodsmentioning

confidence: 99%

Sex hormone binding globulin (SHBG) serum levels and insulin resistance in men on chronic hemodialysis

Nikolaou,

Tziastoudi,

Gougoura

et al. 2024

Diabetol Metab Syndr

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“…Inclusion criteria were: (i) already being on HHD; and (ii) the availability of at least one complete dataset for UKM analysis with SS [ 7 ]. Most patients were on frequent dialysis regimens; various combinations of schedules and treatment times were used to obtain a stdKt/V higher than 2.1 [ 9 ]. The HHD sessions were performed with Physidia S3 monitors (PALEX ® , Spain) and NxStage ® SystemOne monitors (Fresenius Medical Care, Spain).…”

Section: Methodsmentioning

confidence: 99%

“…A total of 231 clinical datasets suitable for UKM analysis and associated with available bimonthly monitoring sessions were retrieved from local electronic clinical databases. It must be underlined that the basic methodological concepts developed in our recent paper constitute the background of the present study [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

“…As detailed elsewhere [ 9 ], we prepared a dialysis simulation plan. To illustrate the structure of our simulation plan, carried out with the version 1.19 of the ‘What-if’ module of SS [ 10 ], it is useful to specify that the input dataset of this software requires, among other things, the indication of the treatment schedule, i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Very recently, we published a study that aimed to validating formulas calculating normalized protein catabolic rate (PCRn) in patients undergoing HHD performed with low-flow dialysate devices [ 9 ]. As a further development of this kinetic modelling study, we explored the possibility of establishing a new formula for estimating stdKt/V that can be easily solved to provide the required dialysis dose (eKt/V_req) to achieve the stdKt/V target of 2.3 in patients undergoing HHD.…”

Section: Introductionmentioning

confidence: 99%

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Prescribing the dialysis dose and treatment frequency in home haemodialysis

Casino,

Roblero,

González-Sanchidrian

et al. 2023

Nephrology Dialysis Transplantation

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Background There is growing interest in home haemodialysis (HHD) performed with low-flow dialysate devices and variable treatment schedules. The target standard Kt/V (stdKt/V) should be 2.3 volumes/week, according to KDOQI guidelines (2015). The current formula for stdKt/V does not help prescribe the dialysis dose (eKt/V) and treatment frequency (TF). Aim of the study was to obtain a formula for stdKt/V able to define the minimum required values of eKt/V and TF to achieve the targeted stdKtV. Methods Thirty-eight prevalent patients on HHD were enrolled. A total of 231 clinical datasets were available for urea modeling using the Solute Solver software (SS), recommended by KDOQI guidelines. A new formula (stdKt/V = a + b x Kru + c x eKt/V) was obtained from multivariable regression analysis of stdKt/V vs. eKt/V and residual kidney urea clearance (Kru). The values of coefficients a, b, and c depend on the treatment schedules and the day of the week of blood sampling for the kinetic study (labdayofwk) and then vary for each of their foreseen 62 combinations. For practical purposes, we used only 7 combinations, assuming Monday as a labdayofwk for each of the most common schedules of the 7 days of the week. Results The stdKt/V values obtained with SS were compared with the paired ones obtained with the formula. The means±SD stdKt/V values obtained with SS and the formula were 3.043±0.530 and 2.990±0.553, respectively, with 95% confidence interval from +0.15 to -0.26. A “prescription graph” was built using the formula to draw lines expressing the relationship between Kru and required eKt/V for each TF. Using this graph, TF could have been reduced from the delivered 5.8±0.8 to 4.8±0.8 weekly sessions. Conclusions The new formula for stdKtV is reliable and can support clinicians to prescribe the dialysis dose and TF in patients undergoing HHD.

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Validation of formulas calculating normalized protein catabolic rate in patients undergoing home hemodialysis

Cited by 2 publications

References 12 publications

Sex hormone binding globulin (SHBG) serum levels and insulin resistance in men on chronic hemodialysis

Sex hormone binding globulin (SHBG) serum levels and insulin resistance in men on chronic hemodialysis

Prescribing the dialysis dose and treatment frequency in home haemodialysis

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