Anastasia Markaki

The role of serum magnesium and calcium on the association between adiponectin levels and all-cause mortality in end-stage renal disease patients.

Background Adiponectin (ADPN) is the most abundant adipocyte-specific cytokine that plays an important role in energy homeostasis by regulating lipid and glucose metabolism. Studies of the impact of ADPN on clinical outcomes have yielded contradictory results so far. Here, we examined the association of ADPN with serum magnesium (s-Mg) and calcium (s-Ca) levels and explored the possibility whether these two factors could modify the relationship between ADPN and all-cause mortality in patients with end-stage renal disease. Methodology/Principal Findings After baseline assessment, 47 hemodialysis and 27 peritoneal dialysis patients were followed- up for a median period of 50 months. S-Mg and s-Ca levels emerged as positive and negative predictors of ADPN levels, respectively. During the follow-up period 18 deaths occurred. There was a significant 4% increased risk for all-cause mortality for each 1-µg/ml increment of ADPN (crude HR, 1.04; 95% CI, 1.01–1.07), even after adjustment for s-Mg and s-Ca levels, dialysis mode, age, albumin and C-reactive protein. Cox analysis stratified by s-Mg levels (below and above the median value of 2.45 mg/dl) and s-Ca levels (below and above the median value of 9.3 mg/dl), revealed ADPN as an independent predictor of total mortality only in the low s-Mg and high s-Ca groups. Furthermore, low s-Mg and high s-Ca levels were independently associated with malnutrition, inflammation, arterial stiffening and risk of death. Conclusions/Significance The predictive value of ADPN in all-cause mortality in end-stage renal disease patients appears to be critically dependent on s-Mg and s-Ca levels. Conversely, s-Mg and s-Ca may impact on clinical outcomes by directly modifying the ADPN’s bioactivity.

A LONGITUDINAL STUDY OF NUTRITIONAL AND INFLAMMATORY STATUS IN PATIENTS ON DIALYSIS

OBJECTIVE Several anthropometric, laboratory and bioelectrical impedance parameters of nutritional status and inflammation are often used as prognostic indices in patients on dialysis. Their longitudinal assessment is necessary for the estimation of their true prognostic value. We aim to estimate this prognostic value in better-nourished dialysis patients, which are commonly under-represented in pertinent studies. METHODS The design is a prospective case series. Pertinent parameters were studied three times during a 20-month period in 47 haemodialysis (HD) and 27 peritoneal dialysis (PD) patients with a low malnutrition-inflammation score (MIS). Mortality rate was assessed three years after the initial evaluation. Correlation coefficients were calculated between mortality rate, the studied parameters and their alteration. RESULTS Serum albumin of less than 40 g/l was strongly correlated with mortality risk. The alteration of studied parameters during a short period of time does not allow for long-term prediction of mortality risk. CONCLUSION Serum albumin had the strongest predictive value of all the pertinent parameters in the study. Thus, better conjugate clinical and laboratory measurements should be developed for patients on PD, as well as for those with a relatively low MIS.

Adiponectin and end-stage renal disease.

Adiponectin (ADPN) is an adipokine with significant anti-inflammatory, insulin-sensitizing and anti-atherogenic properties, which is generally associated with a beneficial cardiometabolic profile. Paradoxically, end-stage renal disease (ESRD) is characterized by markedly increased plasma ADPN levels and increased cardiovascular risk. In spite of the cardioprotective properties attributed to adiponectin, cardiovascular complications remain the main cause of mortality in the ESRD population. Furthermore, these patients have enhanced chronic inflammation, increased insulin resistance and persistent protein-energy wasting. Studies of the impact of ADPN on clinical outcomes among ESRD patients have so far yielded contradictory results. This review article summarizes the current knowledge on ADPN functions and explores the role of ADPN in ESRD patients, with specific focus on inflammation, insulin resistance, cardiovascular disease and wasting.

Practice learning a prelude to work: studies by DIETS2

Purpose – The aim of this study is to describe placement learning opportunities for student dietitians related to future fields of work. Design/methodology/approach – An online questionnaire determined the variety and duration of pre-qualifying practice placements across Europe. Responses from members of the Thematic Network DIETS2 in Europe (n = 39) were analysed. Findings – A response rate of 61 per cent from 19 countries (39 higher education institutions or national dietetic associations) is reported. Four sub-types of placement are used by the respondents for pre-qualifying dietetic students. Placements are in public health, education and social care (28 per cent); clinical (27 per cent); catering (20 per cent) and others (25 per cent), including the food industry. Median number of weeks in the location was 12 for clinical settings; 5 for health, education and social care; 4.5 for in catering and up to 7 weeks in other locations. Research limitations/implications – If dietitians and nutritionists are ...

Associations of adiponectin and leptin levels with protein-energy wasting, in end stage renal disease patients

OBJECTIVE The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW. DESIGN Prospective (18 months). SETTING University Hospital of Heraklion, Crete, Greece. SUBJECTS Seventy-four end-stage-renal-disease patients, 47 on HD and 27 on PD. MAIN OUTCOME MEASURES At three sequential time points (baseline, 6 and 18 months) anthropometric, nutritional and inflammatory status data were collected. Serum adiponectin and leptin were also assessed at each time point. Patients were allocated to 3 strata according to PEW severity (0, 1-2 and ≥3 criteria for PEW). RESULTS Adiponectin and leptin levels were greater among PD compared to HD patients (p≤0.035). Adiponectin levels were incrementally greater across increasing strata of PEW (p≤0.002). Leptin showed the opposite trend, with lower levels in malnourished patients and higher levels in patients with zero PEW criteria (p≤0.042). Alterations of adiponectin levels during the observation period were dependent on PEW stratum (p≤0.021) and mode of dialysis (p≤0.002), after adjustment for age, dialysis vintage, gender and fat mass index. Particularly, adiponectin levels increased over time in HD patients with ≥3 criteria for PEW, whereas adiponectin levels decreased in PD patients with ≥3 criteria for PEW throughout the study. Leptin alterations over time were not affected by dialysis mode or PEW stratification. CONCLUSIONS Our study provides evidence that increased adiponectin and decreased leptin levels are independently associated with PEW and thus, poor prognosis.

Through the Patients’ Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care

Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient’s quality of life. This is why it is important to explore patient experiences concerning the rendered care. However, limited up-to-date studies have addressed this issue. The aim of the present study was to stress the experiences of ESRD patients concerning the provided nursing care in the hemodialysis unit at the University Hospital in Heraklion, Crete. A qualitative methodological approach was used, based on the principles of phenomenological epistemology. Semi-structured interviews were conducted, and open-ended questions were applied to record how patients experienced the rendered care during dialysis. The recorded data were analyzed via qualitative content analysis, which revealed three main themes: ‘Physical Care’, ‘Psychological Support’ and ‘Education’. Patients’ views were conceptualized into sub-themes within each main theme. The interviews revealed the varied and distinct views of ESRD patients, indicating that the rendered care should be individualized.

Original articleAssociations of adiponectin and leptin levels with protein-energy wasting, in end stage renal disease patientsAsociaciones de las concentraciones de adiponectina y leptina con el desgaste proteico-energético en pacientes con nefropatía terminal

Objective The aim of the study was to examine the prevalence of protein-energy wasting (PEW) in hemodialysis (HD) and peritoneal dialysis (PD) patients in our center and determine whether adiponectin and leptin are involved in the development of PEW.

Exploring the quality of European dietetic practice placements

Purpose – The purpose of this paper is to evaluate the quality of dietetic practice placements in European higher education institutions (HEIs). Design/methodology/approach – An online questionnaire was used to investigate adherence to the European Dietetic Practice Placement Standards. Supporting documents were assessed against the “Guide to best practice” criteria. Findings – The questionnaire response rate was 39 out of 67 DIETS2 partners, representing 19 European countries. According to the questionnaire, the majority of HEIs have a formal agreement regarding roles and responsibilities on practice placement. They have clear learning outcomes, policies, standards and procedures to test, approve and monitor practice placements. However, less than half HEIs provide support and training for supervisors. Practice placement documentations from 16 European HEIs were assessed against the 15 “Guide to best practice” criteria. Only 1 HEI met all 15 criteria. The range of the rest HEIs fell between 1-14 criteria...

A systematic review and meta-analysis of weight status among adolescents in Cyprus: scrutinizing the data for the years 2000-2010.

OBJECTIVEThe aim of the present study was to evaluate by pooled and sensitivity analyses all available data on adolescent overweight/obesity in Cyprus.DESIGNA thorough literature search determined the studies to be examined using Cypriot adolescent samples aged 10–18 years old, with weight status in each sex classified according to the IOTF criteria, published between the years 2001–2011. Eight studies were retrieved, but three fulfilled the criteria for the sensitivity analyses.RESULTSThe pooled prevalence of obesity was 9.8% in boys (n=6081). The pooled analysis classified 6.1% (n=3886) of girls as obese, whereas a higher prevalence was observed by the sensitivity analysis 6.4% (n = 1956, p ≤0.001). The boys’ prevalence of overweight was 19.3% and the girls’ 17.1%. Between sexes, boys demonstrated a higher prevalence of obesity and overweight (p ≤0.001 for both). The cumulative analyses demonstrated an increase in the prevalence of overweight/obesity until the year 2005 and thereafter a plateauing in boys and a slight decrease in girls in a non-linear manner.CONCLUSIONApproximately 1/3 of adolescent boys and 1/4 of adolescent girls in Cyprus were overweight/obese during the previous decade.

Weight status of adolescents in Cyprus: seizing the problem

Objective: The aim of the present study was to synthetize (pooled analysis) and evaluate (sensitivity analysis) all available data on adolescent overweight/obesity in Cyprus. Design : A thorough literature search defined the studies using Cypriot adolescent samples aged 10-18 years old, with weight status in each sex classified according to the IOTF criteria, published between the years 2001-2011. Eight studies were retrieved, but three fulfilled the criteria for the sensitivity analyses. Results: The pooled prevalence of obesity was 9.8% in the boys (n=6081). The pooled analysis classified 6.1% (n=3886) of the girls as obese, whereas a higher prevalence was retrieved by the sensitivity analysis 6.4% (n=1956, p≤0.001). The boys’ prevalence of overweight was 19.3% and the girls’ 17.1%. Between sexes, the boys demonstrated a higher prevalence of obesity and overweight (p≤0.001 for both). The cumulative analyses demonstrated an increase in the prevalence of overweight/obesity until the year 2005 and thereafter a stabilization in the boys and a slight non-linear decrease in the girls. Conclusion: Approximately 1/3 of the adolescent boys and 1/4 of the girls in Cyprus were overweight/obese during the previous decade.