Carla Lemos

Body adiposity index assess body fat with high accuracy in nondialyzed chronic kidney disease patients

High body fat (BF) is an alarming condition that also affects nondialyzed chronic kidney disease (CKD) patients. Distinct methods are used to evaluate BF; however, in CKD population it remains unclear which one is more reliable showing high accuracy. Dual‐energy X‐ray absorptiometry (DXA), used as reference method to estimate adiposity, is expensive and time consuming to be applied in clinical settings. Recently, a new body adiposity index (BAI), that estimates BF from easily accessible measures, was validated in the general population. The aim of this study was to evaluate which simple and practical method, routinely used to estimate BF, shows the highest accuracy compared with DXA, in nondialyzed CKD patients.

Waist-to-height ratio: An accurate anthropometric index of abdominal adiposity and a predictor of high HOMA-IR values in nondialyzed chronic kidney disease patients

OBJECTIVE Chronic kidney disease (CKD) is associated with metabolic disorders, including insulin resistance (IR), mainly when associated with obesity and characterized by high abdominal adiposity (AbAd). Anthropometric measures are recommended for assessing AbAd in clinical settings, but their accuracies need to be evaluated. The aim of this study was to evaluate the precision of different anthropometric measures of AbAd in patients with CKD. We also sought to determine the AbAd association with high homeostasis model assessment index of insulin resistance (HOMA-IR) values and the cutoff point for AbAd index to predict high HOMA-IR values. METHODS A subset of clinically stable nondialyzed patients with CKD followed at a multidisciplinary outpatient clinic was enrolled in this cross-sectional study. The accuracy of the following anthropometric indices: waist circumference, waist-to-hip ratio, conicity index and waist-to-height ratio (WheiR) to assess AbAd, was evaluated using trunk fat, by dual x-ray absorptiometry (DXA), as a reference method. HOMA-IR was estimated to stratify patients in high and low HOMA-IR groups. The total area under the receiver-operating characteristic curves (AUC-ROC; sensitivity/specificity) was calculated: AbAd with high HOMA-IR values (95% confidence interval [CI]). RESULTS We studied 134 patients (55% males; 54% overweight/obese, body mass index ≥ 25 kg/m(2), age 64.9 ± 12.5 y, estimated glomerular filtration rate 29.0 ± 12.7 mL/min). Among studied AbAd indices, WheiR was the only one to show correlation with DXA trunk fat after adjusting for confounders (P < 0.0001). Thus, WheiR was used to evaluate the association between AbAd with HOMA-IR values (r = 0.47; P < 0.0001). The cutoff point for WheiR as a predictor for high HOMA-IR values was 0.55 (AUC-ROC = 0.69 ± 0.05; 95% CI, 0.60-0.77; sensitivity/specificity, 68.9/61.9). CONCLUSIONS WheiR is recommended as an effective and precise anthropometric index to assess AbAd and to predict high HOMA-IR values in nondialyzed patients with CKD.

Agreement between anthropometry and bioelectrical impedance for measuring body fat in nonobese and obese nondialyzed chronic kidney disease patients.

OBJECTIVES We investigated reproducibility and agreement between anthropometry (ANT) and bioelectrical impedance (BIA) in nonobese and obese nondialyzed chronic kidney disease (CKD) patients, and examined the factors influencing the agreement between these two methods. PATIENTS AND METHODS One hundred and five clinically stable CKD patients, comprising stages 3 and 4 of CKD, had their body fat (BF) assessed by ANT and BIA. Patients were stratified into nonobese (body mass index [BMI] <25 kg/m(2), n = 48, 26 males, aged 64.5 +/- 13.6 years) and overweight/obese (BMI > or =25 kg/m(2), n = 57, 35 males, aged 63.1 +/- 12.1 years; +/-SD in all values) groups. RESULTS In the nonobese group, BF as assessed by ANT was similar to body fat as assessed by BIA (11.4 +/- 3.8 kg vs 11.7 +/- 4.1 kg, respectively, no significance). The concordance correlation coefficient (CCC) was indicative of good reproducibility for males (0.67; 95% confidence interval [CI], 0.41 to 0.83) and females (0.88; 95% CI, 0.71 to 0.95), and the mean inter-method difference between ANT and BIA and limits of agreement were -0.9 (-6.8 to 4.9) kg for males, and 0.4 (-3.4 to 4.3) kg for females. In the overweight/obese group, a weak CCC was observed for males (0.46; 95% CI, 0.26 to 0.62) and females (0.53; 95% CI, 0.29 to 0.70), and the mean inter-method difference between both methods was 5.7 (-3.2 to 14.7) kg for males, and 6.4 (-1.8 to 14.7) kg for females. In the multiple regression analysis (adjusted r(2) = 0.42, n = 105), BMI, sex, body water, and age were independent determinants of the agreement between ANT and BIA. CONCLUSIONS For nonobese patients, ANT and BIA can be applied equally well for assessing BF. For overweight/obese patients a weak agreement was observed. Body mass index, sex, body water, and age were the factors influencing the agreement between ANT and BIA.

Bone disease in patients with chronic kidney disease under conservative management

CONTEXT AND OBJECTIVE Few studies have focused on bone disease in patients with chronic kidney disease under conservative treatment. The objective was to evaluate bone disease in patients with chronic kidney disease. DESIGN AND SETTING Case series, at the Nephrology Division, Hospital Universitário Pedro Ernesto. METHODS 131 patients with creatinine clearance from 10 to 60 ml/min/1.73 m(2) were followed up for at least one year. Serum creatinine, albumin, calcium, phosphorus, alkaline phosphatase, total CO2 (tCO2), intact parathyroid hormone (iPTH), and alkaline phosphatase were measured. Creatinine clearance was calculated from 24-hour urine creatinine measurements and protein ingestion estimates from urea assays. RESULTS Patients presenting creatinine clearance < 30 ml/min/1.73 m(2) had higher iPTH values, but normal serum levels for calcium, phosphorus, alkaline phosphatase and tCO2. Patients presenting iPTH values of twice the normal upper limit (144 pg/ml) showed lower tCO2 values. Bone alkaline phosphatase was evaluated in 37 patients with creatinine clearance < 30 ml/min/1.73 m(2), showing correlation with alkaline phosphatase but not with parathyroid hormone. Bone biopsy on nine patients with creatinine clearance < 30 ml/min/1.73 m(2) and iPTH > 144 pg/ml showed osteitis fibrosa (4), mild lesion (4) and high turnover (1). CONCLUSION The present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.

Hipertrofia ventricular esquerda em pacientes com doença renal crônica em tratamento conservador

A doenca cardiovascular (DCV) permanece sendo uma das maiores causas de morte em pacientes com doenca renal cronica (DRC). A hipertrofia ventricular esquerda (HVE) esta presente em 75% dos pacientes ao iniciarem dialise, sugerindo que esta deve estar presente precocemente no curso da DRC. Poucos estudos avaliaram a prevalencia de HVE na pre-dialise. Foram avaliados 309 pacientes clinicamente estaveis em acompanhamento por pelo menos tres meses em cinco Centros no Brasil. Perfil bioquimico e marcadores inflamatorios foram avaliados. Dados sao [...]

Gender-related differences in kidney of rats with chronic renal failure

Chronic renal failure is characterized by adaptive mechanisms secondary to the loss of functioning nephrons. Clinical and experimental studies suggest participation of gender-related hormones on renal function and progression of chronic renal failure. We evaluated the effect of castration on renal alterations in male and female Wistar control rats and after 30 days of chronic renal failure (CRF) induced by 5/6 nephrectomy. The CRF male group showed higher proteinuria. Glomerular hypertrophy was similar among groups. Podocyte morphology showed disorders of foot processes and thickening of the basement membrane in the CRF male group. The CRF female group showed fewer alterations compared to males. Castration changed the profile in CRF male animals and the filtration barrier was preserved. CRF males showed the presence of alfa-smooth muscle actin suggesting an early prefibrotic event in this group. After castration this phenomenon was not observed. Noteworthy, in females, castration exacerbated the presence of alfa-smooth muscle actin. In summary, proteinuria was higher in males and appeared early in the course of CRF, probably contributing to fibrotic events. Data were influenced by gender suggesting that male sex hormones aggravate renal alterations.