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Nutrition, inflammation and oxidative stress - CKD 5D

2012; Oxford University Press; Volume: 27; Issue: suppl 2 Linguagem: Inglês

10.1093/ndt/gfs228

1460-2385

Len A. Usvyat, Jochen G. Raimann, Stephan Thijssen, Frank M. van der Sande, Jeroen P. Kooman, N. W. Levin, Peter Kotanko, Gero von Gersdorff, Megan L. Schaller, Inga Bayh, Michael Etter, Aileen Grassmann, Adrián Guinsburg, Jeroen P. Kooman, Maggie Lam, Daniele Marcelli, Cristina Marelli, Laura Scatizzi, Adam P. Tashman, Stephan Thijssen, Ted Toffelmire, Len A. Usvyat, Frank M. van der Sande, Y. Wang, N. W. Levin, C. Barth, Peter Kotanko, T. Moffitt, T. Moffitt, Florence Hariton, M. Devlin, Peter Garrett, Mary P.A Hannon-Fletcher, Maryam Ekramzadeh, Zahra Sohrabi, Masoud Salehi, Mohammad Kazem Fallahzadeh, Mohammad Ayatollahi, Bita Geramizadeh, Jafar Hassanzadeh, Mohammad Mahdi Sagheb, Ilia Beberashvili, Ilia Beberashvili, Inna Sinuani, Ada Azar, Hadas Kadoshi, Galina Shapiro, Laurent J. Feldman, Zhan Averbukh, Joshua Weissgarten, Yuichi Abe, Masashi Watanabe, Kazuhiro Ito, Y. Sasatomi, Satoru Ogahara, H. Nakashima, Tsunehiro Saito, Sarah Witt, Rudolf Kunze, H.-J. Guth, Horst Skarabis, Rudolf Kunze, Jörg Vienken, Piotr Nowak, Renata Wilk, Beata Mamełka, Anna Prymont-Przymińska, Anna Zwolińska, Agata Sarniak, Anna Włodarczyk, Jacek Rysz, Damian Nowak, Lada Trajceska, Pavlina Dzekova‐Vidimliski, S. Gelev, S. Arsov, Aleksandar Sikole, M. Sonikian, Anthony C. Dona, I. Skarakis, Polixeni Metaxaki, Christos Chiotis, Ioannis Papoutsis, A Karaitianou, Chara Spiliopoulou, Daniele Marcelli, Adam P. Tashman, Adrián Guinsburg, Aileen Grassmann, C. Barth, Cristina Marelli, Frank M. van der Sande, Gero von Gersdorff, Inga Bayh, Jeroen P. Kooman, Laura Scatizzi, Maggie Lam, Megan L. Schaller, Michael Etter, Stephan Thijssen, Ted Toffelmire, Y. Wang, Len A. Usvyat, Peter Kotanko, N. W. Levin, Daniel Teta, Daniel Teta, Luc Tappy, Nicolas Theumann, G Halabi, Theresa W. Gauthier, Chantal Mathieu, Sophie Tremblay, P. Coti, Michel Burnier, Anne Zanchi, A. Martinez Vea, Carmen Cabré, D. Villa, Miguel Ponce Muñoz, J. P. Vives, Mercedes Arruche, Joan Soler, Maria Teresa Compte, José Aguilera, Marta Romeu, Mercedes Giralt, Guillermina Barril, S Anaya, C Vozmediano, A. Celayeta, R Novillo, Victor Bernal, I. Beiret, Emma Huarte, Julio César Molina Martín, Helena Maria Pinheiro Sant’Ana, German Torres, Fernanda Severo Sabedra Sousa, Roberto Méndez Sánchez, Aurora López-Montes, Fernando Tornero, Jesús Playán Usón, Marcelo Pousa, Martín Giorgi, B. Rdez Cubillo, Rakesh Malhotra, Rakesh Malhotra, Len A. Usvyat, ShapouriMoghadam Abbas, S. Thjissen, M. Carter, Michael Etter, Adam P. Tashman, Adrián Guinsburg, Aileen Grassmann, C. Barth, Cristina Marelli, Frank M. van der Sande, Gero von Gersdorff, Inga Bayh, Jeroen P. Kooman, Laura Scatizzi, Maggie Lam, Megan L. Schaller, Ted Toffelmire, Y. Wang, Daniele Marcelli, Nathan W. Levin, Peter Kotanko, Ruth Jens, Martin Tepel, Katharina Eberhard, Andrea Hulina, F. Simone, Simone Florian, Oana Slușanschi, Liliana Gârneaţă, Raluca Maria Moraru, Eugen A. Preoteasa, C. Barbulescu, C. Santimbrean, Claudia Klein, Diana Dragomir, Gabriel Mircescu, Thomas Idorn, Filip K. Knop, Jens J. Holst, Mads Hornum, Bo Feldt‐Rasmussen, YOUNGHO SON, Wei An, S. E. Kim, K. H. Kim, Liliana Gârneaţă, Oana Slușanschi, Eugen A. Preoteasa, C. Barbulescu, C. Santimbrean, Claudia Klein, Gabriel Mircescu, Silvio Borrelli, Roberto Minutolo, Luca De Nicola, G. Conte, Walter De Simone, Bruno Zito, P. Guastaferro, F. Nigro, Anna Maria Bassi, Ludovica Leone, Olga Credendino, Raffaele Genualdo, Marianna Capuano, Giuseppe Iulianiello, Maria Rita Auricchio, Sevilay Sezer, Zeynep Bal, Emre Tutal, Murathan Uyar, Fatma Nurhan Özdemir, Susan Pereira Ribeiro, Maria Faria, Fabiana Cristina Silveira Alves de Melo, José Sereno, Isabel Freitas, Mariana Orlandini Mendonça, Henrique Nascimento, Jolyn Fernandes, Petronila Rocha‐Pereira, Vasco Miranda, Denisa Mendonça, Alexandre Quintanilha, Luı́s Belo, Eduardo Caldas Costa, Flavia C. G. Reis, Alice Santos‐Silva, Rodolfo Valtuille, María Elisa Casos, Elisa Fernandez,

Sodium Intake and Health

Introduction and Aims: Higher creatinine levels in dialysis patients are associated with higher muscle mass, insufficient dialysis adequacy or a decline in residual renal function (RRF).We aimed to understand association between changes in creatinine levels and patient outcomes in incident hemodialysis patients with no RRF.Methods: We studied all incident hemodialysis (HD) patients treated in RRI clinics who had their first in-center treatment between 1/2000 and 12/2010.Only patients who survived the first 12 months on HD were included.Patients' baseline serum creatinine was computed as an average over the first 3 months.Slope of serum creatinine was computed on a per patient basis using simple linear regression of available creatinine values between months 4 and 12 from the start of treatment.Patients were stratified based on (a) their baseline creatinine (group 1: < 5 mg/dL; group 2: 5 to 8 mg/dL; group 3: > 8 mg/dL) and (b) the average rate of change in creatinine computed by simple linear regression (declined: < -2 mg/dL/year; stable: -2 to 2 mg/dL/year; increased: > 2 mg/dL/year).Patients were then stratified into 9 groups of baseline creatinine levels and creatinine changes.Only patients with no RRF at the start of dialysis were included.Further, for patients whose creatinine increased or declined, only patients with a significant p-value for the slope were included.Patient survival was assessed in months 13 to 18 from the start of dialysis.Cox proportional hazards model adjusted for age, gender, race, ethnicity, diabetic status, access type, BMI, albumin, systolic blood pressure, body temperature, nPCR, eKt/V, interdialytic weight gain, urea distribution volume, and slope of interdialytic weight gain in months 4 to 12 were constructed to compute associations of creatinine as well as creatinine changes and survival.Results: We studied 2333 patients.In a Cox model that includes only the baseline creatinine levels and not its trend, patients with creatinine < 5 ml/dL had a borderline significant association with poorest survival (HR = 1.43, 95% CI: 0.99-2.06,p = 0.06) compared to reference group (creatinine 5 to 8 mg/dL); no difference between creatinine 5 to 8 mg/dL and > 8 mg/dL was observed.In a model that includes the creatinine trend but not the baseline values, an increase of creatinine in months 4 to 12 was borderline significantly associated with improved survival (HR = 0.67, 95% CI: 0.45-1.02,p = 0.06) compared to the reference group (stable creatinine); no difference between declining and stable levels was observed.Lowest HRs were observed in patients with baseline creatinine 5 to 8 mg/dL and > 8 mg/dL and in who the serum creatinine increased (HR = 0.50, p < 0.05; HR = 0.13, p < 0.05, respectively).Creatinine in the first 3 months was positively associated with nPCR ( p < 0.05); slope of creatinine was positively associated with slope of interdialytic weight gain ( p < 0.05); both alluding to higher creatinine values associated with improved nutrition.Conclusions: In incident HD patients lower creatinine levels at baseline ( < 5 mg/dL) are associated with poorer survival.Increases in creatinine levels in patients with baseline creatinine > 5 mg/dL are associated with improved outcomes ( particularly in patients starting with creatinine > 8 mg/dL).It appears that increases in muscle mass ( possibly due to better nutrition) are primarily responsible for increases in creatinine.