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Abstract Background Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown. Methods Fifty BC patients underwent TTE assessment before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of

Abstract Aging is commonly regarded as a physiological process in which the dynamic complexity of physiological time series and organ systems is gradually lost. This notion is derived from the identification of a decline of nonlinear measures with the advance of aging. However, additional research on cardiovascular control studied through heart rate variability (HRV), i.e., the instantaneous changes in heart rate, shows that despite the constriction of its statistical distribution, the nonlinear organization remains present in advanced age. Here, we used surrogate data testing to investigate the presence of nonlinear information in HRV time series from a publicly available database of 1121 healthy human subjects from 18 to 92 years old. We also studied the influence of basic clinical features, such as sex, body mass index (BMI), and mean heart rate (HR), on such nonlinear information. We found that the percentage of nonlinear time series after 30 years of age diminishes significantly (p

Introduction: Vertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation. Research question: What are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome? Materials and methods: A comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics (t-test, Mann-Whitney U test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures. Results: The review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions. Discussion: The mechanism of injury involved violent muscle contractions during seizures. Conclusion: This review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures.

Heart rate variability (HRV) is a noninvasive approach to studying the autonomic modulation of heart rate in experimental settings, such as active standing sympathetic stimulation. It is known that patients with end-stage renal disease during active standing have few changes in HRV dynamics, which are improved after hemodialysis. However, it is unknown whether the response to active standing is recovered after definitive treatment with kidney transplantation. This work aims to assess the change in HRV dynamics in the supine position and active standing through time and frequency-based metrics, as well as recurrence plot quantitative analysis (RQA). We studied HRV dynamics by obtaining 5-minute electrocardiographic recordings from kidney transplant recipients who underwent an active standing test. The mean duration of heartbeats and their standard deviation diminished in active standing, compared with the supine position. Also, the low-frequency component of HRV and the presence of diagonal and vertical structures in RQA were predominant. A larger estimated glomerular filtration rate was significantly correlated with broader HRV in the supine position and during active standing. The narrower HRV during active standing may indicate a sympathetic response to external stimuli, which is expected in a functional cardiovascular system, and may be influenced by renal function.

Since the COVID-19 pandemic, the world has experienced a large incidence of infections in short periods of time, giving rise to waves of contagion caused by the different variations of SARS-COV-2. Health services, as well as personnel, have been overwhelmed, especially in the poorest countries. Currently and after two years, the pandemic continues and according to experts it is here to stay, which highlights the importance of vaccines and methods of detecting the disease, to curb the number of infections and avoid that the pandemic continues to spread and thus the virus continues to mutate. Detection tests have been scarce and expensive for most of the population, so alternative methods to laboratory ones could be a decisive factor so that people can self-isolate before continuing to infect more people. One of the most effective methods have been statistical predictions of the diagnosis of COVID-19 in a patient, based on certain variables. In this article, it was identified that the most common prediction models were developed from logistic regression and machine-learning, which have shown high percentages of predicting test results for COVID-19. The most important predictor variables in the different models developed in various regions of the world were identified and the opportunities, limitations and perspectives of this prediction method are discussed.

ABSTRACT Analysis of the genes retained in the minimized Mycoplasma JCVI-Syn3A genome established that systems that repair or preempt metabolite damage are essential to life. Several genes known to have such functions were identified and experimentally validated, including 5-formyltetrahydrofolate cycloligase, coenzyme A (CoA) disulfide reductase, and certain hydrolases. Furthermore, we discovered that an enigmatic YqeK hydrolase domain fused to NadD has a novel proofreading function in NAD synthesis and could double as a MutT-like sanitizing enzyme for the nucleotide pool. Finally, we combined metabolomics and cheminformatics approaches to extend the core metabolic map of JCVI-Syn3A to include promiscuous enzymatic reactions and spontaneous side reactions. This extension revealed that several key metabolite damage control systems remain to be identified in JCVI-Syn3A, such as that for methylglyoxal. IMPORTANCE Metabolite damage and repair mechanisms are being increasingly recognized. We present here compelling genetic and biochemical evidence for the universal importance of these mechanisms by demonstrating that stripping a genome down to its barest essentials leaves metabolite damage control systems in place. Furthermore, our metabolomic and cheminformatic results point to the existence of a network of metabolite damage and damage control reactions that extends far beyond the corners of it that have been characterized so far. In sum, there can be little room left to doubt that metabolite damage and the systems that counter it are mainstream metabolic processes that cannot be separated from life itself.

Hypertension in Mexico has a prevalence of 32% and is the second most widespread cause of consultation in primary care. Only 40% of patients in treatment have a blood pressure (BP) below 140/90 mmHg. This clinical trial aimed to compare the effectiveness of the combination of enalapril and nifedipine versus the empirical treatment for hypertension in patients with uncontrolled BP in a primary care center in Mexico City. Participants were randomized to treatment with enalapril and nifedipine (combination group) or to continue with the empirical treatment. Outcome variables were BP control, therapeutic adherence, and adverse effects at 6 months of follow-up. At the end of the follow-up period, BP control (64% versus 77%) and therapeutic adherence (53% versus 93%) showed an improvement from the baseline values in the group that received the combination treatment. BP control (51% versus 47%) and therapeutic adherence (64% versus 59%) in the group who received the empirical treatment did not show improvement from the baseline to follow-up. Combined treatment was 31% more efficacious than conventional empirical treatment (odds ratio = 3.9), which yielded an incremental clinical utility of 18% with high tolerability extent among patients in primary care in Mexico City. These results contribute to the control of arterial hypertension.

Exploring the presence of nonlinearity through surrogate data testing provides insights into the nature of physical and biological systems like those obtained from heart rate variability (HRV). Short-term HRV time series are of great clinical interest to study autonomic impairments manifested in chronic diseases such as the end stage renal disease (ESRD) and the response of patients to treatment with hemodialysis (HD). In contrast to Iterative Amplitude Adjusted Fourier Transform (IAAFT), the Pinned Wavelet Iterative Amplitude Adjusted Fourier Transform (PWIAAFT) surrogates preserve nonstationary behavior in time series, a common characteristic of HRV. We aimed to test synthetic data and HRV time series for the existence of nonlinearity. Recurrence Quantitative Analysis (RQA) indices were used as discriminative statistics in IAAFT and PWIAAFT surrogates of linear stationary and nonstationary processes. HRV time series of healthy subjects and 29 ESRD patients before and after HD were tested in this setting during an active standing test. Contrary to PWIAAFT, linear nonstationary time series may be erroneously regarded as nonlinear according to the IAAFT surrogates. Here, a lower proportion of HRV time series was classified as nonlinear with PWIAAFT, compared to IAAFT, confirming that the nonstationarity condition influences the testing of nonlinear behavior in HRV. A contribution of nonlinearity was found in the HRV data of healthy individuals. A lower proportion of nonlinear time series was also found in ESRD patients, but statistical significance was not found. Although this proportion tends to be lower in ESRD patients, as much as 60% of time series proved to be nonlinear in healthy subjects. Given the important contribution of nonlinearity in HRV data, a nonlinear point of view is required to achieve a broader understanding of cardiovascular physiology.

Several heart rate variability (HRV) characteristics of patients with myocardial ischemia are associated with a higher mortality risk. However, the immediate effect of acute ischemia on the HRV nonlinear dynamical behavior is unknown. The objective of this work is to explore the presence of nonlinearity through surrogate data testing and describe the dynamical behavior of HRV in acutely induced ischemia by percutaneous transluminal coronary angioplasty (PTCA) with linear and recurrence quantification analysis (RQA). Short-term electrocardiographic recordings from 68 patients before and after being treated with elective PTCA were selected from a publicly available database. The presence of nonlinear behavior was confirmed by determinism and laminarity in a relevant proportion of HRV time series, in up to 29.4% during baseline conditions and 30.9% after PTCA without statistical difference between these scenarios. After PTCA, the mean value and standard deviation of HRV time series decreased, while determinism and laminarity values increased. Here, the diminishment in overall variability caused by PTCA is not accompanied by a change in nonlinearity detection. Therefore, the presence of nonlinear behavior in HRV time series is not necessarily in agreement with the change of traditional and RQA measures.

A better understanding of the genetic and metabolic mechanisms that confer stress resistance and tolerance in plants is key to engineering new crops through advanced breeding technologies. This requires a systems biology approach that builds on a genome-wide understanding of the regulation of gene expression, plant metabolism, physiology and growth. In this study, we examine the response to drought stress in Sorghum, as we leverage the tools for transcriptomics and plant metabolic modeling we have implemented at the U.S. Department of Energy Systems Biology Knowledgebase (KBase). KBase enables researchers worldwide to collaborate and advance research by uploading private or public data into the KBase Narrative Interface, analyzing it using a rich, extensible array of computational and data-analytics tools, and securely sharing scientific workflows and conclusions. We demonstrate how to use the current RNA-seq tools in KBase, applicable to both plants and microbes, to assemble and quantify long transcripts and identify differentially expressed genes effectively. More specifically, we demonstrate the utility of the platform by identifying key genes differentially expressed during drought-stress in Sorghum bicolor, an important sustainable production crop plant. We then show how we can use KBase tools to predict the membership of genes in metabolic pathways and examine expression data in the context of metabolic subsystems. We demonstrate the power of the platform by making the data, analysis and interpretation available to the biologists in the reproducible, re-usable, point-and-click format of a KBase Narrative thus promoting FAIR (Findable, Accessible, Interoperable and Reusable) guiding principles for scientific data management and stewardship.

Impaired baroreflex sensitivity (BRS) is partially responsible for erratic blood pressure fluctuations in End-Stage Renal Disease (ESRD) patients on chronic hemodialysis (HD), which is related to autonomic nervous dysfunction. The sequence method with delayed signals allows for the measurement of BRS in a non-invasive fashion and the investigation of alterations in this physiological feedback system that maintains BP within healthy limits. Our objective was to evaluate the modified delayed signals in the sequence method for BRS assessment in ESRD patients without pharmacological antihypertensive treatment and compare them with those of healthy subjects. We recruited 22 healthy volunteers and 18 patients with ESRD. We recorded continuous BP to obtain a 15-min time series of systolic blood pressure and interbeat intervals during the supine position (SP) and active standing (AS) position. The time series with delays from 0 to 5 heartbeats were used to calculate the BRS, number of data points, number of sequences, and estimation error. The BRS from the ESRD patients was smaller than in healthy subjects (p < 0.05). The BRS estimation with the delayed sequences also increased the number of data points and sequences and decreased the estimation error compared to the original time series. The modified sequence method with delayed signals may be useful for the measurement of baroreflex sensitivity in ESRD patients with a shorter recording time and maintaining an estimation error below 0.01 in both the supine and active standing positions. With this framework, it was corroborated that baroreflex sensitivity in ESRD is decreased when compared with healthy subjects.

Cardiovascular regulatory mechanisms that fail to compensate for ultrafiltration and cause hypovolemia during hemodialysis (HD) are not completely understood. This includes the interaction between the autonomic nervous system and the biochemistry that regulates blood pressure and modulates cardiac activity and vascular tone in response to hypovolemia in patients treated with HD. The objective was to evaluate the association of spectral indices of heart rate variability (HRV) with serum levels of angiotensin II, angiotensin 1–7, nitric oxide and total antioxidant capacity during HD. Electrocardiographic records were obtained from 20 patients during HD (3 h), from which HRV data and spectral power data in the very-low-frequency (VLF), low-frequency (LF) and high-frequency (HF) bands were generated. Three blood samples per patient were collected during HD (0.0, 1.5, 3.0 h) to determine the levels of biomarkers involved in the pressor response during HD. Angiotensin II had a positive correlation with VLF (r = 0.390) and with LF/HF (r = 0.359) and a negative correlation with LF (r = −0.262) and HF (r = −0.383). There were no significant correlations between HRV and the other biomarkers. These results suggest that during HD, VLF could reflect the serum levels of angiotensin II, which may be associated with the autonomic response to HD.

Background: Cerebral hypoperfusion before syncope has been shown in patients with chronic orthostatic intolerance (OI) without tachycardia, but it is unknown if an initial decrease of cerebral blood flow velocity (CBFv) could be related to the vasovagal response (VVR) to head-up tilt test (HUTT). Objective: The objective of the study was to compare cardiovascular, cerebrovascular, and autonomic variables during HUTT in OI patients with or without a VVR. Methods: We included 74 subjects (58% female, mean age 33 ± 12 years) who underwent a 30-min HUTT and were divided into three groups: OI with VVR positive (VVR+), OI without VVR negative (VVR−), and asymptomatic healthy subjects with negative HUTT (control group). Cardiovascular, cerebrovascular, and autonomic variables were assessed beat-to-beat during HUTT with a Task Force monitor and a trans-cranial Doppler. Mean values were evaluated at baseline and throughout the first 10 min of tilting. Results: Cardiovascular variables were similar in the three groups. Systolic, diastolic, and mean CBFv were similar in VVR+ and VVR−, but both groups had lower CBFv than the control group. Systolic and diastolic CBFv decreased from baseline since min 1 in VVR+ and VVR− and since min 5 in the control group. The mean CBFv had a significant decrease since min 1 compared to baseline in all groups. Spectral indices of heart rate and blood pressure variability showed a similar autonomic response to HUTT in all groups. Conclusion: Patients with chronic OI without tachycardia have early postural cerebral hypoperfusion, regardless of the VVR during HUTT.

Ocular complications are common among end-stage renal disease patients and some complications had been linked to increments of intraocular pressure (IOP) during hemodialysis. The changes of IOP during hemodiafiltration (HDF) have been scarcely investigated and the potential influence of the sodium dialysate concentration is unknown. The aim of this study was to compare the IOP changes during HDF with sodium dialysate concentration, either fixed or individualized. Thirteen end-stage renal disease patients participated in the study; they were treated with HDF using a dialysate sodium profile fixed at 138 mmol and another session with an individualized sodium profile. The intraocular pressure was measured before and after each session and every 30 min during HDF. Both groups had a similar HDF prescription, blood pressure, and biochemical parameters. At the end of hemodiafiltration, sodium concentration decreased only in the fixed sodium profile group. The number of patients with at least an episode of intraocular hypertension during HDF ranged from 5 (19%) to 8 (31%) without significant differences between right and left eye nor between dialysate sodium concentration. During HDF, there is a large variability of IOP; transient events of intraocular hypertension are highly prevalent in this sample, and they are not related to the sodium dialysate concentration.

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

Intradialytic hypotension occurs in 10–30% of hemodialysis (HD) sessions. This phenomenon affects the cardiovascular system’s functions, which are reflected in the activity of the autonomic nervous system (ANS). To indirectly assess the ANS during HD, we analyzed the mean R–R intervals and the spectral power of heart rate variability (HRV) from 20 end-stage renal disease patients divided into hypotensive and non-hypotensive groups. The spectrotemporal analysis was accomplished using short-time Fourier transform with 10 min epochs of HRV overlapping by 40%. The spectral power was divided into three segments according to high frequency, low frequency, and very low frequency bandwidths and averaged to fit quadratic regression models. The analysis of the mean R–R intervals showed significant differences between the groups (p = 0.029). The power variation over time was significant in each spectral band (p ≪ 0.05). The average power, maximum power, and time when the peak was reached differed for each band and between groups, showing the ability to correctly identify the decompensation of the ANS and discriminate between hypotensive and non-hypotensive patients. Additionally, the changes in the sympathovagal ratio were not significant and very scattered for the hypotensive group (p = 0.23) compared to the non-hypotensive group, where the changes were significant (p ≪ 0.05) and much less scattered.

Most methods for sudden cardiac death (SCD) prediction require long-term (24 h) electrocardiogram recordings to measure heart rate variability (HRV) indices or premature ventricular complex indices (with the heartprint method). This work aimed to identify the best combinations of HRV and heartprint indices for predicting SCD based on short-term recordings (1000 heartbeats) through a support vector machine (SVM). Eleven HRV indices and five heartprint indices were measured in 135 pairs of recordings (one before an SCD episode and another without SCD as control). SVMs (defined with a radial basis function kernel with hyperparameter optimization) were trained with this dataset to identify the 13 best combinations of indices systematically. Through 10-fold cross-validation, the best area under the curve (AUC) value as a function of γ (gamma) and cost was identified. The predictive value of the identified combinations had AUCs between 0.80 and 0.86 and accuracies between 80 and 86%. Further SVM performance tests on a different dataset of 68 recordings (33 before SCD and 35 as control) showed AUC = 0.68 and accuracy = 67% for the best combination. The developed SVM may be useful for preventing imminent SCD through early warning based on electrocardiogram (ECG) or heart rate monitoring.

Objective: To characterize the multifractal behavior of the beat to beat heart-period or RR fluctuations in fibromyalgia patients (FM) in comparison with healthy-matched subjects.Methods: Multifractral detrended fluctuation analysis (MDFA) was used to study multifractality in heartbeat times-series from 30 female healthy subjects and 30 female patients with fibromyalgia during day and night periods.The multifractal changes as derived from the magnitude and sign analysis of these RR fluctuations were also assessed.Results: The RR fluctuations dynamics of healthy subjects showed a broad multifractal spectrum. By contrast, a noticeable decrease in multifractality and non-linearity was observed for patients with fibromyalgia. In addition, the spectra corresponding to FM subjects were located on the average to the right of the spectra of healthy individuals, indicating that the local scaling exponents reflect a smoother behavior compared to healthy dynamics. Moreover, the multifractal analysis as applied to the magnitude and sign heartbeat series confirmed that, in addition to a decreased nonlinearity, fibromyalgia patients presented stronger anticorrelation in directionality, which did not remain invariant for small or rather larger fluctuations as it occurred in healthy subjects.Conclusion: When compared to healthy controls, fibromyalgia patients display decreased nonlinearity and stronger anticorrelations in heart period fluctuations. These findings reinforce the hypothesis of the potential role of the dysfunctional autonomic nervous system in the pathogenesis of fibromyalgia.

Pharmacoepidemiological research about antibiotics is supported by the World Health Organization (WHO), but data regarding antibiotic prevalence based on actual prescriptions and dosing patterns are insufficient. The aims were: (i) To estimate the prevalence and prescribed daily dose (PDD) of antibiotics in outpatients from Mexico City and (ii) to compare the PDD against the defined daily dose (DDD), as established by the WHO. The study included 685 prescriptions of antibiotics selected randomly from five geographical zones of Mexico City. Drug, dose, frequency, and duration of treatment were obtained from each prescription. PDD values of each antibiotic drug were calculated as the average of the daily doses. Sub-use and overuse were determined by the ratio PDD/DDD for each prescription. The most prescribed antibiotics to outpatients from Mexico City included six pharmacological groups: quinolones (28%), penicillins (23%), cephalosporins (17%), macrolides (10%), lincosamides (9%), and sulfonamides (4%). Both overuse and sub-use were high (55% and 63%, respectively). In conclusion, most of the antibiotics with a high prevalence of prescription also had a high rate of either sub-use or overuse, with prescribed doses that significantly differ with their corresponding DDD. The dosing variation has important clinical implications since it denotes low prescription control.

Linear heart rate variability (HRV) indices are dependent on the mean heart rate, which has been demonstrated in different models (from sinoatrial cells to humans). The association between nonlinear HRV indices, including those provided by recurrence plot quantitative analysis (RQA), and the mean heart rate (or the mean cardiac period, also called meanNN) has been scarcely studied. For this purpose, we analyzed RQA indices of five minute-long HRV time series obtained in the supine position and during active standing from 30 healthy subjects and 29 end-stage renal disease (ESRD) patients (before and after hemodialysis). In the supine position, ESRD patients showed shorter meanNN (i.e., faster heart rate) and decreased variability compared to healthy subjects. The healthy subjects responded to active standing by shortening the meanNN and decreasing HRV indices to reach similar values of ESRD patients. Bivariate correlations between all RQA indices and meanNN were significant in healthy subjects and ESRD after hemodialysis and for most RQA indices in ESRD patients before hemodialysis. Multiple linear regression analyses showed that RQA indices were also dependent on the position and the ESRD condition. Then, future studies should consider the association among RQA indices, meanNN, and these other factors for a correct interpretation of HRV.

Aortic-valve sclerosis increases cardiovascular mortality risk and precedes aortic-valve stenosis, but its mechanisms are not well understood. The purpose of this study was to compare the cardiac autonomic modulation and inflammation markers between subjects with aortic-valve normal leaflets and subjects with aortic-valve sclerosis. According to 2-D transthoracic echocardiograms, 61 middle-aged volunteers without chronic or acute illnesses were classified in two groups: with no aortic-valve sclerosis (NAVS, N = 16) and with aortic-valve sclerosis (AVS, N = 45). An electrocardiogram at the supine position and active standing was collected to estimate heart rate variability (HRV) indices. A blood sample was obtained to quantify markers of inflammation. Compared to NAVS, AVS subjects showed higher levels of IL-6 (1619 ± 650 vs. 1169 ± 676 pg/mL, p = 0.044) as well as TNFα (370.8 ± 182.0 vs. 247.3 ± 188.2 pg/mL, p = 0.032), and larger low-frequency (LF) to high-frequency (HF) ratio during supine position (Ln(LF/HF) = 0.85 ± 0.85 vs. 0.11 ± 0.69, p = 0.003). Multiple logistic regression analysis showed that AVS was independently associated with LF/HF, TNFα and left ventricle mass index (p < 0.05). In conclusion, a significant reduction of the parasympathetic-driven cardiac modulation and low-grade inflammation occurs in aortic-valve sclerosis.

Appetite level evaluated by the appetite and diet assessment tool (ADAT) is associated with several clinical and nutritional variables. Our aim was to expand the study to psychological variables (depression symptoms, anxiety symptoms, and distorted thinking). We studied 96 chronic kidney disease patients treated with hemodialysis three times per week. Representative variables are shown as median (percentile 25–percentile 75) or absolute values. DRI = daily recommended intake. Appetite level Very poor, poor (N=10) Fair, Good (N=31) Very Good (N=55) Tau Sex (F/M) 9 / 1 12 / 19* 22 / 33* -- Age (years) 65 (46–2) 50 (29–65) 47 (33–58)* −0.18& Creatinine (mg/dL) 7.4 (6.9–8.6) 11.1 (8.0–13.9)* 11.3 (9.4–13.0)* Kt/V 1.5 (1.3-1.6) 1.4 (1.2-1.5) 1.4(1.2-1.5) −0.03 Albumin (g/dL) 3.5 (3.3-3.9) 3.6 (3.5-3.8) 3.6 (3.5-3.8) 0.09 DRI (%) 78 (74–88) 88 (80–99)* 101 (99–103)* 0.54& Anxiety score 12 (12–20) 9 (4–16)* 5 (3–10)* –0.26 & ⁎ p < 0.05 versus poor or poor appetite, Mann-Whitney or chi2 test. & p < 0.05, correlation with appetite level (Kendall´s Tau coefficient) Very poor or poor appetite level was associated with female sex, older age, lower creatinine, lower DRI, and higher anxiety symptoms. Intervention of anxiety with cognitive behavioral therapy could improve nutritional treatment among vulnerable patients.