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Protein-energy wasting (PEW) and poor health-related quality of life (HRQoL) are independently associated with morbi-mortality in continuous ambulatory peritoneal dialysis (CAPD). PEW may reduce HRQoL; however, we hypothesized HRQoL is affected differentially by PEW degrees or by individual criteria of nutritional status. AIM: To evaluate HRQoL according to PEW severity and nutritional status indicators in CAPD. This is a cross-sectional study in 151 patients. Subjective global assessment (SGA) was employed, and nutritional status classified as normal, mild-moderate PEW, and severe PEW. HRQoL was evaluated using Kidney Disease Quality of Life Short Form™, including physical (PCS), mental (MCS) and kidney disease (KDCS) components, and their subscales. Dietary intake, anthropometric and biochemical variables were measured. Forty-six percent of patients were well-nourished, 44% had mild-moderate PEW, and 10% severe PEW. Compared with well-nourished patients, those with mild-moderate (p=0.06) and severe (p=0.005) PEW had lower HRQoL score [68 (52-75), 55 (45-72), 46 (43-58), respectively]. PCS, MCS, and KDCS and their subscales had lower values as PEW was more severe. Patients with obesity and hypoalbuminemia had significantly lower HRQoL overall and component scores than their counterparts. Dietary intake was not associated with quality of life. In multivariate analysis obesity, PEW (by SGA), hypoalbuminemia, and low educational level predicted poor HRQoL (χ2 58.2, p

Summary Background & aims Evidence suggests that multiple-behavior interventions (with a specialist) have a greater impact on public health than single-behavior interventions, particularly in a chronic patient. However, there is little understanding of some very basic principles concerning multiple health behavior change, especially in situations such as kidney transplantation, which requires a great willingness to change negative lifestyle behaviors to achieve intermediate and long-term success. We compared healthy lifestyles and nutritional status according to the willingness to change dietary and exercise behavior in dialysis patients from a living donor kidney transplant program. Methods 400 dialysis patients had a dietetic, anthropometric, protein-energy wasting [subjective global assessment (SGA)] and biochemical evaluation. Lifestyle was evaluated with an adapted instrument to measure lifestyle in chronic disease. Willingness to change behaviors was evaluated by the trans-theoretical model; 2 groups were formed: willingness to change dietary and exercise behaviors and unwillingness to change. Results Willingness to change dietary behavior was 50% and exercise 25%. Patients with willingness to change dietary and exercise behaviors had better healthy lifestyle scores, and higher frequency of healthy food consumption. Healthy lifestyle score (R2=0.37, p Conclusions Willingness to change dietary and exercise behaviors was associated with healthy lifestyle, as well as with higher frequency of healthy food consumption and with lower frequency of unhealthy food consumption.

Increased muscle protein catabolism leading to muscle wasting is a prominent feature of the syndrome of protein-energy wasting (PEW) in patients with chronic kidney disease (CKD). PEW and muscle wasting are induced by factors such as inflammation, oxidative stress and metabolic acidosis that activate theubiquitin–proteasome system, the main regulatory mechanism of skeletal muscle degradation. Whether deficiency of nuclear factor erythroid 2-related factor 2 (NRF2), which regulates expression of antioxidant proteins protecting against oxidative damage triggered by inflammation, may exacerbate PEW has yet to be examined in aging patients with CKD. This review focuses on the hypothesis that NRF2 is involved in the maintenance of muscle mass and explores whether sustained activation of NRF2 by non-pharmacological interventions using nutraceutical activators to improve redox homeostasis could be a plausible strategy to prevent skeletal muscle disorders, including muscle wasting, sarcopenia and frailty associated with PEW in aging CKD patients.Graphical abstract

Objective The aim of this study was to evaluate the interaction between diet quality and interleukin (IL)-6 genotypes and its association with metabolic and renal function parameters in Mexican patients with type 2 diabetes mellitus (T2DM). Design and Methods Using an analytical cross-sectional design, 219 patients with T2DM (92 men; age 62 ± 10 years) were evaluated for selected metabolic and renal function parameters. Diet quality according to the Healthy Eating Index was evaluated and classified as good diet or poor diet in all patients. IL-6 serum concentrations and genotypes and haplotypes for IL6–597G > A (rs180097), –572G > C (rs180096), and –174G > C (rs180095) polymorphisms were determined. Results Eighty-two percent of patients reported having a poor diet. Carriers of alleles –572C and –174C showed higher high-density lipoprotein cholesterol levels (44 ± 12 vs. 40 ± 9 mg/dL; P = .01) and lower total cholesterol levels (184 ± 33 vs. 197 ± 42 mg/dL; P = .03) than did those homozygous for G/G. Neither IL6 genotypes nor haplotypes were significantly associated with serum concentrations of IL-6. Some significant interactions between IL6 genotypes/haplotypes and diet quality were associated with body mass index, waist circumference, high-density lipoprotein cholesterol levels, and estimated glomerular filtration rate. Conclusions Interactions between diet quality and IL6 genotypes/haplotypes were associated with the main metabolic and renal function parameters in Mexican patients with T2DM. It will be important to consider genetic profiles in designing dietary portfolios and nutritional interventions for the management of such patients.

The aim of this study was to validate a direct taste perception test (TPT) and evaluate its performance in patients on dialysis.This cross-sectional study was carried out in a tertiary-care hospital. A TPT was validated on 112 healthy subjects and applied on 43 patients on hemodialysis and 32 patients on peritoneal dialysis. All participants were presented a 10-mL sample to identify and rate intensity of primary tastes: sweet (sucrose 2%), sour (citric acid 0.1%), bitter (caffeine 0.06%), salty (sodium chloride 0.5%), and umami (sodium glutamate 0.25%). The internal consistency and repeatability of TPT was assessed by Cronbach's alpha and intraclass correlation coefficient. Chi-square and Mann-Whitney U tests were used to compare groups.TPT had Cronbach's alpha of 0.77. Intraclass correlation coefficient was 0.74 for sweet, P.0001; 0.57 for salty, P = .001; 0.62 for sour, P.0001; 0.78 for bitter, P.0001; and 0.76 for umami, P.0001. Compared with controls, patients on peritoneal dialysis were less able to identify sweet and umami tastes (P.05) and marginally (P = .06) sour taste, whereas patients on hemodialysis were marginally (P = .06) less able to identify sweet and salty tastes. Bitter was not differently identified between groups. According to the visual analog scale (0-10), all patients on dialysis perceived sour taste less intensely than control subjects (P.05).This TPT for patients on dialysis had adequate reliability to identify five primary tastes in a clinical setting. Except for bitter taste, perception of all the primary tastes was altered in patients on dialysis compared with control subjects. A broader use of this test would help identify taste alterations and implement strategies for malnutrition.

Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). In diabetes, changes in serum levels of both soluble alpha Klotho (sKL) and fibroblast growth factor 23 (FGF-23) have been associated with CKD progression.To evaluate the associations of circulating levels of sKL and FGF-23 with the presence of early nephropathy (EN) in diabetic patients.A cross-sectional study in 136 Mexicans with type 2 diabetes mellitus (T2DM). Early nephropathy was defined as an estimated glomerular filtration rate (≥60 ml/min) and urinary albumin excretion (≥30 mg/g). Serum concentrations of sKL and FGF-23 were measured using ELISA. Associations were evaluated with multiple logistic regression.Fifty-two subjects had EN. Median values of sKL and FGF-23 for all individuals were 244 pg/mL (interquartile range [IQR]: 201-402) and 92 pg/mL (IQR: 39-507), respectively. A positive correlation was found between levels of sKL and FGF-23 (r = 0.38; p 0.001). FGF-23 levels correlated negatively with angiotensin-II receptor blocker therapy (ARB, r = 0.24; p 0.01). Subjects without EN were younger (59 vs. 63 years old, p = 0.02). Elevated concentrations of FGF-23 were negatively associated with EN (Odds Ratio [ORIn Mexican diabetic patients, serum levels of FGF-23 were positively correlated with sKL but negatively correlated with ARB therapy. In addition, a higher concentration of FGF-23 reduced the odds of early nephropathy in patients with T2DM.