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1. Extracellular overhydration linked with endothelial dysfunction in the context of inflammation in haemodialysis dependent chronic kidney disease.

Author

Nicos Mitsides, Tom Cornelis, Natascha J H Broers, Nanda M P Diederen, Paul Brenchley, Frank M van der Sande, Casper G Schalkwijk, Jeroen P Kooman, and Sandip Mitra

Subjects
Medicine, Science
Abstract

Haemodialysis (HD) patients are predisposed to dysregulated fluid balance leading to extracellular water (ECW) expansion. Fluid overload has been closely linked with outcome in these patients. This has mainly been attributed to cardiac volume overload, but the relation between abnormalities in fluid status with micro- and macrovascular dysfunction has not been studied in detail. We studied the interaction of macro- and microvascular factors in states of normal and over- hydration in HD-dependent CKD.Fluid compartments [total body water (TBW) and ECW] and overhydration index (OH) were measured with Multifrequency bio-impedance (BCM). Overhydration was defined as OH/ECW>7%. Overhydration was also assessed using the ECW/TBW ratio. Macrocirculation was assessed by pulse-wave velocity (PWV) and mean arterial pressure (MAP) measurements while microcirculation through sublingual capillaroscopy assessment of the Perfused Boundary Region of the endothelial glycocalyx (PBR 5-25mcg). A panel of pro-inflammatory and vascular serum biomarkers and growth factors was analysed.Of 72 HD participants, 30 were in normohydration (N) range and 42 overhydrated according to the OH/ECW ratio. Average ECW/TBW was 0.48±0.03. Overhydrated patients had higher MAP (122.9±22.5 v 111.7±22.2mmHg, p = 0.04) and comorbidities (median Davies score 1.5 v 1.0, p = 0.03). PWV (p = 0.25) and PBR 5-25mcg (p = 0.97) did not differ between the 2 groups. However, Vascular Adhesion Molecule (VCAM)-1, Interleukin-6 and Thrombomodulin, and reduced Leptin were observed in the overhydrated group. Elevation in VCAM-1 levels (OR 1.03; 95% CI 1.01-1.06; p = 0.02) showed a strong independent association with OH/ECW>7% in an adjusted logistic regression analysis and exhibited a strong linear relationship with ECW/TBW (Bata = 0.210, p = 0.03) in an also adjusted model.Extracellular fluid overload is significantly linked to microinflammation and markers of endothelial dysfunction. The study provides novel insight in the cardiovascular risk profile associated with overhydration in uraemia.

Published
2017
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2. Health-related quality of life in end-stage renal disease patients: the effects of starting dialysis in the first year after the transition period

Author

Nanda M. P. Diederen, Natascha J. H. Broers, Frank Stifft, Bernard Canaud, Frank M. van der Sande, Tom Dejagere, Jeroen P. Kooman, Remy J.H. Martens, Tom Cornelis, Joris J. J. M. Wirtz, Karel M.L. Leunissen, Constantijn J.A.M. Konings, Marc M. H. Hermans, Interne Geneeskunde, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: MA Med Staf Artsass Interne Geneeskunde (9), Promovendi NTM, RS: CARIM - R3.02 - Hypertension and target organ damage, MUMC+: CCZ Hemodialyse (9), and MUMC+: MA Nefrologie (9)

Subjects
Male, CHRONIC KIDNEY-DISEASE, Nephrology, PREDICTOR, Health-related quality of life, medicine.medical_treatment, 030232 urology & nephrology, HEMODIALYSIS-PATIENTS, Walking, End-stage renal disease, INITIATION, 0302 clinical medicine, Quality of life, Surveys and Questionnaires, Longitudinal Studies, 030212 general & internal medicine, education.field_of_study, Middle Aged, SUBSEQUENT DISABILITY, humanities, FUNCTIONAL STATUS, HOSPITALIZATION, Female, Adult, medicine.medical_specialty, Urology, Population, Physical activity, End stage renal disease, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Nephrology - Original Paper, Humans, education, Dialysis, Aged, Health related quality of life, business.industry, Physical Activity, medicine.disease, Comorbidity, LOWER-EXTREMITY FUNCTION, Cross-Sectional Studies, PHYSICAL-ACTIVITY, Quality of Life, Kidney Failure, Chronic, COMORBIDITY, business
Abstract

Background/aims Prevalent dialysis patients have low scores of health-related quality of life (HRQOL) which are associated with increased risk of hospitalization and mortality. Also in CKD-5 non-dialysis patients, HRQOL scores seem to be lower as compared with the general population. This study firstly aimed to compare HRQOL between CKD-5 non-dialysis and prevalent dialysis patients in a cross-sectional analysis and to assess longitudinal changes over 1 year after the dialysis initiation. Secondly, the correlation between HRQOL and physical activity (PA) was explored. Methods Cross-sectional 44 CKD-5 non-dialysis, 29 prevalent dialysis, and 20 healthy controls were included. HRQOL was measured by Short Form-36 questionnaires to measure physical and mental domains of health expressed by the physical component summary (PCS) and mental component summary (MCS) scores. PA was measured by a SenseWear™ pro3. Longitudinally, HRQOL was assessed in 38 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before dialysis initiation until 1 year after dialysis initiation. Results PCS scores were significantly lower both in CKD-5 non-dialysis patients and in prevalent dialysis patients as compared with healthy controls (p

Published
2018

3. Body Composition in Dialysis Patients: A Functional Assessment of Bioimpedance Using Different Prediction Models

Author

Natascha J. H. Broers, Nanda M. P. Diederen, Jeroen P. Kooman, Peter Wabel, Remy J.H. Martens, Frank M. van der Sande, Tom Cornelis, Karel M.L. Leunissen, Interne Geneeskunde, and RS: NUTRIM - R3 - Chronic inflammatory disease and wasting

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Urology, Nutritional Status, Medicine (miscellaneous), Adipose tissue, Dialysis patients, Peritoneal dialysis, Fat mass, Renal Dialysis, Electric Impedance, medicine, Humans, Renal Insufficiency, Chronic, Nutrition and Dietetics, Hand Strength, business.industry, Walking test, Middle Aged, Nutrition Surveys, medicine.disease, Confidence interval, Body Fluids, Surgery, Adipose Tissue, Nephrology, Sarcopenia, Body Composition, Exercise Test, Female, Hemodialysis, business, human activities
Abstract

OBJECTIVES: The assessment of body composition (BC) in dialysis patients is of clinical importance given its role in the diagnosis of malnutrition and sarcopenia. Bioimpedance techniques routinely express BC as a 2-compartment (2-C) model distinguishing fat mass (FM) and fat-free mass (FFM), which may be influenced by the hydration of adipose tissue and fluid overload (OH). Recently, the BC monitor was introduced which applies a 3-compartment (3-C) model, distinguishing OH, adipose tissue mass, and lean tissue mass. The aim of this study was to compare BC between the 2-C and 3-C models and assess their relation with markers of functional performance (handgrip strength [HGS] and 4-m walking test), as well as with biochemical markers of nutrition. METHODS: Forty-seven dialysis patients (30 males and 17 females) (35 hemodialysis, 12 peritoneal dialysis) with a mean age of 64.8 +/- 16.5 years were studied. 3-C BC was assessed by BC monitor, whereas the obtained resistivity values were used to calculate FM and FFM according to the Xitron Hydra 4200 formulas, which are based on a 2-C model. RESULTS: FFM (3-C) was 0.99 kg (95% confidence interval [CI], 0.27 to 1.71, P = .008) higher than FFM (2-C). FM (3-C) was 2.43 kg (95% CI, 1.70-3.15, P < .001) lower than FM (2-C). OH was 1.4 +/- 1.8 L. OH correlated significantly with DeltaFFM (FFM 3-C - FFM 2-C) (r = 0.361; P < .05) and DeltaFM (FM 3-C - FM 2-C) (r = 0.387; P = .009). HGS correlated significantly with FFM (2-C) (r = 0.713; P < .001), FFM (3-C) (r = 0.711; P < .001), body cell mass (2-C) (r = 0.733; P < .001), and body cell mass (3-C) (r = 0.767; P < .001). Both physical activity (r = 0.456; P = .004) and HGS (r = 0.488; P = .002), but not BC, were significantly related to walking speed. CONCLUSIONS: Significant differences between 2-C and 3-C models were observed, which are partly explained by the presence of OH. OH, which was related to DeltaFFM and DeltaFM of the 2-C and 3-C models, is therefore an important parameter for the differences in estimation of BC parameters of the 2-C and 3-C models. Both FFM (3-C) and FFM (2-C) were significantly related to HGS. Bioimpedance, HGS, and the 4-m walking test may all be valuable tools in the multidimensional nutritional assessment of both hemodialysis and peritoneal dialysis patients.

Published
2015

4. Physical Activity in End-Stage Renal Disease Patients: The Effects of Starting Dialysis in the First 6 Months after the Transition Period

Author

Joris J. J. M. Wirtz, Natascha J. H. Broers, Marc M. H. Hermans, Nanda M. P. Diederen, Jeroen P. Kooman, Peter Wabel, Remy J.H. Martens, Frank Stifft, Tom Cornelis, Bernard Canaud, Karel M.L. Leunissen, Frank M. van der Sande, Tom Dejagere, Constantijn J.A.M. Konings, Interne Geneeskunde, RS: NUTRIM - R3 - Respiratory & Age-related Health, RS: NUTRIM - R1 - Metabolic Syndrome, MUMC+: MA Med Staf Artsass Interne Geneeskunde (9), Promovendi NTM, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, MUMC+: MA Nefrologie (9), MUMC+: CCZ Hemodialyse (9), Afdeling Onderwijs FHML, and RS: CARIM - R3.02 - Hypertension and target organ damage

Subjects
CHRONIC KIDNEY-DISEASE, Male, Time Factors, Stage 5 chronic kidney disease, medicine.medical_treatment, 030232 urology & nephrology, HEMODIALYSIS-PATIENTS, 030204 cardiovascular system & hematology, urologic and male genital diseases, AMBULATORY PERITONEAL-DIALYSIS, End-stage renal disease, MUSCLE STRENGTH, 0302 clinical medicine, Risk Factors, Longitudinal Studies, Hand Strength, SUBSEQUENT DISABILITY, Middle Aged, Clinical Practice: Original Paper, Energy expenditure, Body Composition, Female, Adult, medicine.medical_specialty, BODY-COMPOSITION, Physical activity, Dialysis patients, End stage renal disease, 03 medical and health sciences, INTERNATIONAL COHORT, Renal Dialysis, Internal medicine, medicine, OLDER ADULTS, Humans, Exercise, Dialysis, Aged, business.industry, SENSEWEAR ARMBAND, Walking Speed, Preferred walking speed, LOWER-EXTREMITY FUNCTION, Cross-Sectional Studies, Physical performance, Case-Control Studies, Physical therapy, Kidney Failure, Chronic, business, Energy Metabolism
Abstract

Objectives: Physical inactivity in end-stage renal disease (ESRD) patients is associated with increased mortality, and might be related to abnormalities in body composition (BC) and physical performance. It is uncertain to what extent starting dialysis influences the effects of ESRD on physical activity (PA). This study aimed to compare PA and physical performance between stage 5 chronic kidney disease (CKD-5) non-dialysis and dialysis patients, and healthy controls, to assess alterations in PA during the transition from CKD-5 non-dialysis to dialysis, and to relate PA to BC. Methods: For the cross-sectional analyses 44 CKD-5 non-dialysis patients, 29 dialysis patients, and 20 healthy controls were included. PA was measured by the SenseWear™ pro3. Also, the walking speed and handgrip strength (HGS) were measured. BC was measured by the Body Composition Monitor©. Longitudinally, these parameters were assessed in 42 CKD-5 non-dialysis patients (who were also part of the cross-sectional analysis), before the start of dialysis and 6 months thereafter. Results: PA was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. HGS was significantly lower in dialysis patients as compared to that in healthy controls. Walking speed was significantly lower in CKD-5 non-dialysis patients as compared to that in healthy controls but not as compared to that in dialysis patients. Six months after starting dialysis, activity related energy expenditure (AEE) and walking speed significantly increased. Conclusions: PA is already lower in CKD-5 non-dialysis patients as compared to that in healthy controls and does not differ from that of dialysis patients. However, the transition phase from CKD-5 non-dialysis to dialysis is associated only with a modest improvement in AEE.

Published
2017

5. Cardiovascular and Patient Phenotype of Extended Haemodialysis: A Critical Analysis of Studying a Unique Patient Population

Author

Paul Brenchley, Frank M. van der Sande, Nicos Mitsides, Nanda M. P. Diederen, Jeroen P. Kooman, Sandip Mitra, Tom Cornelis, Natascha J. H. Broers, Casper G. Schalkwijk, Interne Geneeskunde, RS: NUTRIM - R3 - Respiratory & Age-related Health, MUMC+: CCZ Hemodialyse (9), MUMC+: MA Nefrologie (9), and RS: CARIM - R3.01 - Vascular complications of diabetes and the metabolic syndrome

Subjects
Male, Time Factors, GLYCOCALYX, medicine.medical_treatment, 030232 urology & nephrology, Blood Pressure, 030204 cardiovascular system & hematology, DISEASE, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Longitudinal Studies, Pulse wave velocity, education.field_of_study, NOCTURNAL HOME HEMODIALYSIS, Hematology, General Medicine, Middle Aged, Cardiovascular physiology, Extended dialysis, Nephrology, Cardiology, SURVIVAL, Biomarker (medicine), Female, Adult, medicine.medical_specialty, Ambulatory blood pressure, Population, Pulse Wave Analysis, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, ENDOTHELIAL SURFACE-LAYER, Humans, education, Dialysis, Aged, Inflammation, CONVENTIONAL HEMODIALYSIS, business.industry, medicine.disease, Comorbidity, DIALYSIS PATIENTS, RANDOMIZED-CONTROLLED-TRIAL, business, Biomarkers
Abstract

Background: Extended haemodialysis (EHD) has been associated with better outcomes compared to conventional (CHD) regimes. The cardiovascular (CV) profile of these patients has not been assessed in detail. Methods: We report baseline demographic and CV phenotype of 36 CHD and 36 EHD participants to a longitudinal multicentre study. We measured pulse wave velocity (PWV), 24-h ambulatory blood pressure, sublingual dark-field capillaroscopy and vascular biomarkers. Results: EHD patients were younger (p < 0.01), with less CV comorbidity (p = 0.04) and higher dialysis vintage (p < 0.01). Higher PWV in CHD (p = 0.02) was not independent of demographic differences in the 2 groups. Biomarker profiles were similar in EHD and CHD but abnormal compared to healthy controls. Conclusion: Although CV profiles in these 2 cohorts were similar, EHD patients were distinct from the CHD population in terms of age and dialysis vintage and appear to comprise a unique group. Direct comparison of outcomes in these groups is challenging due to clinical bias.

Published
2017

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