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To assess the prevalence of frailty by the Clinical Frailty Scale (CFS) and the 5-item FRAIL scale and their association with hospitalization in hemodialysis (HD) patients.This was a prospective observational study. We included patients of both genders ≥ 18 years old in HD treatment for at least 3 months. Demographic, clinical, and routine laboratory data were retrieved from the medical charts. Two different frailty assessment tools were used, the CFS and the FRAIL scale. Participants were followed up for 9 months and hospitalizations for all causes were evaluated. A Venn diagram was constructed to show the overlap of possible frailty and pre-frailty. Cox regression was used to identify the association between frailty and hospitalization. The significance level was 5%.A total of 137 subjects were included in the analysis. The median age was 61 (52-67) years and 60% were male. The hospitalization rate and mortality in 9 months were 22.6% and 7.29%, respectively. Regarding frailty, the overall prevalence was 13.8% assessed by CFS and 36.5% according to the FRAIL scale. In the Cox regression, frailty by FRAIL scale was associated with a 2.8-fold increase in the risk of hospitalization (OR = 2.880; 95% CI = 1.361-6.096; p = 0.006), but frailty assessed by the CFS was not associated with the need for hospitalization.In HD patients, the FRAIL scale proved to be an easy-to-apply tool, identifying a high prevalence of frailty and being a predictor of hospital admission.

Myostatin functions as a negative regulator of skeletal muscle growth. The association of myostatin with muscle parameters in dialysis patients is inconsistent, and there are no studies associating myostatin with physical function and outcomes in peritoneal dialysis (PD) patients. Therefore, we assessed the association of serum myostatin with lean mass, physical function, and hospitalization in a prospective cohort of PD patients.Lean mass, physical function, and serum myostatin were assessed at baseline. Patients were followed up for at least 24 months and hospitalization was recorded.Serum myostatin levels were positively correlated with handgrip strength and Appendicular Lean Mass Index among male patients. Binary logistic regression models were performed including myostatin levels and physical function parameters as independent variables. Serum myostatin, handgrip strength, gait speed, and Short Physical Performance Battery were associated with hospitalization.Lower serum myostatin and physical function were associated with hospitalization in PD patients.

Made available in DSpace on 2022-04-29T08:32:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-09-01 Background: Kidney transplantation (KT) has the advantage of providing a better quality of life and freedom for the patient. However, nutritional changes can occur, with clinical repercussions. The aim of the study was to compare the nutritional status in the initial and late post-KT period. Methods: A cross-sectional study was conducted involving 169 outpatients post-KT. Clinical, demographic, biochemical, food intake, handgrip strength (HGS), and anthropometric data were collected from medical records for the first nutritional care after KT. Statistical tests were performed to compare the groups according to the time of KT: early (≤1 year) and late (>1 year). The level of significance adopted was 5%. Results: The median age of the patients was 46 years (range, 38-57), 50.3% were men, and it was observed that 66.9% underwent KT with a deceased donor. There was a higher prevalence of diabetes mellitus (42.6% vs 23.5%; P =.011), and higher body mass index (28.80 ± 7.26 vs 26.51 ± 6.62 kg/m2; P =.046), arm muscle circumference (25.84 ± 4.63 vs 24.09 ± 3.36 cm; P =.019), and HGS (26.97 ± 10.70 vs 20.21 ± 10.83 kg; P =.010) in patients with late KT. Linear regression analysis showed that at each log of time, there was an increase of 1.90 kg in HGS (P =.045) and 0.48 cm (P =.036) in mid-arm muscle circumference. Conclusion: The present study demonstrated that late kidney transplantation was associated with higher values of body mass index, mid-arm muscle circumference, and HGS. Specialization in Health Sciences Botucatu Medical School São Paulo State University UNESP Dialysis Unit Clinical Hospital Botucatu Medical School São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP Specialization in Health Sciences Botucatu Medical School São Paulo State University UNESP Dialysis Unit Clinical Hospital Botucatu Medical School São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP

Made available in DSpace on 2021-06-25T11:02:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-31 Introduction: Muscle mass depletion, overhydration, and inflammatory state have been related to impaired physical function in chronic kidney disease patients. The relationship between bioelectrical impedance analysis (BIA) parameters, such as hydration status and phase angle (PhA), with physical function in peritoneal dialysis (PD), is still not well-established. Therefore, the objective was to evaluate the association of BIA parameters (overhydration index and PhA) and inflammatory markers with physical function in patients on PD. Methods: The present cross-sectional study enrolled PD patients. Multifrequency BIA was performed to obtain overhydration index and PhA. The Short Physical Performance Battery (SPPB) test battery was applied to assess physical function. The time to complete the 4-m gait test and sit-to-stand test was also considered for physical function assessment. The inflammatory markers tumor necrosis factor-alpha and C-reactive protein levels were determined. Multiple linear regression models were performed, with the physical function variables as dependent variables, adjusted for age, diabetes, and sex. Results: Forty-nine PD patients were enrolled, 53.1% (n = 26) women; mean age, 55.5 ± 16.3 years. There were significant correlations between PhA and SPPB (r = 0.550, p < 0.001), time of 4-m gait test (r = −0.613, p < 0.001) and sit-to-stand test and (r = −0.547, p < 0.001). Overhydration index was significantly correlated with SPPB, 4-m gait test (r = 0.339, p = 0.017), and sit-to-stand test (r = 0.335, p = 0.019). Inflammatory markers were not significantly correlated with physical function parameters. In the multiple linear regression analysis, PhA was associated with physical function parameters, even after adjustments. Overhydration index was associated with all physical function tests only in the models with no adjustments. Conclusion: PhA was independently associated with physical function in PD patients. Inflammatory markers and overhydration index were not associated with physical function. Clinical Hospital of Botucatu Medical School Multiprofessional Specialization in Adult and Elderly Health São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP Graduate Program in Health Sciences Medicine Faculty Federal University of Uberlândia (UFU) Clinical Hospital of Botucatu Medical School Multiprofessional Specialization in Adult and Elderly Health São Paulo State University UNESP Internal Medicine Department Botucatu Medical School São Paulo State University UNESP

Made available in DSpace on 2021-06-25T15:07:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-31 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: Protein-energy wasting is related to impairment of quality of life and lower survival of end-stage kidney disease (ESKD) patients. The evaluation of body composition, especially fat free mass (FFM) and fat mass (FM), is important for the prediction of outcomes in these individuals. The aim of this study was to compare the FFM and FM measurements obtained by single-frequency bioimpedance (SF-BIA) and by a multiple frequency bioimpedance (MF-BIA) device, using dual energy X-ray absorptiometry (DXA) peritoneal dialysis (PD) patients. Methods: This was a cross-sectional study involving adult patients undergoing regular PD, in which we performed SF-BIA, MF-BIA, and DXA at the same visit. To compare the bioimpedance values with DXA, we used: Person correlation (r), intraclass correlation coefficient (ICC), and Bland-Altman concordance analysis. Results: The sample consisted of 50 patients in the PD, with mean age of 55.1 +/- 16.3 years. Both bioimpedance methods showed a strong correlation (r > 0.7) and excellent reproducibility (ICC > 0.75) compared to DXA. According to the Bland-Altman diagram, SF-BIA showed agreement in body compartment measurements, with no proportionality bias (p > 0.05), without systematic bias for FFM (-0.5 +/- 4.9, 95% CI -1.8 to 0.9, p = 0.506), and for FM (0.3 +/- 4.6, p = 0.543). MF-BIA did not present a proportionality bias for the FFM, but it underestimated this body compartment by 2.5 +/- 5.4 kg (p = 0.002). In addition, MF-BIA presented proportionality bias for FM. Conclusion: SF-BIA was a more accurate assessing method than MBIA for FFM and FM measurements in PD patients. Because it is a low-cost, non-evaluator-dependent measurement and has less systematic bias, it can also be recommended for fat mass and free-fat mass evaluation in PD patients. Sao Paulo State Univ, Botucatu Med Sch, Internal Med Dept, Botucatu, SP, Brazil Sao Paulo State Univ, Botucatu Med Sch, Internal Med Dept, Botucatu, SP, Brazil

Patients on peritoneal dialysis (PD) may be affected by sarcopenia, which is a progressive and generalized skeletal muscle disorder characterized by muscle mass atrophy with decline of muscle strength and function. The aim was to evaluate differences in the diagnosis and prevalence of sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP). The screening for sarcopenia was performed in PD patients older than 18 years, with evaluation of appendicular skeletal muscle mass index (ASMMI), handgrip strength (HGS) and gait speed (GS). The diagnosis was according to the 2010 and 2019 versions of EWGSOP consensus on sarcopenia. Fifty subjects on PD were included, mean age 55.74 ± 16.22 years old, 52% female. The prevalence of sarcopenia ranged from 4 to 10% according to cut points and references used.

Made available in DSpace on 2021-06-25T10:33:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-05-01 Objectives: After dialysis initiation, a high protein diet is recommended due to significant nutrient losses through dialysate and increased risk of protein energy wasting. In peritoneal dialysis (PD) patients, protein intake can be assessed through different methods that have some advantages and limitations, which affect its use on routine care. The aim of this study is to evaluate the agreement between 2 different methods (24-hour dietary recall and PNA—protein equivalent of total nitrogen appearance) on estimating protein intake in PD patients. Design and Methods: Patients on PD for at least 3 months, aged 18 years old or more, were enrolled. To estimate protein intake, 24-hour dietary recall and PNA was used. PNA was calculated from 24-hour urine on the same day of the 24-hour dietary recall. Results: Fifty individuals on PD were included, mean age 55.7 ± 16.2 years, and body mass index 26.0 ± 4.5 kg/m2. The average energy consumption was 1788.79 ± 504.40 kcal/day, which corresponds to 26.81 ± 9.11 kcal/kg current body weight (BW)/day and 29.82 ± 8.39 kcal/kg ideal body weight (IBW)/day. The median of total daily and normalized protein intake estimated using dietary recall was 61.43 (45.28-87.40) g/day, 0.90 (0.58-1.22) g/kg current BW/day, and 1.04 (0.77-1.32) g/kg IBW/day, respectively. Daily protein intake estimated by PNA was 55.75 (48.27-67.74) g/day, protein intake normalized by current BW was 0.81 (0.72-0.99) g/kg and 0.92 (0.83-1.06) g/kg IBW/day. Bland-Altman analysis indicates no systematic bias for the assessment of total protein intake and normalized protein intake for current and ideal BW. Significant proportionality bias was observed for both evaluations, showing there is a dispersion of the values. Conclusions: Despite the absence of systematic bias in the Bland-Altman analysis, there is no agreement in the assessment of protein intake by dietary recall and PNA, due to the existence of proportionality bias. Thus, values can be influenced biased by the magnitude of the measures. Department of Internal Medicine Botucatu Medical School São Paulo State University (UNESP) Medical School Federal University of Uberlândia (UFU) Department of Internal Medicine Botucatu Medical School São Paulo State University (UNESP)

Realizou-se o presente trabalho objetivando avaliar o comportamento produtivo de genotipos de tomate do tipo salada, com habito de crescimento determinado, em duas epocas do ano, nas condicoes do Submedio do Vale do Sao Francisco. O experimento foi conduzido no Campo em Petrolina - PE, utilizando o delineamento blocos ao acaso no esquema de parcelas subdivididas, com tres repeticoes. Nas parcelas ficaram as epocas de plantio (entre agosto e dezembro de 2012 e entre marco e julho de 2013) e na subparcela os genotipos (LAM 327 (Embrapa); LAM 336 (Embrapa); LAM 337 (Embrapa); LAM 338 (Embrapa); LAM 341 (Embrapa); PI922863 (IPA); Itapua (Eagle); Nanda (Agristar) e Colono (Sakata). Em termos de produtividade total e comercial, dependentemente do genotipo, o cultivo de segundo semestre foi sempre superior, com medias de 75,9 e 62,9 t ha-1. Quanto a produtividade omercial de frutos, no cultivo de primeiro semestre, as cvs. Itapua (40,6 t ha -1) e Nanda (36,4 t ha-1 ) foram superiores as demais. Nas condicoes de segundo semestre, as cvs. Itapua (85,5 t ha-1), Colono (75,6 t ha-1) e Nanda (72,3 t ha -1 ) foram os materiais que se destacaram. Maiores massas frescas de frutos foram obtidas no cultivo de segundo semestre. A excecao dos genotipos LAM 336, LAM 337 e LAM 338, os demais apresentaram similaridade em termos de massa fresca de fruto, nao apresentando diferencas estatisticas nas duas epocas de cultivo. Assim, conclui-se que e viavel o cultivo de tomate do tipo salada de habito de crescimento determinado no Submedio do Vale do Sao Francisco o ano todo, sendo que no cultivo de primeiro semestre as cultivares Itapua e Nanda sao as mais recomendadas, enquanto para o segundo semestre alem dessas, indica-se tambem a cultivar Colono, por apresentarem maiores produtividades e frutos de padrao comercial adequado.

To evaluate protein intake, nitrogen balance and nutritional status of clinically stable patients with Parkinson's disease (PD).A cross-sectional study of PD patients Hoehn-Yahr scale stage 1-3 and subjects with no neurologic disease (controls) matched for age and gender. All participants underwent a diet history interview, anthropometric measurements, bioelectrical impedance and food record over three non-consecutive days, including a weekend. A 24-hour urine collection and fasting venous blood sampling were collected from the participants for evaluation of creatinine clearance, creatinine height index and the nitrogen balance.The mean age of PD patients was 58.9 ± 12.8 year compared to 54.7 ± 12.6 year of the controls, P = 0.34. One third of PD group had symptoms of dysphagia and ingested less water and fibers when compared to controls. Calf circumference was small in PD group (35.5 ± 2.8 vs. 38.4 ± 3.5 cm, P = 0.012). Intake of nitrogen was significantly lower and nitrogen balance was negative in PD patients (-1.8 ± 3.9 vs. 1.1 ± 4.2 controls, P = 0.06). The antioxidants folate and vitamin E were consumed in small amounts in both groups, although significantly less in PD patients (P = 0.04 and 0.03, respectively).Daily intakes of protein of approximately 1.1 g/kg by clinically stable PD patients may not be enough to ensure a neutral calorie-nitrogen balance and muscle tissue conservation. Larger studies are necessary to provide a more comprehensive picture of PD patients' metabolic status.Objetivo: evaluar ingestión proteica, balance nitrogenado y estado nutricional de pacientes con enfermedad de Parkinson (EP) clínicamente estables. Métodos: estudio transversal de pacientes con EP en los niveles 1-3 según la escala de Hoehn-Yahr e individuos sin enfermedad neurológica (controles), pareados por edad y género. Todos los participantes fueron sometidos a una entrevista de la historia nutricional, antropometría, impedancia eléctrica y registro alimentario de 3 días consecutivos, incluyendo un fin de semana. Fueron colectados sangre venosa en ayuno y orina de 24 horas para evaluación de la depuración de la creatinina, índice creatinina-altura y balance nitrogenado. Resultados: el promedio de edad en pacientes con EP fue 58,9 ± 12,8 años en comparación con 54,7 ± 12,6 años de los controles, p = 0,345. Un tercio del grupo EP tuvo síntomas de disfagia, con menor ingestión de agua y fibras, comparados a los controles. La circunferencia de la pantorrilla fue menor en grupo EP (35,5 ± 2,8 vs. 38,4 ± 3,5 cm, p = 0,012). La ingestión de nitrógeno fue significativamente menor y el balance de nitrógeno fue negativo en grupo EP (-1,8 ± 3,9 vs. 1,1 ± 4,2 controles, p = 0,064). Los antioxidantes folato y vitamina E fueron consumidos en pequeñas cantidades en ambos grupos, aunque significativamente menor en los pacientes con EP (p = 0,042 y 0,031, respectivamente). Discusión: la ingestión proteica diaria de aproximadamente 1,1 g/kg en pacientes clínicamente estables con EP puede no ser suficiente para garantizar un balance neutro de calorías-nitrógeno, así como para mantener la masa muscular. Serán necesarios mayores estudios que produzcan una imagen más completa del estado metabólico de los pacientes con Parkinson.