Estimating glomerular filtration rate in Asian patients with chronic kidney diseases from bioelectrical impedance analysis.

BACKGROUND: Estimation of glomerular filtration rate (GFR) is usually determined from 24-hour urine collection, but it is time-consuming, and difficult in clinical practice. The authors attempted to select an accurate and safe, but more convenient test to obtain an estimated GFR. Objective: To compare estimation of GFR by Bioelectrical impedance analysis (BIA) with GFR calculated by 24-hour urine averaged creatinine clearance and urea clearance (Ccr-Cu-GFR). MATERIAL AND METHOD: The authors examined 79 non-diabetic chronic kidney disease (CKD) patients that had estimated GFR between 15 and 89 ml/min/1. 73 m(2). Subjects were categorized into three subgroups according to K/DOQI-CKD classification: GFR of 60-89 m/min/1. 73m(2) (stage 2, 5 subjects), 30-59 ml/min/ 1.73m(2) (stage 3, 31 subjects), and 15-29 ml/min/1.73m(2) (stage 4, 43 subjects). RESULTS: The mean value of Ccr-Cu-GFR was 33.79+/-14.78 ml/min/1. 73 m(2) and GFR by BIA (BIA-GFR), 34.63 +/- 14.86 ml/min/1. 73 m(2) with no overall statistical differences (p = 0.838). In stage 3 CKD patients, the mean BIA-GFR and Ccr-Cu-GFR were similar (38.84+/-12.47 vs 41.16+/-9.17, p = 0. 399) while in stage 2 CKD, BIA-GFR tended to underestimate (63.50+/- 19.35 vs 70.94+/-7.82, p = 0.407) and in stage 4 CKD, BIA-GFR significantly overestimated Ccr-Cu-GFR (27.31+/-9.11 vs 23.76+/-5.68, p = 0.040). CONCLUSION: The findings suggest that BIA-GFR in non-diabetic CKD patients closely resembled with Ccr-Cu-GFR especially in stage 3 CKD patients. BIA-GFR may be considered as a more convenient test for an assessment of GFR in non-diabetic CKD patients.

The correlation of insulin resistance and renal function in non diabetic chronic kidney disease patients.

INTRODUCTION: A greater degree of insulin resistance may predispose to renal injury by worsening renal hemodynamics through the elevation of glomerular filtration fraction. However, there are sparse data on the relationship between insulin resistance, glomerular filtration rate (GFR) and body composition in chronic kidney disease (CKD) without diabetes. OBJECTIVES: To evaluate the relationship between insulin resistance, total body fat and GFR in CKD without diabetes. MATERIAL AND METHOD: The authors screened 84 non-diabetic CKD patients according to the K/DOQI definitions and only 78 patients were enrolled into the study (CKD stages 2-4, GFR between 15 and 90 ml/min/ 1.73 m2). Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR). Bioelectrical impedance analysis was performed to determine the percentage of total body fat. GFR was calculated by the average of creatinine and urea clearances. RESULTS: The correlation analysis showed that HOMA-IR was positively correlated with percent body fat (r = 0.32, P<0.05), BMI (r = 0.46, P<0.01), serum triglyceride (TG) (r =0.29, P<0.01), and mean arterial pressure (r =0.25, P<0.05), but not significantly correlated with GFR, age, cholesterol, HDL, uric acid and 24-hr urinary protein. CONCLUSION: In non-diabetic CKD patients, the independent factor for insulin resistance was the amount of total body fat. The insulin level and HOMA-IR were not dependent on the GFR in the present study.

Dementia and depression in end stage renal disease: comparison between hemodialysis and continuous ambulatory peritoneal dialysis.

OBJECTIVES: To determine the prevalence, risk factors of dementia and depression in end stage renal disease (ESRD) who were treated with hemodialysis (HD) compared with those who had continuous ambulatory peritoneal dialysis (CAPD). MATERIAL AND METHOD: A cross-sectional study was conducted on 90 ESRD patients (60 HD and 30 CAPD groups). The authors reviewed the demographic data, investigation results. Thai Mental State Examination, DSM IV criteria and Thai Depression Inventory were interviewed to determine dementia and depression respectively. RESULTS: Both prevalence of dementia and depression in ESRD on continuous dialysis were 6.7%. In the HD group had 8.3% prevalence of dementia and 6.7% of depression, whereas there was 3.3% of dementia and 6.7% of depression in the CAPD group. The severity of depression in the present study was mild to moderate (6.7%) and no major depression was seen. The significant risk factors for dementia were age > or = 60 years (p=0.003), Education < 10 years (p=0.037) and female sex (p=0.036). The significant risk factor for depression was female sex (p=0.036). There was no significance different on prevalence of dementia and depression comparison between the HD and CAPD group. CONCLUSION: Prevalence of dementia and depression in the overall dialysis in ESRD was 6.7% (with 8.3%, 6.7% among the HD group and 3.3%, 6.7% among CAPD group). There was no significant difference on prevalence of dementia and depression comparison between the HD and CAPD group.

Prevalence of the metabolic syndrome, and its association factors between percentage body fat and body mass index in rural Thai population aged 35 years and older.

OBJECTIVES: To obtain the prevalence of metabolic syndrome (MS) and its associated socioeconomic factors, and also to evaluate the association between percentage body fat (BF) and body mass index (BMI) in a rural Thai population. MATERIAL AND METHOD: MS defined by the National Cholesterol Education Program Adult Treatment Panel III criteria. The prevalence of the MS was then determined using the NCEP III criteria with and without the modified waist circumference criteria. BMI indicating normal weight, overweight and obesity as re-defined for the Asian by International Association for the Study of Obesity (IASO), WHO. Four-hundred and four rural Thai men and women aged 35 years and older were evaluated. Data on anthropometry, blood pressure, socioeconomic status, lifestyle-related information, blood studies, and bioelectrical impedance (BIA) values had been collected. RESULTS: The prevalence of the MS in the rural Thai people was 18%, but increased to 23% with the modified Asian criteria. High BMI, female gender, and older age were associated with increased odds of the MS. Household income, dietary composition, smoking and drinking status were not associated with increased odds of the MS. There was significant association between percent BF and BMI in men and women in rural Thai population. CONCLUSION: The MS was present in about 18% of the rural Thai population and was significantly influenced by body mass index, gender and age. Metabolic syndrome becomes an important problem in rural Thai populations who even live basic lifestyle in the non-urbanized and non-industrialized areas. Identification and clinical management of this high-risk group is an important strategy for coronary heart disease prevention.