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      Nutritional Adequacy and Latent Tuberculosis Infection in End-Stage Renal Disease Patients

      Nutrients
      MDPI
      dialysis, latent tuberculosis, kidney failure

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          Abstract

          Background: Latent tuberculosis infection (LTBI) is prevalent in end-stage renal disease (ESRD) patients. The risk of tuberculosis activation is also high. The appropriate LTBI screening and treatment is required in this population. Meanwhile, whether hemodialysis adequacy is associated with LTBI in the ESRD population is unclear. In this study, we aimed to investigate the association between hemodialysis adequacy and LTBI in ESRD patients. Methods: In the present cross-sectional study, we reviewed all outpatient-based ESRD patients in our artificial kidney room. Interferon gamma release assay (IGRA) was used for the diagnosis of LTBI. Clinical variables including nutritional adequacy (i.e., normalized protein catabolic rate, nPCR) and dialysis adequacy (i.e., Kt/V) were compared between IGRA-positive and IGRA-negative patients. Results: A total of 90 patients were enrolled, of which 20 (22.2%) had positive IGRA results using the QuantiFERON-TB method. Old fibrotic changes and nPCR (g/kg/day) were significantly different between IGRA-positive and IGRA-negative patients (both p < 0.005), while serum albumin and Kt/V were comparable (p = 0.429 and p = 0.590, respectively). Normalized PCR remained to be significant in a multivariate logistic regression analysis (adjusted hazard ratio, 0.911 (0.861–0.963); p = 0.001). The cutoff nPCR value less than 0.87 g/kg/day had an adjusted hazard ratio of 7.74 (1.77–33.74) for predicting LTBI. Patients with nPCR value less than 0.87 g/kg/day were older and had lower serum hemoglobin, albumin, calcium concentration, and Kt/V levels than those with nPCR value greater than 0.87 g/kg/day. Conclusions: Nutritional adequacy, especially when assessing nPCR value, was associated with LTBI, while dialysis adequacy was not associated with LTBI.

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          Most cited references15

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          Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy.

          Protein-energy wasting (PEW), characterized by a decline in body protein mass and energy reserves, including muscle and fat wasting and visceral protein pool contraction, is an underappreciated condition in early to moderate stages of chronic kidney disease (CKD) and a strong predictor of adverse outcomes. The prevalence of PEW in early to moderate CKD is ≥20-25% and increases as CKD progresses, in part because of activation of proinflammatory cytokines combined with superimposed hypercatabolic states and declines in appetite. This anorexia leads to inadequate protein and energy intake, which may be reinforced by prescribed dietary restrictions and inadequate monitoring of the patient's nutritional status. Worsening uremia also renders CKD patients vulnerable to potentially deleterious effects of uncontrolled diets, including higher phosphorus and potassium burden. Uremic metabolites, some of which are anorexigenic and many of which are products of protein metabolism, can exert harmful effects, ranging from oxidative stress to endothelial dysfunction, nitric oxide disarrays, renal interstitial fibrosis, sarcopenia, and worsening proteinuria and kidney function. Given such complex pathways, nutritional interventions in CKD, when applied in concert with nonnutritional therapeutic approaches, encompass an array of strategies (such as dietary restrictions and supplementations) aimed at optimizing both patients' biochemical variables and their clinical outcomes. The applicability of many nutritional interventions and their effects on outcomes in patients with CKD with PEW has not been well studied. This article reviews the definitions and pathophysiology of PEW in patients with non-dialysis-dependent CKD, examines the current indications for various dietary modification strategies in patients with CKD (eg, manufactured protein-based supplements, amino acids and their keto acid or hydroxyacid analogues), discusses the rationale behind their potential use in patients with PEW, and highlights areas in need of further research.
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            Tuberculosis control in the Republic of Korea

            The incidence and mortality rates of tuberculosis (TB) in the Republic of Korea are 77 and 5.2 per 100,000 people, respectively (2016), which are the highest among the member countries of the Organization for Economic Cooperation and Development. Recently, the incidence of TB among teens and individuals in their 20s in the Republic of Korea decreased significantly. The decrease is largely attributed to the TB screening and contact investigation efforts targeting schools over the past few years. However, the incidence of TB among elderly individuals remains high, and it is even increasing compared to that in the past 10 years. Older individuals account for 42% of all TB cases and 82% of TB-related deaths. The success rate of TB treatment in the Republic of Korea has gradually increased due to various programs, such as control of non-compliance, insurance coverage for TB diagnosis and treatment, and TB public–private mix models. This study suggests that policy makers should focus their efforts on policies that prioritize a significant reduction in the incidence of TB based on the 2nd National Strategic Plan for Tuberculosis Control (2018–2022).
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              1990 McCollum Award lecture. Nutrition and immunity: lessons from the past and new insights into the future.

              S. Chandra (1991)
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                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                26 September 2019
                October 2019
                : 11
                : 10
                : 2299
                Affiliations
                [1 ]Division of Nephrology, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon KS006, Korea; soominj@ 123456sejongh.co.kr
                [2 ]Division of Nephrology, Department of Internal Medicine, Sejong General Hospital, Bucheon KS009, Korea; jykangmd@ 123456naver.com
                Author notes
                [* ]Correspondence: sdbaek@ 123456sejongh.co.kr ; Tel.: +82-32-240-8567
                Author information
                https://orcid.org/0000-0002-4764-0449
                https://orcid.org/0000-0002-4528-3441
                Article
                nutrients-11-02299
                10.3390/nu11102299
                6835669
                31561559
                92d997a0-3758-466f-8b89-9cfff7d3c4b0
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 27 August 2019
                : 10 September 2019
                Categories
                Article

                Nutrition & Dietetics
                dialysis,latent tuberculosis,kidney failure
                Nutrition & Dietetics
                dialysis, latent tuberculosis, kidney failure

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