Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients

Background: An association of higher levels of b-hydroxybutyrate (b-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/b-HB), a relevant marker of energy state, in HD patients.Methods: The levels of arterial AcAc and b-HB, and AcAc/b-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers.Results: Arterial b-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/b-HB ratio seen in those with DM. Although the arterial AcAc/b-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of b-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log b-HB, and log AcAc/b-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ b-HB ratio, but not log b-HB, with serum albumin and uric acid. Conclusion: We found that a decreased AcAc/b-HB ratio resulting from increased b-HB, but not increased b-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/b-HB ratio.

Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients

Background An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/β-HB), a relevant marker of energy state, in HD patients. Methods The levels of arterial AcAc and β-HB, and AcAc/β-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers. Results Arterial β-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/β-HB ratio seen in those with DM. Although the arterial AcAc/β-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of β-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log β-HB, and log AcAc/β-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ β-HB ratio, but not log β-HB, with serum albumin and uric acid. Conclusion We found that a decreased AcAc/β-HB ratio resulting from increased β-HB, but not increased β-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/β-HB ratio.

Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients

Background: An association of higher levels of b-hydroxybutyrate (b-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/b-HB), a relevant marker of energy state, in HD patients.Methods: The levels of arterial AcAc and b-HB, and AcAc/b-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers.Results: Arterial b-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/b-HB ratio seen in those with DM. Although the arterial AcAc/b-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of b-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log b-HB, and log AcAc/b-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ b-HB ratio, but not log b-HB, with serum albumin and uric acid. Conclusion: We found that a decreased AcAc/b-HB ratio resulting from increased b-HB, but not increased b-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/b-HB ratio.

Association of higher arterial ketone body ratio (acetoacetate/β-hydroxybutyrate) with relevant nutritional marker in hemodialysis patients

Background: An association of higher levels of β-hydroxybutyrate (β-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/β-HB), a relevant marker of energy state, in HD patients. Methods: The levels of arterial AcAc and β-HB, and AcAc/β-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, changes in those levels during the session were examined to investigate their associations with clinical nutritional markers. Results: Arterial β-HB, but not AcAc, was significantly higher at the baseline in 25 patients with type 2 diabetes mellitus (T2DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/β-HB ratio seen in those with DM. Although the arterial AcAc/β-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of β-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log β-HB, and log AcAc/β-HB ratio as independent variables, revealed an independent and significant association of log AcAc/β-HB ratio, but not log β-HB, with serum albumin and uric acid. Conclusion: We found that a decreased AcAc/β-HB ratio resulting from increased β-HB, but not increased b-HB itself, was a significant factor independently associated with decreased levels of serum albumin and uric acid, known to be related to higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients can be explained by reduced arterial AcAc/β-HB ratio.

Association of Higher Arterial Ketone Body Ratio (acetoacetate/β -hydroxybutyrate) with Relevant Nutritional Marker in Hemodialysis Patients

Background: An association of higher levels of b-hydroxybutyrate (b-HB) in serum with greater mortality in hemodialysis (HD) patients has been reported. This study examined the significance of arterial ketone body ratio (AcAc/b-HB), a relevant marker of energy state, in HD patients.Methods: The levels of arterial AcAc and b-HB, and AcAc/b-HB ratio were determined in 49 HD patients just before undergoing an HD session. Additionally, their changes during the session were examined to investigate their associations with clinical nutritional markers.Results: Arterial b-HB, but not AcAc, was significantly higher at the baseline in 25 patients with diabetes mellitus (DM) as compared to 24 non-DM patients, with a significant reduction in arterial AcAc/b-HB ratio seen in those with DM. Although the arterial AcAc/b-HB ratio before the HD session was significantly higher in the non-DM group, it did not differ significantly after the session between the groups, indicating a faster rate of b-HB disappearance from circulation in non-DM HD patients during the interdialytic period. Multiple regression analysis, which included age, gender, presence/absence of DM, log HD duration, log b-HB, and log AcAc/b-HB ratio as independent variables, revealed an independent and significant association of log AcAc/ b-HB ratio, but not log b-HB, with serum albumin and uric acid. Conclusion: We found that a decreased AcAc/b-HB ratio resulting from increased b-HB, but not increased b-HB itself, was significant factor independently associated with decreased serum albumin and uric acid, which are both known as risks for higher mortality in HD patients. Furthermore, it is possible that higher mortality in DM HD patients might be explained by their lower arterial AcAc/b-HB ratio.

P1850Usefulness and predictive value of the prognostic nutritional index compared to other commonly-used nutritional indexes as a prognostic nutritional marker for short- and mid-term survival after TAVR

Background Several nutritional indexes predict clinical outcomes after trans-catheter aortic valve replacement (TAVR). The Prognostic Nutritional Index (PNI) is based on serum albumin and lymphocyte count, which makes it a highly practical tool to assess nutritional status. Prognostic value of PNI has been shown in some heart diseases and interventions. Usefulness and predictive value of PNI were investigated in patients with symptomatic aortic stenosis undergoing TAVR. PNI was compared with other commonly-used nutritional indexes that predict survival after TAVR. Methods A prospective observational study was carried out in a cohort of 114 patients with aortic stenosis undergoing TAVR in a high-volume centre from 09/2016 to 02/2018. Pre-procedural characteristics and laboratory parameters were measured, and a 1-year follow-up was completed. PNI was estimated with the formula: (10 × serum albumin [g/dl]) + (0.005 × total lymphocytes [1,000/μl]). Baseline clinical features and 1-year survival were compared in patients with PNI values above vs below median. A multivariate Cox regression analysis was used to assess the independent predictive value of PNI, for 1-year mortality after TAVR. Kaplan-Meier curves were constructed for patients with PNI above vs below median value. ROC curves were created to assess discrimination ability of PNI, and to compare its AUC values with those for other common nutritional markers, such as Geriatric Nutritional Risk Index (GNRI) and body mass index (BMI). Results Mean age was 82.2 years and 59.6% of patients were female. Mean PNI was 46±5. No differences were found in pre-procedural clinical characteristics between patients with PNI values above vs below median. One-year mortality was significantly higher in patients with PNI values below median (19/23) than in patients with higher PNI values (4/23) (p<0.001). No differences were found in complications according to Valve Academic Research Consortium Criteria-2. Lower PNI values significantly predicted a lower 1-year survival, even after adjusting for all clinical factors showing significant differences in a univariate analysis (model 1: HR 0.8, 95% CI 0.7–0.9, p<0.0001). Significance persisted also after adjusting for relevant laboratory factors (NT-proBNP, hs-Troponin, CRP, eGFR, cystatin, haemoglobin) (model 2: HR 0.8, 95% CI 0.7–0.9, p<0.05). Kaplan-Meier curves started to diverge soon after the intervention (figure). ROC curves revealed a stronger predictive value for PNI (AUC 0.80) compared to GNRI (0.77) and BMI (0.6) (figure). Kaplan-Meier curve for PNI and ROC curve Conclusion PNI is a useful and practical nutritional marker predicting 1-year survival after TAVR in aortic stenosis. It appears to reflect malnutrition and inflammation prior to the intervention, and to have an impact on prognosis. PNI seems to be a better prognostic marker than BMI or GNRI after TAVR.