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    Abstracts of the 5th Cachexia Conference, Barcelona, Spain,December 58, 2009

    # The Author(s) 2010. This article is published with open access at

    001How does the new diagnostic criteria for protein-energywasting in chronic kidney disease comparewith the ICD-10 AM definitions?

    Sharyn Denmeade1, Lynda Moynahan2, Judy D. Bauer31Nutrition Services Department, The Wesley Hospital,Brisbane, Queensland, Australia; 2Haemodialysis Unit,The Wesley Hospital, Brisbane, Queensland, Australia;3School of Human Movement Studies, University ofQueensland, Brisbane, Queensland, Australia

    Background and aims: Malnutrition is associated withhigher levels of morbidity and mortality in patients withCKD. The aim of this study was to determine theprevalence of protein-energy wasting (PEW) using newdiagnostic criteria compared with ICD-10 AM definitionsin patients with CKD.Methods: Forty-two patients (22 male, 20 female; meanage, 65.7 (SD 17.6)years) from a private haemodialysis unitparticipated. To determine PEW, four categories areassessed: biochemistry serum albumin (

  • patients at risk for malnutrition, but guide less practice. Acommon clinical classification, with simple, robust assess-ments specific for cancer and the PCC context, is required toimprove care decisions, outcomes, and clinical trial design.The aim of this study is to develop a cancer-specific,practice-guiding cachexia classification and assessmentsystem, based on the generic cachexia definition.Methods: Three systematic literature reviews, two focusgroup rounds, and a formal Delphi process amongclinical academic cancer cachexia experts were con-ducted to reach an agreement, based on current evidenceand consensus on definition, diagnosis, classification,and practical assessment of cancer cachexia. A resultingclassification/assessment (SIPP system) is pilot tested inPCC clinics.Results: Consensus on assessments is reached for domains,but not (yet) for selection of measures. The SIPP containsstorage (gap of usual to current weight, WL duration,control for fluid retention or obesity, and specific nutrientsdeficit), intake (anorexia, early satiety, percentage ofnormal intake, 12 days dietary record, and secondarynutrition impact symptoms), potential (tumor (catabolic)activity and C-reactive protein), and performance (perfor-mance status, cachexia-related suffering, and prognosis).Three phases (pre-cachexia (risk for cachexia), cachexiasyndrome, and late unlikely-to-be-reversible cachexia) areproposed. Feasibility, content validity, and independentclinicians agreement on multidimensional interventions arepromising (n=10; age, 4672 years).Conclusion: The SIPP system seems promising to guidepractice in PCC, final agreement on assessments isrequired, and prospective testing to refine cancer cachexiaphases and phenotypes is needed.

    003Cachexia-related suffering: developmentof an assessment system guiding clinical interventions

    Hanspeter Haene1, Rolf Oberholzer1, Jane B. Hopkinson2,Susanne Linder1, David Blum1, Susanne Jaworski1,Florian Strasser11Oncological Palliative Medicine, Section Oncology,Department of Internal Medicine and Palliative Care Centre,Cantonal Hospital St. Gallen, St. Gallen, Switzerland; 2Schoolof Health Sciences, University of Southampton, Southampton,Hampshire, UK

    Introduction: Interventions for cancer cachexia (CC)patients typically focus on pharmacological and nutritionalapproaches, rarely on the under-diagnosed CRS: psychoso-cial suffering related to eating and weight loss (WL). The

    aim of the study is to develop an assessment instrument forCRS.Methods: Based on patients and proxies focus groups(Strasser, Palliat Med 21:129137, 2007) and a systematicliterature review, a CRS item pool was developed. Amultidisciplinary team (nurses, nutritionists, and palliativecare physicians; n=9) reviewed and rated items (agreed, notagreed, and discuss) in two rounds, resulting in 121 items.We test their face validity, completeness, and practicability(negative emotions) in a cross-sectional design, providingeach patient two-item sets (n=25). Demographics includeliving situation, age, nationality, education, religion, BMI,cachexia staging, cognition, Edmonton Symptom Assess-ment Scale, Hospital Anxiety Depression Scale, subjective(0=none, 10=maximal) importance of eating, eating with apartner, amount of eating, and eating-related suffering(ERS).Results: Thirteen patients (age, 4874 years; five female;weight loss, 312.5%; HADS-A, 6; HADS-D, 9.5; ERSpatient, 7.7; ERS family, 7.5) judged at 15 interviews 36 items(eight items, 2 patients) as insufficient comprehensiblebefore explanation. These items contained subordinate clausesor complicated words and were reworded. Twenty-two items(four items, 2 patients) released desire to talk or mildemotions. Findings lacked an association to demographicdata. No items about ERS/CRS are missing.Discussion: This is the first study investigating systemat-ically items for a subjective assessment of cachexia-relatedsuffering. The item pool will be further refined bymulticenter calibration and analysis; the resulting CRSquestionnaire is likely to guide decision and practicalinterventions.

    004General fatigue in hemodialysis patients

    GiorgosK. Sakkas1, Christoforos D. Giannaki1, EuaggeliaPatrikalou2, Paraskevi Founta2, Vassilios Liakopoulos1,Ioannis Stefanidis11Department of Medicine, University of Thessaly, Larissa,Thessaly, Greece; 2Department of Nephrology, GeneralHospital of Trikala, Trikala, Thessaly, Greece

    Background and aims: Hemodialysis patients suffer fromgeneralized fatigue and lack of energy. It has beensuspected that the observed excessive fatigue do not dependonly on muscle atrophy and weakness but also depend onother factors. The aim of the current study was toinvestigate whether factors related to quality of life andgeneral health contribute to the level of general fatigue inpatients receiving hemodialysis therapy.

    44 J Cachexia Sarcopenia Muscle (2010) 1:43128

  • Methods: Fifty-two hemodialysis patients (15 female/37male; age, 5517; BMI, 25.44.4; years in dialysis, 2.41.2) consented to participate in this study. Hemodialysispatients were assessed for their functional capacity; bodycomposition (DEXA); levels of central adiposity, musclequality, and liver fat by CT; insulin resistance (OGTT);perceived quality of life parameters; and fatigue by variousquestionnaires.Results: The overall quality of life score was below 70%(6718), implying a low level of perceived life quality.Fatigue significantly correlated with gait speed (0.397, P=0.01), exercise performance (0.338, P=0.01), abdominalgirth (0.357, P=0.02), visceral adiposity (0.421, P=0.01), liver fat levels (0.528, P=0.01), indices of insulinsensitivity (0.432, P=0.01), sleep diary (0.435, P=0.01),daily sleepiness (0.354, P=0.01), and depression (0.526,P=0.01). Lean body mass and percentage of body fat didnot correlate significantly with fatigue score, while thethigh muscle cross-sectional area correlated weakly (0.277,P=0.08).Conclusions: Hemodialysis patients present with increasedlevels of generalized fatigue, leading to a considerablereduction of physical activity, impaired insulin action, andglucose disposal, implicating various metabolic alterationswith a common denominator: the increased cardiovascularrisk and a high mortality rate.

    005Metabolic gene expression in skeletal muscle of chronicheart failure patients: the effect of exercise training

    AnM. van Berendoncks1, Anne Garnier2, Paul Beckers1,Christiaan J. Vrints1, Rene Ventura-Clapier2, VivianeM. Conraads11Department of Cardiology, Antwerp University Hospital,Edegem, Belgium; 2Facult de Pharmacie, INSERM U-769,Chtenay-Malabry, France

    Background: Chronic heart failure (CHF) patients arecharacterized by insulin resistance and impaired energymetabolism. Adiponectin is an insulin-sensitizing adipo-cytokine. In CHF, high adiponectin confers poorprognosis. We investigated the expression of adiponec-tin, the adiponectin receptor, and genes involved indownstream lipid and glucose metabolism in the skeletalmuscle of CHF patients before and after exercisetraining (ET).Methods: Nine CHF patients and ten healthy subjectsunderwent clinical assessment, echocardiography, andCPET. Muscle biopsies (m. vastus lateralis) were takento assess mRNA expression of adiponectin, AdipoR1,

    and downstream metabolic genes. The effect of com-bined endurance-resistance ET (ambulatory training,three sessions/week, and 60 min duration) in CHF wasassessed after 4 months.Results: Adiponectin expression in CHF patients washigher compared to healthy subjects (P

  • 2/21/11) and 30 healthy controls of similar age and BMI.Muscle biopsies were obtained from the vastus lateralis ofthe quadriceps using the Bergstrom needle technique. Theobtained samples were homogenized in lysis buffer. Ofprotein, 20 g was used for the fluorogenic assay(substrate:benzyloxycarbonyl-Leu-Leu-Glu-7-amido-4-methylcoumarin-Z-LLE-AMC, Biomol), in which substrateturnover was determined. The activity was calculated by usingfree amidomethylcoumarin (AMC) as working standard.Results: Proteasome activity was significantly increased inCHF patients compared to controls (0.350.16 vs 0.040.01 units/mg; p=0.038). Among CHF patients, sevensubjects have been diagnosed as cachectic following thecurrent consensus-based definition. The highest proteasomeactivity was observed in the cachectic subgroup (0.610.46 units/mg) as compared to non-cachectic CHF (0.240.13 units/mg) and to controls (Con: 0.040.01 units/mg;ANOVA, p=0.04).Conclusion: Our study shows that proteasome activity iselevated in patients with CHF as compared to healthysubjects of similar age. This finding is in accord with theobserved overall increased catabolic drive in CHF.Proteasome activity is highest in the cachectic subgroup.Increased proteasome activit