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Duan X, Wang L, Wei W, Wang Z, Zhang X, Liu J, Ding D. Chronic kidney disease and functional impairment in a longitudinal study of older adults in China. BMJ Open 2023; 13:e074819. [PMID: 38011971 PMCID: PMC10685976 DOI: 10.1136/bmjopen-2023-074819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/07/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES To examine the associations of chronic kidney disease (CKD) with dynamic functional impairment among older Chinese adults. DESIGN This was a prospective longitudinal study. SETTING Data were derived from the Chinese Longitudinal Healthy Longevity Study. PARTICIPANTS All adults aged ≥60 years were potentially eligible. This study included 2970 participants. PRIMARY OUTCOME MEASURES CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Functional performances included instrumental activities of daily living (IADL) and basic activities of daily living (BADL), which were measured using six daily activities, including eating, dressing, transferring, using the toilet, bathing and continence, and eight daily activities, including visiting neighbours, shopping, cooking, washing clothes, walking 1 km, lifting 5 kg, crouching and standing up three times and taking public transportation, respectively. RESULTS This study included 2970 participants, including 988 (33.60%) participants with CKD. Participants with CKD had higher IADL scores than those without CKD (β=0.895, 95% CI: 0.761 to 1.029). Furthermore, there was a significant linear trend in the association of CKD severity with the IADL score (p<0.001). Similarly, CKD was significantly associated with higher BADL scores (β=0.067, 95% CI: 0.017 to 0.118). However, only participants with moderate and advanced CKD had a higher BADL score (β=0.088 and 0.152, 95% CI: 0.006 to 0.171 and 0.019 to 0.286, respectively). CONCLUSIONS CKD was associated with worse functional impairment. Furthermore, there was a significant linear trend in the association of the severity of CKD with the IADL score. However, only participants with moderate and advanced CKD had higher BADL scores.
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Affiliation(s)
- Xiaoyu Duan
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Lingdian Wang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhifeng Wang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xiaoli Zhang
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianjun Liu
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Degang Ding
- Department of Urology, Henan Provincial People's Hospital, Zhengzhou, China
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Osunbor OA, Unuigbe EI, Okaka EI, Adejumo OA. Protein energy wasting in pre-dialysis chronic kidney disease patients in Benin City, Nigeria: A cross-sectional study. PLoS One 2023; 18:e0286075. [PMID: 37220148 DOI: 10.1371/journal.pone.0286075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Protein energy wasting (PEW) is common among chronic kidney disease (CKD) patients, especially those with advanced stage. It worsens frailty, sarcopenia and debility in CKD patients. Despite the importance of PEW, it is not routinely assessed during management of CKD patients in Nigeria. The prevalence of PEW and its associated factors were determined in pre-dialysis CKD patients. METHODS This was a cross-sectional study that involved 250 pre-dialysis CKD patients and 125 age- and sex- matched healthy controls. Body mass index (BMI), subjective global assessment (SGA) scores and serum albumin levels were used in PEW assessment. The factors associated with PEW were identified. P-value of < 0.05 was taken as significant. RESULTS The mean age of CKD and control group were 52.3±16.0 years and 50.5±16.0 years, respectively. The prevalence of low BMI, hypoalbuminaemia and malnutrition defined by SGA in pre-dialysis CKD patients were 42.4%, 62.0% and 74.8%, respectively. The overall prevalence of PEW among the pre-dialysis CKD patients was 33.3%. On multiple logistic regression, the factors associated with PEW in CKD were being middle aged (adjusted odds ratio: 12.50; confidence interval: 3.42-45.00; p <0.001), depression (adjusted odds ratio: 2.34; confidence interval: 1.02-5.40; p = 0.046) and CKD stage 5 (adjusted odds ratio: 12.83; confidence interval: 3.53-46.60; p <0.001). CONCLUSION PEW is common in pre-dialysis CKD patients and it was associated with middle age, depression and advanced CKD. Early intervention aimed at addressing depression in early stages of CKD may prevent PEW and improve overall outcome in CKD patients.
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Affiliation(s)
| | | | - Enajite Ibiene Okaka
- Department of Internal Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - Oluseyi Ademola Adejumo
- Department of Internal Medicine, University of Medical Sciences, Ondo City, Ondo State, Nigeria
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Sheikh RY, Samoon HJ, Bhat NA, Wani I. Malnutrition and inflammatory parameters in patients with chronic kidney disease stages 3–5 from northern India. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.1186/s43162-022-00149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Malnutrition is highly prevalent in chronic kidney disease (CKD). This study is conducted to find out the prevalence of malnutrition and its association with inflammation in patients with CKD stages 3–5.
Method
This is a hospital-based cross-sectional study conducted at the Sri Ram Murti Smarak Institute of Medical Science, Uttar Pradesh, India. CKD stages 3–5 patients were included. The nutritional status was assessed by subjective global assessment (SGA). Anthropometric and biochemical measurements were also checked at the time of enrollment.
Results
A total of 213/354 (60.2%) of patients were malnourished. The triceps skinfold thickness (TSFT) was 8.2 ± 1.2 mm and 10.9 ± 1.2 mm in the malnourished and well-nourished groups, respectively; p < 0.001. TSFT was ≤ 10 mm in 91.1% of patients with malnutrition. Mid-arm muscle circumference (MAMC) was 21.3 ± 2.2 cm and 24 ± 2.9 cm, and the body mass index (BMI) was 19.8 ± 1.5 and 22.5 ± 1.4 kg/m2 in the malnourished and well-nourished group, respectively; p < 0.001. A significant direct correlation between BMI, TSFT, MAMC, and eGFR was noted. Median eGFR was 11.9 ml/min/1.73 m2 in the malnourished compared to 24.2 ml/min/1.73 m2 in the well-nourished group; p < 0.001. Serum ferritin level was 246.77 ± 18.24 mg/L in the malnourished group, higher than the well-nourished group at 237.23 ± 16.13 mg/L; p < 0.001. CRP was elevated (> 0.6 mg/dl) in 53.5% patients with malnutrition; p 0.003.
Conclusions
Malnutrition is highly prevalent in the CKD population. The incidence increases as the eGFR decrease. TSFT ≤ 10 mm compares favorably with SGA in detecting malnutrition (sensitivity > 90%), and BMI > 20 kg/m2 compares favorably with SGA in ruling out malnutrition (specificity 97%). Malnutrition and inflammation often coexist. Early detection and appropriate management are crucial.
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Martínez-Villaescusa M, Aguado-García Á, López-Montes A, Martínez-Díaz M, Gonzalvo-Díaz C, Pérez-Rodriguez A, Pedrón-Megías A, García-Arce L, Sánchez-Sáez P, García-Martínez C, Azaña-Rodríguez A, García-Martínez AB, Andrés-Pretel F, Botella-Romero F, Vega-Martínez A, Giménez Bachs JM, León-Sanz M. New approaches in the nutritional treatment of advanced chronic kidney disease. Nefrologia 2022; 42:448-459. [PMID: 36402686 DOI: 10.1016/j.nefroe.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/04/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. OBJETIVES To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. SECUNDARY OBJETIVES To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. MATERIAL AND METHODS A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. RESULTS At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. CONCLUSIONS Malnutrition is not exclusively an intake defficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.
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Affiliation(s)
- María Martínez-Villaescusa
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete y Instituto Médico Ricart, Alicante, Spain.
| | | | - Aurora López-Montes
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Mercedes Martínez-Díaz
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - César Gonzalvo-Díaz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Ana Pérez-Rodriguez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Asunción Pedrón-Megías
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Llanos García-Arce
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Paloma Sánchez-Sáez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Fernando Andrés-Pretel
- Unidad de apoyo a la investigación clínica, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Francisco Botella-Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | - Miguel León-Sanz
- Servicio de Endocrinología y Nutrición, Hospital Universitario 12 de Octubre, Madrid, Spain
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Recent and current low food intake – prevalence and associated factors in hospital patients from different medical specialities. Eur J Clin Nutr 2022; 76:1440-1448. [PMID: 35411028 PMCID: PMC9550619 DOI: 10.1038/s41430-022-01129-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/22/2022]
Abstract
Background/Objectives Poor food intake is a major etiological factor of malnutrition. This research aims to describe the prevalence of recent and current low food intake (LIRC) and to identify factors associated with LIRC in adult hospital patients from different medical specialities. Subject/Methods 1865 patients participating in the nutritionDay survey 2016–2020 in Germany were included. LIRC was defined by decreased eating both on nutritionDay and in the week before hospitalisation. Multivariate binary logistic regression was used to identify factors associated with LIRC overall and in different specialities. Results LIRC was observed in 21.1% of all patients, with the highest prevalence in Gastroenterology (26.6%) and the lowest in Neurology (11.2%). Weight loss within three months before nutritionDay (OR 2.62 [95% CI 1.93–3.56]), (very) poor self-rated health (2.17 [1.62–2.91]), female sex (1.98 [1.50–2.61]), uncertain weight loss (1.90 [1.03–3.51]), digestive disease (1.90 [1.40–2.56]), inability to walk without assistance (1.55 [1.14–2.12]) and emergency admission (1.38 [1.02–1.86]) were associated with increased risk, cardiac insufficiency (0.55 [0.37–0.83]) and being in a neurological ward (0.51 [0.28–0.92]) with decreased risk in the total sample. In Gastroenterology and Oncology, estimates were higher than in the entire sample; no significant associations were found in Neurology and Geriatrics, presumably due to the low prevalence of LIRC in Neurology and limited data quality in Geriatrics. Conclusion LIRC is common in German hospital patients and associated with female sex, poor health and decreased functional status. Interdisciplinary differences suggest a discipline-specific approach to dealing with malnutrition.
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Pyo JY, Ahn SS, Lee LE, Song JJ, Park Y, Lee S. New body mass index for predicting prognosis in patients with antineutrophil cytoplasmic antibody‐associated vasculitis. J Clin Lab Anal 2022; 36:e24357. [PMID: 35312104 PMCID: PMC9102757 DOI: 10.1002/jcla.24357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Method Results Conclusion
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Affiliation(s)
- Jung Y. Pyo
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Sung S. Ahn
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Lucy E. Lee
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
| | - Jason J. Song
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
- Institute for Immunology and Immunological Diseases Yonsei University College of Medicine Seoul Korea
| | - Yong‐Beom Park
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
- Institute for Immunology and Immunological Diseases Yonsei University College of Medicine Seoul Korea
| | - Sang‐Won Lee
- Division of Rheumatology Department of Internal Medicine Yonsei University College of Medicine Seoul Korea
- Institute for Immunology and Immunological Diseases Yonsei University College of Medicine Seoul Korea
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Barutcu Atas D, Tugcu M, Asicioglu E, Velioglu A, Arikan H, Koc M, Tuglular S. Prognostic nutritional index is a predictor of mortality in elderly patients with chronic kidney disease. Int Urol Nephrol 2021; 54:1155-1162. [PMID: 34562196 DOI: 10.1007/s11255-021-03002-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Prognostic nutritional index (PNI), a composite indicator of inflammation and nutritional status, has recently been recognized as an independent prognostic marker for chronic kidney disease (CKD). We aimed to investigate PNI and its relationship with mortality in elderly patients with CKD. METHODS Three hundred and fifty-nine patients over the age of 80 years with stage 3-4 CKD were enrolled in this retrospective study. PNI was used to assess the nutritional status of the patients. Patients were divided into two different groups as deceased and survived and as low PNI (< 39) and high PNI (≥ 39) according to median value of PNI. RESULTS The mean age of the patients was 85.7 ± 3.7 years. One hundred and ninety-five (54.3%) patients died during follow-up. Multivariate analysis revealed that male gender, PNI, proteinuria, and diabetes mellitus (DM) were independent predictors of mortality in elderly patients with CKD. When patients with low PNI were compared to those with high PNI, initiation of dialysis and mortality rate were significantly higher whereas albumin, hemoglobin and lymphocyte count were lower. Pearson correlation analysis showed that PNI was significantly correlated with albumin (r = 1.000, p < 0.001), hemoglobin (r = 0.340, p < 0.001) and eGFR (r = 0.123, p = 0.020). Hemoglobin was an independent predictor of PNI in multivariate analysis. CONCLUSION In this study, we observed that PNI was significantly associated with mortality over the age of 80 years in patients with CKD and can be used to monitor nutritional status in this patient population.
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Affiliation(s)
- Dilek Barutcu Atas
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey.
| | - Murat Tugcu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Mehmet Koc
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Marmara University, Pendik Teaching and Training Hospital, Fevzi Cakmak Mah. MuhsinYazicioglu Cad. No: 10 Ust Kaynarca-Pendik, Istanbul, Turkey
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Martínez-Villaescusa M, Aguado-García Á, López-Montes A, Martínez-Díaz M, Gonzalvo-Díaz C, Pérez-Rodriguez A, Pedrón-Megías A, García-Arce L, Sánchez-Sáez P, García-Martínez C, Azaña-Rodríguez A, García-Martínez AB, Andrés-Pretel F, Botella-Romero F, Vega-Martínez A, Giménez Bachs JM, León-Sanz M. New approaches in the nutritional treatment of advanced chronic kidney disease. Nefrologia 2021; 42:S0211-6995(21)00152-1. [PMID: 34393001 DOI: 10.1016/j.nefro.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (ACKD) have a high prevalence of malnutrition. The dietary restrictions that we usually apply in terms of macro and micronutrients force our patients to follow dietary guidelines that deviate from healthy patterns. OBJECTIVES To determine if a personalized nutritional intervention program, minimizing the usual restrictions would be justified in case it improved the evolution of kidney disease compared to standard treatment. SECONDARY OBJECTIVES To determine changes in nutrient intakes and in anthropometric and biochemical parameters, as well as quantify episodes of hyperkalemia. MATERIAL AND METHODS A single-center, randomized and controlled educational intervention clinical trial was conduct in patients from the ERCA outpatients clinic at the Complejo Hospitalario Universitario de Albacete. 75 patients were included, assigning 35 to a Control group and 40 to the Intervention group with 1-year follow-up. The nutritional status was determined using anthropometric data, body composition by Bioimpedance, blood and urine biochemical parameters and a 24-h recall questionnaire. The nutritional intervention was carried out in three different ways: individual, collective and telephone recall. RESULTS At the beginning of the study, the BMI showed a situation of weight excess with a mean of 28.83 kg/m2 (5.4) in men and 26.96 kg/m2 (4.09) in women. 70% of our patients had overweight. The abdominal circumference was 105.3 cm (10.2) and 92.3 cm (13.7) for men and women respectively without significant changes throughout the study. The percentage of fat mass (FM) was high in both groups for men and women throughout the study. We did not find biochemical parameters of malnutrition and only significant differences were observed in glomerular filtration rate (GFR), which increased in the intervention group. No patient presented any episodes of hyperkalemia during the study. The energy intake in both groups showed an inadequate distribution of macronutrients with a poor intake of carbohydrates (CH) that was supplemented with an excess of fat. In the case of micronutrients, we did observe an increase in potassium and fiber intakes with a decrease in sodium and phosphorus in the intervention group. CONCLUSIONS Malnutrition is not exclusively an intake deficit and encompasses both the problems derived from a deficit and an excess of nutrients intake. Un to 70% of our patients showed weight excess and a fat mass higher than desirable. The implementation of an individualized nutritional education program, including a vegetables and fiber rich diet, less atherogenic, not only did not cause electrolyte alterations but also slowed the progression of kidney disease.
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Affiliation(s)
- María Martínez-Villaescusa
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete y Instituto Médico Ricart, Alicante, España.
| | | | - Aurora López-Montes
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Mercedes Martínez-Díaz
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - César Gonzalvo-Díaz
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Ana Pérez-Rodriguez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Asunción Pedrón-Megías
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Llanos García-Arce
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Paloma Sánchez-Sáez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | | | - Fernando Andrés-Pretel
- Unidad de apoyo a la investigación clínica, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Francisco Botella-Romero
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | | | - Miguel León-Sanz
- Servicio de Endocrinología y Nutrición, Hospital Universitario 12 de Octubre, Madrid, España
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Franco BB, Hopman WM, Lamarche MC, Holden RM. Protein energy wasting and long-term outcomes in nondialysis dependent chronic kidney disease. J Ren Care 2021; 48:14-23. [PMID: 34053197 DOI: 10.1111/jorc.12378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/17/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nutritional status and protein energy wasting (PEW) is prevalent in patients with nondialysis-dependent chronic kidney disease (CKD). The relationship between PEW and long-term development of clinically important outcomes remains to be examined. OBJECTIVES To investigate the relationships between PEW, as measured by Subjective Global Assessment (SGA 1-7), and progression to important clinical outcomes: mortality and/or kidney failure. DESIGN Prospective cohort design. PARTICIPANTS One hundred and thirty-nine participants were well-nourished and 37 moderately malnourished patients with CKD 3-5. MEASUREMENTS The outcomes were 2, 5, and 10-year progression to kidney failure (dialysis or transplant) or mortality, kidney failure alone, and mortality alone. SGA was determined by a registered renal dietitian. Food frequency questionnaires were used to assess dietary intake. Clinical and laboratory baseline characteristics were collected. Multivariable regression models and Cox models were created to examine the relationship between SGA and outcomes. RESULTS PEW was associated with the combined outcome of kidney failure or mortality at 2 (p = 0.003), 5 (p = 0.004), but not at 10 (p = 0.73) years. This relationship was primarily driven by the relationship between PEW and kidney failure. In Cox models, the relationship between PEW and kidney failure remained after adjusting for Kidney Failure Risk Equation scores. The multivariable modeling revealed that PEW remained a statistically significant predictor of the combined outcome and ESKD after adjustment for age, estimated glomerular filtration rate (eGFR), sex, albumin-to-creatinine ratio, diabetes, albumin, and protein intake. CONCLUSIONS PEW, determined by the SGA 1-7, is an important prognostic tool. Further research looking at clinically important outcomes are needed to implement nutritional interventions for nondialysis-dependent CKD patients.
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Affiliation(s)
- Bryan B Franco
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Wilma M Hopman
- Clinical Research Centre, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Rachel M Holden
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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LaVallee C, Seelam P, Balakrishnan S, Lowen C, Henrikson A, Kesting B, Perugini M, Araujo Torres K. Real-World Evidence of Treatment, Tolerance, Healthcare Utilization, and Costs Among Postacute Care Adult Patients Receiving Enteral Peptide-Based Diets in the United States. JPEN J Parenter Enteral Nutr 2021; 45:1729-1735. [PMID: 33734462 PMCID: PMC9292286 DOI: 10.1002/jpen.2074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/17/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022]
Abstract
Objective Peptide ‐based (PB) enteral tube feeding (ETF) formulas have been shown to reduce gastrointestinal (GI) intolerance in patients receiving enteral nutrition. However, limited data exist in relation to their use in the postacute/home care setting. We sought to assess the real‐world GI tolerance, healthcare utilization, and resource use costs of 100% whey‐protein PB ETF in adults in a postacute care setting and describe their demographic, clinical, and treatment characteristics. Method Using medical claims data from the United States, we analyzed GI intolerance events occurring in adults receiving 100% whey‐protein PB ETF (Peptamen® adult formulas) for one year before and after initiation of ETF. Resource use costs were subsequently estimated using a multivariate general linearized model and adjusted for age, gender, and Charlson Comorbidity Index score. Results The proportion of adults experiencing no GI intolerance events increased from 41% (418/1022) to 59% (601/1022) in the one‐year period after initiation of 100% whey PB ETF (P < .001). The proportion of patients with at least one hospital inpatient visit also decreased from 100% (1022/1022) to 72% (737/1022) over the same period, and the mean number of inpatient visits per patient decreased from 15.6 to 13.0. Cost modeling revealed that outpatient visits accounted for 42% ($1174/$2820) of total estimated healthcare resource costs in the first 30 days after 100% whey PB ETF initiation, with only 9% ($255/$2820) due to emergency room visits. Conclusion These 100% whey‐protein PB ETF formulas are a valuable nutrition treatment option for patients with or at risk of malnutrition who show intolerance to standard ETF formulas and may reduce hospital inpatient visits and associated costs.
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Affiliation(s)
- Chris LaVallee
- Health Outcomes Research, Decision Resources Group, Burlington, Massachusetts, USA
| | | | | | - Cynthia Lowen
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Aimee Henrikson
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Bill Kesting
- Market Access, Nestlé Health Science, Bridgewater Township, New Jersey, USA
| | - Moreno Perugini
- Medical Affairs, Nestlé Health Science, Bridgewater Township, New Jersey, USA.,Market Access, Nestlé Health Science, Bridgewater Township, New Jersey, USA
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11
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Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants. Nutrients 2020; 12:nu12123608. [PMID: 33255334 PMCID: PMC7760142 DOI: 10.3390/nu12123608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.
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12
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Kosaka S, Ohara Y, Naito S, Iimori S, Kado H, Hatta T, Yanishi M, Uchida S, Tanaka M. Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study. BMC Nephrol 2020; 21:357. [PMID: 32819288 PMCID: PMC7441609 DOI: 10.1186/s12882-020-02019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/13/2020] [Indexed: 12/19/2022] Open
Abstract
Background Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan. Methods This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3–5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis. Results In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47–0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function. Conclusion We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.
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Affiliation(s)
- Shiho Kosaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Yuki Ohara
- Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan
| | - Shotaro Naito
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Soichiro Iimori
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Hiroshi Kado
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Tsuguru Hatta
- Omihachiman Community Medical Center, 1379 Tuchida-cho, Omihachiman-city, Shiga, 523-0082, Japan
| | - Masaaki Yanishi
- Kansai Medical University, 2-3-1 Shinmachi, Hirakata-city, Osaka, 573-1191, Japan
| | - Shinichi Uchida
- Department of Nephrology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Makoto Tanaka
- Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Derivation and validation of a new nutritional index for predicting 90 days mortality after ICU admission in a Korean population. J Formos Med Assoc 2020; 119:1283-1291. [PMID: 32439248 DOI: 10.1016/j.jfma.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/26/2020] [Accepted: 05/05/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/PURPOSE Predicting the mortality in patients admitted to the ICU is important for determining a treatment strategy and public health policy. Although many scores have been developed to predict the mortality, these scores were based on Caucasian population. We aimed to develop a new prognostic index, the New nutritional index (NNI), to predict 90-days mortality after ICU admission based on Korean population. METHODS Patients (1453) who admitted intensive care unit (ICU) of the Gangnam Severance hospital were analyzed. After exclusion, 984 patients were randomly divided into internal (n = 702) and external validation (n = 282) data set. The new nutritional index (NNI) was developed using univariate and multivariate logistic regression with backward selection of predictors. Receiver operating characteristic (ROC) curve analysis and comparison of the area under the curve (AUC) verified the better predictor of 90 days-mortality after ICU admission. RESULTS The NNI better predicted 90 days-mortality compared to modified NUTRIC score, APACHE II scores, SOFA scores, CRP, glucose, total protein, and albumin level in internal and external data sets, with AUC of 0.862 (SE: 0.017, 95% CI: 0.829-0.895) and 0.858 (SE: 0.015, 95% CI: 0.829-0.887), respectively. The calibration plots using external data set for validation showed a close approximation to the logistic calibration of each nomogram, and p-value of Hosmer and Lemeshow test was 0.1804. CONCLUSION The NNI has advantages as a predictor of 90 days mortality based on nutritional status in the Korean population.
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Geriatric nutritional risk index predicts poor outcomes in patients with acute ischemic stroke - Automated undernutrition screen tool. PLoS One 2020; 15:e0228738. [PMID: 32053672 PMCID: PMC7017988 DOI: 10.1371/journal.pone.0228738] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/21/2020] [Indexed: 12/26/2022] Open
Abstract
Background Premorbid undernutrition has been proven to have an adverse effect on the prognosis of stroke patients. The evaluation of nutritional status is important, but there is no universally accepted screen methodology. Purpose We aimed to use the geriatric nutritional risk index (GNRI) for evaluating the effect of premorbid undernutrition on short-term outcomes in patients with acute ischemic stroke. Methods A total of 1,906 patients were included for analysis. Baseline characteristics were collected. We evaluated the nutritional status of the patients using the GNRI and body mass index(BMI). The GNRI was calculated as {1.519×serum albumin(g/dL) + 41.7×present weight (kg)/ideal body weight (kg)}. All patients were categorized into four groups on the basis of the GNRI score. Results Among the included patients, 546 patients had an unfavorable outcomes. The proportion of patients with moderate and severe risk, assessed in GNRI, was significantly higher in the unfavorable outcome group compared to the favorable outcome group (33.3% vs 15.0%). The increased risk of premorbid undernutrition was associated with an increased risk of unfavorable outcome in a dose-response manner after adjusting for covariates. Conclusions This study demonstrated that GNRI was associated with poor prognosis in patients with acute ischemic stroke. GNRI may be used to screen patients at high risk for unfavorable outcome.
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Kim SH, Bang YI, Ri Y, Choe GH. Epidemiological study of body fat percentage, lean body mass, and total body water for Asian patients with chronic kidney disease. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_33_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Assessment of Malnutrition Inflammation Score in Different Stages of Chronic Kidney Disease. ACTA ACUST UNITED AC 2019; 39:51-61. [PMID: 30864357 DOI: 10.2478/prilozi-2018-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Protein-energy wasting (PEW) is common in patients with chronic kidney disease (CKD), and is associated with high morbidity and mortality. Malnutrition-Inflammation Score (MIS) has significant correlations with prospective hospitalization and mortality, as well as measures of anemia, inflammation, and nutrition in dialysis patients. MATERIAL AND METHODS The study was conducted on 100 adult patients of CKD selected from K&D clinic PGIMS, Rohtak. All the patients went under detailed socioeconomic, clinical, biochemical and radiological examination. The average of three measurements of body weight, height, triceps skin fold thickness (TST), and mid-arm muscle circumference (MAMC) were measured in all patients. MIS was calculated for all the patients. RESULTS Out of total 100 patients, 64 were male and 36 were female. Overall, the prevalence of malnutrition was 60%. A total of 42%, 16% and 2% patients had mild, moderate and severe malnutrition respectively. Our study also shows significant association between staging of CKD (3 to 5-D) and MIS. A significant negative correlation was found between MIS and factors such as BMI, eGFR, serum calcium and hemoglobin levels. A significant positive correlation of this score was found with blood urea serum creatinine, serum uric acid, serum potassium and serum phosphate. Multivariate analysis showed significant association between MIS and serum albumin, TIBC, BMI, family income and hs-CRP. CONCLUSION Assessment of key components of malnutrition and inflammation early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life for CKD patients.
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[So doctor, what could I eat then?]. NUTR HOSP 2019; 36:898-904. [PMID: 31291738 DOI: 10.20960/nh.02576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: the strict dietary recommendations we impose on patients with advanced chronic kidney disease (ACKD) have negative impact on quality of life. Objective: determine whether such restrictions are justified and if an educational program can improve health-related quality of life (HRQL) parameters. Methods: we carried out an educational intervention, single center, randomized, controlled clinical trial on ACKD outpatients in Albacete. Seventy-five patients were included, 35 in the control group and 40 in the intervention group. Nutritional assessment was based on the Subjetive Global Assessment (SGA) and body mass index (BMI). We used the SF-36 health questionnaire to measure HRQL. In the intervention group we carried out individual, collective and telephone nutritional interventions, adapting diet advice and restrictions in a personalized way. Results: malnutrition measured by Subjective Global Assessment (SGA) in the control group was 20%; meanwhile, in the intervention group it was 29.3% and it improved at the end of the study, but not significantly. BMI showed overweight with a mean of 28.83 kg/m² (DE: 5.4) and 26.96 kg/m² (DE: 4.09), respectively, and did not change throughout the study. The nutritional intervention improved the score in all the subscales except for body pain score. Besides, mental and physical components also improved their scores in the intervention group and worsened them in the control group (p < 0.001). Conclusions: quality of life can be improved in ACKD patients applying an educational nutrition program.
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18
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Oliveira EA, Zheng R, Carter CE, Mak RH. Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment. Semin Dial 2019; 32:493-499. [PMID: 31286575 DOI: 10.1111/sdi.12832] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cachexia is a multifactorial syndrome defined by significant body weight loss, fat and muscle mass reduction, and increased protein catabolism. Protein energy wasting (PEW) is characterized as a syndrome of adverse changes in nutrition and body composition being highly prevalent in patients with CKD, especially in those undergoing dialysis, and it is associated with high morbidity and mortality in this population. Multiple mechanisms are involved in the genesis of these adverse nutritional changes in CKD patients. There is no obvious distinction between PEW and cachexia from a pathophysiologic standpoint and should be considered as part of the spectrum of the same nutritional disorder in CKD with similar management approaches for prevention and treatment based on current understanding. A plethora of factors can affect the nutritional status of CKD patients requiring a combination of therapeutic approaches to prevent or reverse protein and energy depletion. At present, there is no effective pharmacologic intervention that prevents or attenuates muscle atrophy in catabolic conditions like CKD. Prevention and treatment of uremic muscle wasting involve optimal nutritional support, correction of acidosis, and physical exercise. There has been emerging consistent evidence that active treatment, perhaps by combining nutritional interventions and resistance exercise, may be able to improve but not totally reverse or prevent the supervening muscle wasting and weakness. Active research into more direct pharmacological treatment based on basic mechanistic research is much needed for this unmet medical need in patients with CKD.
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Affiliation(s)
- Eduardo A Oliveira
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California.,Pediatric Nephrourology Division, Department of Pediatrics, School of Medicine, Federal University of Minas Gerais (UFMG), Minas Gerais, Brazil
| | - Ronghao Zheng
- Department of Pediatric Nephrology, Rheumatology and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Caitlin E Carter
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California San Diego, California
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Messenger S, Bainbridge L, DaSilva L. Renal Dietitians' Perceptions of the Value of Subjective Global Assessment: A Mixed Methods Study. J Ren Nutr 2019; 30:e5-e13. [PMID: 31248658 DOI: 10.1053/j.jrn.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study is to assess how renal registered dietitians (RDs) in Canada perceive the value of Subjective Global Assessment (SGA) to assess protein-energy wasting for clients with chronic kidney disease. DESIGN AND METHODS A sequential exploratory mixed method approach included 2 focus groups (n = 6 and 8) and a national survey (n = 54). Two online focus groups were conducted 1 month apart followed by an online survey. Participants included renal RDs working with Stage 5 chronic kidney disease (dialysis and non-dialysis) patients. RESULTS Five main themes (consistency, organizational/environment, confidence, interpretation, and education) emerged. Renal RDs support using a tool to provide a standardized process for nutrition assessment and feel SGA is an effective educational tool; however, barriers such as time, privacy, confidence in the tool, as well as ability to perform physical assessment, interpretation, and subjectivity limit the use of SGA. Renal RDs feel that it is important to examine nutrition interventions in conjunction with SGA results. CONCLUSION The main results of the study describing the limitations to the clinical use of the SGA tool revolve around RDs' time, confidence, ability to interpret the SGA tool, and how SGA is used by administration. The results support the need for educators and administrators to communicate the use of SGA results and provide education opportunities focusing on the use of validated, reliable, responsive tools to assess nutrition status as well as hands-on physical assessment. In some situations, an alternative validated version of SGA or screening tool may be appropriate.
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Affiliation(s)
- Shelly Messenger
- Clinical Dietitian, Fraser Health Authority, Abbotsford, BC, Canada.
| | - Lesley Bainbridge
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Liz DaSilva
- Research Dietitian, Fraser Health Authority, Surrey, BC, Canada
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Ryu H, Park HC, Kim H, Heo J, Kang E, Hwang YH, Cho JY, Lee KB, Oh YK, Oh KH, Ahn C. Bioelectrical impedance analysis as a nutritional assessment tool in Autosomal Dominant Polycystic Kidney Disease. PLoS One 2019; 14:e0214912. [PMID: 30947248 PMCID: PMC6449065 DOI: 10.1371/journal.pone.0214912] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
Objective Autosomal dominant polycystic kidney disease (ADPKD) patients with massive organomegaly suffer from pressure-related complications including malnutrition. In this study, we analyzed the efficacy of segmental bioelectrical impedance analysis (BIA) for objective and quantitative nutritional assessment in ADPKD patients Design and methods We conducted a cross-sectional study, to evaluate the clinical utility of segmental BIA for assessing the nutritional status of ADPKD patients. BIA measurements was assessed according to modified subjective global assessment (SGA) scores and were compared with data from a healthy population. The association between BIA measurements and the height adjusted kidney and liver volumes (htTKLV), were analyzed. Subjects A total of 288 ADPKD patients, aged ≥ 18 years old, were analyzed Main outcome measures Nutritional status was evaluated with SGA and segmental BIA. The htTKLV were measured in each patients using computed tomonography images. Results Higher ratios of extracellular water to total body water (ECW/TBW) in the whole-body (ECW/TBWWB), trunk (ECW/TBWTR), and lower extremities (ECW/TBWLE) and lower phase angle of lower extremities (PhALE) correlated with lower SGA scores in the ADPKD population and in both gender. The four parameters, ECW/TBWWB, ECW/TBWTR, and ECW/TBWLE of >0.38 and PhALE of <5.8 θ were associated with malnutrition in ADPKD patients. These correlations were preserved in the subgroup analysis for chronic kidney disease stages 1-3A. Compared to healthy populations’ data, body fluid parameters and segmental ECW/TBW values, except for the upper extremities (ECW/TBWUE), were greater in ADPKD patients. Increased htTKLV was an independent risk factor for malnutrition in ADPKD. The highest correlation with htTKLV was observed for the ECW/TBWTR (r = 0.466), followed by ECW/TBWWB (r = 0.407), ECW/TBWLE (r = 0.385), PhALE (r = -0.279), and PhATR (r = 0.215). Conclusions These results demonstrated that segmental BIA parameters of ECW/TBWWB, ECW/TBWTR, ECW/TBWLE and PhALE provide useful information on nutritional status including the impact of organomegaly in ADPKD.
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Affiliation(s)
- Hyunjin Ryu
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jongho Heo
- National Assembly Futures Institute, Seoul, South Korea
| | - Eunjung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | | | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (CA); (KHO)
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (CA); (KHO)
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Derin NZA, Karahan İ, Çifci A. Factors affecting malnutrition in hospitalized patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2018. [DOI: 10.32322/jhsm.443422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Cosola C, Sabatino A, di Bari I, Fiaccadori E, Gesualdo L. Nutrients, Nutraceuticals, and Xenobiotics Affecting Renal Health. Nutrients 2018; 10:nu10070808. [PMID: 29937486 PMCID: PMC6073437 DOI: 10.3390/nu10070808] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) affects 8–16% of the population worldwide. In developed countries, the most important risk factors for CKD are diabetes, hypertension, and obesity, calling into question the importance of educating and acting on lifestyles and nutrition. A balanced diet and supplementation can indeed support the maintenance of a general health status, including preservation of renal function, and can help to manage and curb the main risk factors for renal damage. While the concept of protein and salt restriction in nephrology is historically acknowledged, the role of some nutrients in renal health and the importance of nutrition as a preventative measure for renal care are less known. In this narrative review, we provide an overview of the demonstrated and potential actions of some selected nutrients, nutraceuticals, and xenobiotics on renal health and function. The direct and indirect effects of fiber, protein, fatty acids, curcumin, steviol glycosides, green tea, coffee, nitrates, nitrites, and alcohol on kidney health are reviewed here. In view of functional and personalized nutrition, understanding the renal and systemic effects of dietary components is essential since many chronic conditions, including CKD, are related to systemic dysfunctions such as chronic low-grade inflammation.
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Affiliation(s)
- Carmela Cosola
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, 70124 Bari, Italy.
| | - Alice Sabatino
- Department of Medicine and Surgery, Parma University Medical School, 43126 Parma, Italy.
| | - Ighli di Bari
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, 70124 Bari, Italy.
| | - Enrico Fiaccadori
- Department of Medicine and Surgery, Parma University Medical School, 43126 Parma, Italy.
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, 70124 Bari, Italy.
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García De Alba Verduzco J, Hurtado López EF, Pontón Vázquez C, de la Torre Serrano A, Romero Velarde E, Vásquez Garibay EM. Factors Associated With Anthropometric Indicators of Nutritional Status in Children With Chronic Kidney Disease Undergoing Peritoneal Dialysis, Hemodialysis, and After Kidney Transplant. J Ren Nutr 2018; 28:352-358. [PMID: 29759796 DOI: 10.1053/j.jrn.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 02/10/2018] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objective of the study was to demonstrate that there are differences in the factors associated with anthropometric indicators of nutritional status, with particular emphasis on arm indicators, in children with end-stage kidney disease undergoing peritoneal dialysis (PD), hemodialysis (HD), and after kidney transplant (KT). METHODS An analytical cross-sectional study of consecutive cases included 130 children and adolescents with end-stage kidney disease undergoing substitutive treatment: 49 patients who underwent KT, 33 undergoing PD, and 47 undergoing HD. Socioeconomic data were obtained from all the 3 groups; anthropometric indicators of nutritional status were calculated. Student's t-test and analysis of variance were used for parametric variables. Chi-square test, Mann-Whitney U test, Kruskal-Wallis test, and odds ratio (OR) were used for nonparametric variables. RESULTS The number of parents living as couples was higher for patients who underwent KT (OR = 3.5 [95% confidence interval {CI} 1.34-9.0]) and undergoing PD (OR = 3.0 [95% CI 1.06-8.8]) than those undergoing HD. The number of mothers who worked outside the home was higher for patients who underwent KT and undergoing PD than the mothers of patients undergoing HD (OR = 13.7 [95% CI: 4.56-41.05]; OR = 15.4 [CI 95% 4.8-49], respectively). Family income was higher for patients who underwent KT and undergoing PD (P = .019, P = .093, respectively). More than 40% of patients in all the 3 groups had growth impairment. Body mass index, mid-upper arm circumference, tricipital and subscapular skinfolds, total arm area, and arm fat area were affected in HD and PD groups (9 to 40%), while of the patients who underwent KT, 36.7% were overweight or obese. More than 50% of patients who underwent KT and undergoing HD and PD had involvement in the arm muscular area. CONCLUSIONS Socioeconomic conditions are more influential for children in the HD program. The nutritional status of children after KT improves; however, not all anthropometric indicators are fully recovered. Children after KT are up to 9 times more likely to be overweight or obese.
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Affiliation(s)
- Julieta García De Alba Verduzco
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México; Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Erika Fabiola Hurtado López
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México; Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Consuelo Pontón Vázquez
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Adriana de la Torre Serrano
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Enrique Romero Velarde
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Edgar Manuel Vásquez Garibay
- Instituto de Nutrición Humana, Centro Universitario de Ciencias de la Salud, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Universidad de Guadalajara, Guadalajara, Jalisco, México.
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Muscle wasting in chronic kidney disease. Pediatr Nephrol 2018; 33:789-798. [PMID: 28508131 DOI: 10.1007/s00467-017-3684-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022]
Abstract
Loss of lean body mass is a relevant component of the cachexia, or protein energy wasting (PEW), syndrome. Reduced muscle mass seems to be the most solid criterion for the presence of cachexia/PEW in patients with chronic kidney disease (CKD), and those with greater muscle mass loss have a higher risk of death. Children with CKD have many risk factors for lean mass and muscle wasting, including poor appetite, inflammation, growth hormone resistance, and metabolic acidosis. Mortality risks in patients with CKD increases as body mass index (BMI) and weight decreases. However, data regarding cachexia/PEW and muscle wasting in children with CKD is scarce due to lack of consensus in diagnostic criteria and an appropriate investigative methodology. Further research is urgently needed to address this important complication in the pediatric CKD setting, which may have fundamental impact on clinical outcomes.
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Feasel-Aklilu S, Marcus A, Parrott JS, Peters E, Byham-Gray L. Is Nutrition Specific Quality of Life Associated With Nutritional Status? J Ren Nutr 2018; 28:283-291. [PMID: 29631758 DOI: 10.1053/j.jrn.2017.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/28/2017] [Accepted: 12/27/2017] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The study purpose was to explore the relationship between nutritional status, as measured by Subjective Global Assessment (SGA), and Health Related Quality of Life measured using the Nutrition Specific Quality of Life (NS-QoL), tool among participants on maintenance hemodialysis (MHD). The study aim was to determine if NS-QoL may be an adjuvant tool for detecting changes in nutritional status among patients on MHD. DESIGN, SETTING, AND SUBJECTS This is a cross-sectional, secondary analysis of data from a multi-center study. Participants were adult (>18) men and women on MHD (n = 145) recruited from 3 institutions in the Northeastern United States. METHODS Statistical tests were conducted to determine the relationship between key demographic characteristics (age, sex, dialysis vintage, gender, and ethnicity) and SGA and NS-QoL. Spearman's correlation examined the relationship between the independent variable, SGA and the dependent variable, NS-QoL. A univariate general linear model was conducted to adjust for confounding variables. MAIN OUTCOME MEASURE The relationship between overall SGA score and composite NS-QoL score. RESULTS The sample consisted of 85 men (58.6%), with a mean age of 55.3 ± 11.9 years, who were largely African-American (84.1%) and non-Hispanic (77.2%). Mean SGA score was 5.5 ± 1.0, and the mean NS-QoL composite score was 9.51 ± 3.77. No key demographic characteristics had a statistically significant relationship with SGA, whereas sex (P < .001) and race (P = .015) both had statistically significant relationships with NSQoL. After adjusting for the variables of race and sex, NS-QoL score was positively correlated with SGA composite score (P = .042); as NS-QoL score increased so did the SGA score. CONCLUSION The present study found a positive linear correlation between NS-QoL composite score and SGA, as well as 5 SGA subcomponent scores and NS-QoL. These findings indicate that NS-QoL can complement the SGA to provide information about a patient's nutritional status.
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Affiliation(s)
| | - Andrea Marcus
- Department of Nutritional Sciences at Rutgers, The State University of New Jersey, Newark, NJ
| | - J Scott Parrott
- Department of Nutrition, Rutgers University, School of Health Professions, Newark, NJ; Department of Interdisciplinary Studies, Rutgers University, School of Health Professions, Newark, NJ
| | - Emily Peters
- Department of Nutritional Sciences at Rutgers, The State University of New Jersey, Newark, NJ
| | - Laura Byham-Gray
- Department of Nutritional Sciences at Rutgers, The State University of New Jersey, Newark, NJ
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Jagadeswaran D, Indhumathi E, Hemamalini AJ, Sivakumar V, Soundararajan P, Jayakumar M. Inflammation and nutritional status assessment by malnutrition inflammation score and its outcome in pre-dialysis chronic kidney disease patients. Clin Nutr 2018; 38:341-347. [PMID: 29398341 DOI: 10.1016/j.clnu.2018.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/03/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Malnutrition-inflammation complex syndrome (MICS), hyperhomocysteinemia, calcium and phosphate levels derangement have been predicted as important contributing factors for the progression of cardiovascular burden. Among patients with earlier stage of CKD, hypoalbuminaemia and inflammation deliberated as non-traditional cardiovascular risk factors, which add more burden to circulatory disease, mortality and rapid advancement to CKD stage 5. AIM The aim of the study is to evaluate inflammation and nutritional status of CKD patients not on dialysis using Malnutrition inflammation score (MIS) and to verify the association with mortality in the follow-up period. METHODS AND MATERIAL In this prospective cohort study 129 (66 males, 63 females) pre-dialysis CKD patients enrolled between June 2013 to August 2014 and censored until March 2017. Malnutrition and Inflammation assessed using Malnutrition inflammation score. Blood urea nitrogen, serum creatinine, albumin, Interleukin - 6, highly sensitive C reactive protein (hsCRP), total cholesterol and anthropometric data were analyzed. RESULTS The Malnutrition inflammation score in pre-dialysis CKD patients ranged from 0 to 18 with the median score of two. During 36 or more months of follow-up, there were 30 (23.2%) deaths, 35 (27%) patients initiated on hemodialysis, one (0.7%) patient was initiated on peritoneal dialysis, two (1.4%) patients underwent renal transplantation and two (1.4%) patients were lost for follow-up. In this study, 33% had varying degree of malnutrition and inflammation. Patients who had MIS ≥7 had significant increase in IL-6 (p = 0.003) and HsCRP levels (p < 0.001) when compared with other tertiles of MIS. ROC curve analysis of MIS showed 56.5% sensitivity and 81% specificity in predicting death rate (AUC 0.709; 95% CI 0.604-0.815, p < 0.001). Kaplan-Meier survival analysis showed MIS ≥7 had a strong association (log rank test, p < 0.001) with mortality during 36 and more months of follow-up time. In unadjusted analyses, MIS (HR 1.140; 95% CI 1.054-1.233; p < 0.05) and HsCRP (HR 2.369; 95% CI 1.779-3.154; p < 0.001) found to be predictors of mortality. MIS and HsCRP remained predictors of mortality even after adjustments. CONCLUSIONS This study shows MIS is an important factor that determines mortality in pre-dialysis CKD patients during 36 and more months of follow-up time. Patients with MIS ≥7 have high risk for mortality and needs close monitoring. In clinical setting application of MIS has a greater utilization in pre-dialysis CKD patients. Further research with longitudinal assessment of MIS and its association with outcomes are warranted. Pre-dialysis CKD patients should be assessed for their nutritional status and inflammation using MIS regularly to prevent malnutrition and its associated complications through appropriate medical and nutritional intervention.
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Affiliation(s)
- D Jagadeswaran
- Department of Nephrology, Sri Ramachandra Medical College and Research Institute (Deemed to be University), No 1, Ramachandra Nagar Porur, Chennai, 600 116, India.
| | - E Indhumathi
- Department of Nephrology, Sri Ramachandra Medical College and Research Institute (Deemed to be University), No 1, Ramachandra Nagar Porur, Chennai, 600 116, India
| | - A J Hemamalini
- Department of Clinical Nutrition, Sri Ramachandra Medical College and Research Institute (Deemed to be University), No 1, Ramachandra Nagar, Porur, Chennai, 600 116, India
| | - V Sivakumar
- Department of Nephrology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, 517 507, Andhra Pradesh, India
| | - P Soundararajan
- Department of Nephrology, Saveetha Medical College, Saveetha Nagar, Thandalam, Chennai, 602 105, India
| | - M Jayakumar
- Department of Nephrology, Sri Ramachandra Medical College and Research Institute (Deemed to be University), No 1, Ramachandra Nagar Porur, Chennai, 600 116, India
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Sabatino A, Regolisti G, Gandolfini I, Delsante M, Fani F, Gregorini MC, Fiaccadori E. Diet and enteral nutrition in patients with chronic kidney disease not on dialysis: a review focusing on fat, fiber and protein intake. J Nephrol 2017; 30:743-754. [PMID: 28884267 DOI: 10.1007/s40620-017-0435-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/24/2017] [Indexed: 02/07/2023]
Abstract
The clinical data available on dietary requirements of patients with chronic kidney disease (CKD) not on dialysis are limited and largely inconclusive in terms of the renal, cardiovascular and nutritional outcomes achievable through dietary modifications. Restriction of protein intake during the early stages of CKD may in fact slow its progression, but at the same time this approach may also lead to protein-energy wasting, if energy intake is not adequate and properly monitored. Unfortunately, compliance to dietary recommendations is traditionally low in this patient population. A switch from saturated to mono- and polyunsaturated fats is generally recognized as advantageous for cardiac health; however, the benefits in term of renal function are largely unknown. Similarly, the association between dietary fiber intake and kidney disease is largely unknown. In fact, while there is evidence on the positive health effects of dietary fibers in the general population, nutritional guidelines for CKD lack formal recommendations concerning fiber intake. This paper reviews data and evidence from clinical trials and meta-analyses on renal and cardiovascular outcomes related to modifications in protein, fat and fiber intake. Suggestions for maintaining nutritional status through patient-oriented dietary patterns and enteral supplementation in CKD patients on conservative therapy are also presented.
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Affiliation(s)
- Alice Sabatino
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Giuseppe Regolisti
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Ilaria Gandolfini
- Postgraduate School of Nephrology, University of Parma, Parma, Italy
| | - Marco Delsante
- Postgraduate School of Nephrology, University of Parma, Parma, Italy
| | - Filippo Fani
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy
| | | | - Enrico Fiaccadori
- Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43100, Parma, Italy. .,Postgraduate School of Nephrology, University of Parma, Parma, Italy.
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Pérez-Torres A, González Garcia ME, San José-Valiente B, Bajo Rubio MA, Celadilla Diez O, López-Sobaler AM, Selgas R. Protein-energy wasting syndrome in advanced chronic kidney disease: prevalence and specific clinical characteristics. Nefrologia 2017; 38:141-151. [PMID: 28755901 DOI: 10.1016/j.nefro.2017.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/19/2017] [Accepted: 06/06/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%. OBJECTIVE To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA). PATIENTS AND METHODS Cross-sectional study of 186 patients (101 men) with a mean age of 66.1±16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis. RESULTS The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio. The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084-1.457, p=0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893-0.983, p=0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998-0.999, p=0.001) and cell mass index (OR: 0.995; 95% CI: 0.992-0.998). CONCLUSION Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria.
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Affiliation(s)
| | | | | | | | - Olga Celadilla Diez
- Servicio de Nefrología, Hospital Universitario La Paz. IdiPAZ, Madrid, España
| | - Ana M López-Sobaler
- Departamento de Nutrición y Bromatología I, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, España
| | - Rafael Selgas
- Servicio de Nefrología, Hospital Universitario La Paz. IdiPAZ, Madrid, España
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Pontón-Vázquez C, Vásquez-Garibay EM, Hurtado-López EF, de la Torre Serrano A, García GP, Romero-Velarde E. Dietary Intake, Nutritional Status, and Body Composition in Children With End-Stage Kidney Disease on Hemodialysis or Peritoneal Dialysis. J Ren Nutr 2017; 27:207-215. [PMID: 28215492 DOI: 10.1053/j.jrn.2016.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/12/2016] [Accepted: 12/13/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE(S) This study aimed to demonstrate that dietary intake, anthropometric indicators, and body composition in children with end-stage kidney disease differs between those on peritoneal dialysis (PD) and those on hemodialysis (HD). METHODS This was a cross-sectional and consecutive study that included 55 children and adolescents with end-stage kidney disease who were undergoing replacement therapy (22 PD patients and 33 HD patients). Two 24-hour dietary recall surveys were conducted for each patient. Anthropometric, biochemical, and body composition indicators were estimated. A Student's t-test and a Mann-Whitney U test were used for the parametric variables, whereas association tests were estimated for the nonparametric variables (i.e., χ2, Fisher exact test, and odds ratio). Regression models were designed to predict dietary intake on anthropometric and body composition indicators. RESULTS The mid-upper arm circumference was greater on the patients undergoing HD than on the PD patients (odds ratio = 15.8 [95% confidence interval (CI): 2.9, 85.1], P < .001); the arm muscular area was greater in the HD patients than in the PD patients (P = .07). Children on PD had significantly greater creatinine concentration (8.4 ± 3.0 mg/dL vs. 4.6 ± 1.2 mg/dL, P < .001), urea (101 ± 27 mg/dL vs. 50 ± 17 mg/dL, P < .001), and glucose (87 ± 14.4 mg/dL vs. 77 ± 10.2 mg/dL, P = .003). Children on PD had lower lipid intake (31.2 ± 15.8 vs. 40.9 ± 19.1 g/day, P = .032), lower percentage of adequacy of vitamin C (128 ± 66 vs. 146 ± 70, P = .046), and lower sodium (62 ± 43 vs. 79 ± 42, P = .044) than children on HD. Dietary intake predicted 40% to 80% of the variability in the nutritional status in children on PD and 28% to 60% in children on HD. CONCLUSIONS Nutritional status is affected in most patients on dialysis treatment, which differs significantly among those who are undergoing PD or HD.
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Affiliation(s)
- Consuelo Pontón-Vázquez
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México; Instituto de Nutrición Humana, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Edgar Manuel Vásquez-Garibay
- Instituto de Nutrición Humana, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México.
| | - Erika Fabiola Hurtado-López
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México; Instituto de Nutrición Humana, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
| | - Adriana de la Torre Serrano
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Germán Patiño García
- Unidad Médica de Alta Especialidad, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Enrique Romero-Velarde
- Instituto de Nutrición Humana, Departamento de Clínicas de la Reproducción Humana, Crecimiento y Desarrollo Infantil, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Jalisco, México
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Total kidney and liver volume is a major risk factor for malnutrition in ambulatory patients with autosomal dominant polycystic kidney disease. BMC Nephrol 2017; 18:22. [PMID: 28088190 PMCID: PMC5237538 DOI: 10.1186/s12882-016-0434-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 12/28/2016] [Indexed: 01/29/2023] Open
Abstract
Background In patients with autosomal dominant polycystic kidney disease (ADPKD), malnutrition may develop as renal function declines and the abdominal organs become enlarged. We investigated the relationship of intra-abdominal mass with nutritional status. Methods This cross-sectional study was performed at a tertiary hospital outpatient clinic. Anthropometric and laboratory data including serum creatinine, albumin, and cholesterol were collected, and kidney and liver volumes were measured. Total kidney and liver volume was defined as the sum of the kidney and liver volumes and adjusted by height (htTKLV). Nutritional status was evaluated by using modified subjective global assessment (SGA). Results In a total of 288 patients (47.9% female), the mean age was 48.3 ± 12.2 years and the mean estimated glomerular filtration rate (eGFR) was 65.3 ± 25.3 mL/min/1.73 m2. Of these patients, 21 (7.3%) were mildly to moderately malnourished (SGA score of 4 and 5) and 63 (21.7%) were at risk of malnutrition (SGA score of 6). Overall, patients with or at risk of malnutrition were older, had a lower body mass index, lower hemoglobin levels, and poorer renal function compared to the well-nourished group. However, statistically significant differences in these parameters were not observed in female patients, except for eGFR. In contrast, a higher htTKLV correlated with a lower SGA score, even in subjects with an eGFR ≥45 mL/min/1.73 m2. Subjects with an htTKLV ≥2340 mL/m showed an 8.7-fold higher risk of malnutrition, after adjusting for age, hemoglobin, and eGFR. Conclusions Nutritional risk was detected in 30% of ambulatory ADPKD patients with relatively good renal function. Intra-abdominal organomegaly was related to nutritional status independently from renal function deterioration. Electronic supplementary material The online version of this article (doi:10.1186/s12882-016-0434-0) contains supplementary material, which is available to authorized users.
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Farrington K, Covic A, Aucella F, Clyne N, de Vos L, Findlay A, Fouque D, Grodzicki T, Iyasere O, Jager KJ, Joosten H, Macias JF, Mooney A, Nitsch D, Stryckers M, Taal M, Tattersall J, Van Asselt D, Van den Noortgate N, Nistor I, Van Biesen W. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR <45 mL/min/1.73 m2). Nephrol Dial Transplant 2016; 31:ii1-ii66. [DOI: 10.1093/ndt/gfw356] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Kalantar-Zadeh K, Moore LW, Tortorici AR, Chou JA, St-Jules DE, Aoun A, Rojas-Bautista V, Tschida AK, Rhee CM, Shah AA, Crowley S, Vassalotti JA, Kovesdy CP. North American experience with Low protein diet for Non-dialysis-dependent chronic kidney disease. BMC Nephrol 2016; 17:90. [PMID: 27435088 PMCID: PMC4952055 DOI: 10.1186/s12882-016-0304-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/14/2016] [Indexed: 12/20/2022] Open
Abstract
Whereas in many parts of the world a low protein diet (LPD, 0.6-0.8 g/kg/day) is routinely prescribed for the management of patients with non-dialysis-dependent chronic kidney disease (CKD), this practice is infrequent in North America. The historical underpinnings related to LPD in the USA including the non-conclusive results of the Modification of Diet in Renal Disease Study may have played a role. Overall trends to initiate dialysis earlier in the course of CKD in the US allowed less time for LPD prescription. The usual dietary intake in the US includes high dietary protein content, which is in sharp contradistinction to that of a LPD. The fear of engendering or worsening protein-energy wasting may be an important handicap as suggested by a pilot survey of US nephrologists; nevertheless, there is also potential interest and enthusiasm in gaining further insight regarding LPD’s utility in both research and in practice. Racial/ethnic disparities in the US and patients’ adherence are additional challenges. Adherence should be monitored by well-trained dietitians by means of both dietary assessment techniques and 24-h urine collections to estimate dietary protein intake using urinary urea nitrogen (UUN). While keto-analogues are not currently available in the USA, there are other oral nutritional supplements for the provision of high-biologic-value proteins along with dietary energy intake of 30–35 Cal/kg/day available. Different treatment strategies related to dietary intake may help circumvent the protein- energy wasting apprehension and offer novel conservative approaches for CKD management in North America.
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Affiliation(s)
- Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA. .,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA. .,Department Epidemiology, UCLA Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA. .,Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
| | | | - Amanda R Tortorici
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA
| | - Jason A Chou
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA
| | - David E St-Jules
- Center for Healthful Behavior Change, Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Arianna Aoun
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Vanessa Rojas-Bautista
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA
| | | | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California Irvine Medical Center, 101 The City Drive South, Orange, CA, 92868-3217, USA.,Long Beach Veterans Affairs Healthcare System, Long Beach, CA, USA
| | - Anuja A Shah
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Susan Crowley
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joseph A Vassalotti
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,National Kidney Foundation, Inc., New York, NY, USA
| | - Csaba P Kovesdy
- University of Tennessee Health Science Center, Memphis, TN, USA
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Vanitha RN, Kavimani S, Soundararajan P, Chamundeeswari D, Kannan G, Rengarajan S. Ghrelin and its Association with Nutritional and Inflammatory Status of Patients on Maintenance Hemodialysis in a South Indian Tertiary Care Hospital. Ann Med Health Sci Res 2016; 6:146-55. [PMID: 27398245 PMCID: PMC4924487 DOI: 10.4103/2141-9248.183937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Malnutrition and inflammation are associated with morbidity and mortality in patients on maintenance hemodialysis (MHD). Ghrelin, an orexigenic peptide hormone, is speculated to be associated with nutritional and inflammatory status in MHD. AIM To assess the serum total ghrelin levels and its possible relationship with inflammation and nutritional status in patients on MHD. SUBJECTS AND METHODS The study was conducted on 90 patients on MHD for 6 months and above (56 males, 34 females, mean age 52.6 [11.7] years; mean dialysis vintage 20.9 [12.1] months) and 70 healthy volunteers as control (5 males, 25 females, mean age 50.6 [9.7] years). Demographics were obtained for the study population, and dialysis-related data were collected for cases. Anthropometry, biochemical parameters, serum total ghrelin and inflammatory markers tumor necrosis factor-alpha (TNF-α), and high-sensitivityC-reactive protein (hsCRP) were assessed for cases and control. Self-reported appetite (five questions of appetite and diet assessment tool) and nutritional status (subjective global assessment-dialysis malnutrition score) were assessed for cases. RESULTS Ghrelin (242.5 [62.3] pg/mL vs. 80.2 [19.6] pg/mL; P < 0.001), TNF-α (39.8 [15.2] pg/mL vs. 6.5 [1.2] pg/mL; P < 0.001), hsCRP (10.2 [2.8] mg/L vs. 2.7 [0.54] mg/L; P < 0.001) were significantly elevated in cases versus control, anthropometry, and biochemical parameters were significantly decreased in hemodialysis patient. Of 90 cases, (13/90 [14.4%]) were well-nourished, (28/90 [31%]) mild to moderately malnourished, and (49/90 [54.4%]) were moderate to severely malnourished. Appetite was very good for14.4%, good and fair for 47.8%, poor and very poor for 37.8% patients. There was a significant difference in appetite with respect to nutritional status (P < 0.001). Ghrelin had positive correlation with inflammatory markers and negative correlation with nutritional status (P < 0.001). CONCLUSION The study identified the association of ghrelin with appetite, nutritional, and inflammatory status of the patients on MHD.
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Affiliation(s)
- R N Vanitha
- Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - S Kavimani
- Department of Pharmacology, Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry, India
| | - P Soundararajan
- Department of Nephrology, Sri Ramachandra Medical Center, Chennai, Tamil Nadu, India
| | - D Chamundeeswari
- Department of Pharmacognosy, Faculty of Pharmacy, Sri Ramachandra University, Chennai, Tamil Nadu, India
| | - G Kannan
- Department of Pharmacy Practice, Saastra College of Pharmaceutical Education and Research, Nellore, Andhra Pradesh, India
| | - S Rengarajan
- Research Scientist, V Clin Bio Labs, Sri Ramachandra University, Chennai, Tamil Nadu, India
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Satirapoj B, Prapakorn J, Punpanich D, Pongsuparbchon C, Supasyndh O. The effect of ONCE Renal on minerals and electrolytes in predialysis patients with chronic kidney disease. Int J Nephrol Renovasc Dis 2016; 9:81-6. [PMID: 27103839 PMCID: PMC4827907 DOI: 10.2147/ijnrd.s98179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Malnutrition is one common adverse consequence in patients with advanced chronic kidney disease (CKD), and most patients have a lower-than-normal dietary energy intake. The present study was undertaken to examine whether orally administered ONCE Renal formula (ORF) supplement would improve energy intake without minerals and electrolytes disturbances in predialysis patients with CKD. Methods All eligible nondiabetic patients with CKD received ORF supplement for 1 week. Nutrition markers, renal function, and minerals and electrolytes were evaluated before and after supplementing. All patients kept a 3-day food record and were interviewed by a registered dietitian. Results A total of 29 patients with mean age 64.9±13.3 years were included. Mean estimated glomerular filtration rate was 37.7±12.1 mL/min/1.73 m2. A significant increase was observed in amount of energy, fat, fiber, calcium, and magnesium intake after 1 week of ORF supplement. Moreover, in comparison with baseline values, the patients displayed decreased dietary protein intake and blood urea nitrogen and increased serum magnesium. However, no significant change was found in renal function, nutritional markers (body weight, prealbumin, albumin, and protein equivalence of total nitrogen appearance), serum calcium, phosphorus, sodium, potassium, and bicarbonate. Conclusion In patients with CKD, ingestion of ORF was well tolerated and had a positive effect with an increase in dietary energy, fat, and fiber intake, as well as a decreased dietary protein intake. No mineral or electrolyte abnormalities were observed during the study.
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Affiliation(s)
- Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Janjira Prapakorn
- Research Unit, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Dollapas Punpanich
- Research Unit, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Chantima Pongsuparbchon
- Clinical Research Center, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
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Abstract
OBJECTIVES The association between nutritional status and mortality in critically ill patients is unclear based on the current literature. To clarify this relation, we analyzed the association between nutrition and mortality in a large population of critically ill patients and hypothesized that mortality would be impacted by nutritional status. DESIGN Retrospective observational study. SETTING Single academic medical center. PATIENTS Six thousand five hundred eighteen adults treated in medical and surgical ICUs between 2004 and 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All cohort patients received a formal, in-person, standardized evaluation by a registered dietitian. The exposure of interest, malnutrition, was categorized as nonspecific malnutrition, protein-energy malnutrition, or well nourished and determined by data related to anthropometric measurements, biochemical indicators, clinical signs of malnutrition, malnutrition risk factors, and metabolic stress. The primary outcome was all-cause 30-day mortality determined by the Social Security Death Master File. Associations between nutrition groups and mortality were estimated by bivariable and multivariable logistic regression models. Adjusted odds ratios were estimated with inclusion of covariate terms thought to plausibly interact with both nutrition status and mortality. We used propensity score matching on baseline characteristics to reduce residual confounding of the nutrition status category assignment. In the cohort, nonspecific malnutrition was present in 56%, protein-energy malnutrition was present in 12%, and 32% were well nourished. The 30-day and 90-day mortality rates for the cohort were 19.1% and 26.6%, respectively. Nutritional status is a significant predictor of 30-day mortality following adjustment for age, gender, race, medical versus surgical patient type, Deyo-Charlson index, acute organ failure, vasopressor use, and sepsis: nonspecific malnutrition 30-day mortality odds ratio, 1.17 (95% CI, 1.01-1.37); protein-energy malnutrition 30-day mortality odds ratio, 2.10 (95% CI, 1.70-2.59), all relative to patients without malnutrition. In the matched cohort, the adjusted odds of 30-day mortality in the group of propensity score-matched patients with protein-energy malnutrition was two-fold greater than that of patients without malnutrition. CONCLUSION In a large population of critically ill adults, an association exists between nutrition status and mortality.
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Oluseyi A, Enajite O. Malnutrition in pre-dialysis chronic kidney disease patients in a teaching hospital in Southern Nigeria. Afr Health Sci 2016; 16:234-41. [PMID: 27358637 PMCID: PMC4915439 DOI: 10.4314/ahs.v16i1.31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Malnutrition is a complication in chronic kidney disease (CKD) known to affect quality of life and prognosis although not often diagnosed. It is associated with rapid progression to end stage renal disease (ESRD) and mortality. Early identification and treatment will slow down progression to ESRD and mortality. OBJECTIVE To determine the prevalence and pattern of malnutrition in pre-dialysis CKD patients in Southern Nigeria. METHODS One hundred and twenty consecutive pre-dialysis CKD and 40 control subjects without CKD were studied. Data obtained from participants were demographics, body mass index (BMI), and aetiology of CKD. Indices used to assess presence of malnutrition were low BMI, hypocholesterolaemia and hypoalbuminaemia. Statistical significance was taken at 0.05 level. RESULTS The mean age of the CKD subjects was 48.8±16.6years with a male: female ratio of 1.7:1. Prevalence of malnutrition in the CKD subjects was 46.7%, higher than 27.5% observed in the controls (p=0.033). Prevalence of malnutrition increased significantly across CKD stages 2 to 5 (p=0.020). It was significantly commoner in elderly patients (p=0.047) but not significantly different between males and females(p=0.188). CONCLUSION Malnutrition is common in pre-dialysis CKD patients even in early CKD stages. Prevalence of malnutrition increases with worsening kidney function and increasing age.
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de Waal D, Heaslip E, Callas P. Medical Nutrition Therapy for Chronic Kidney Disease Improves Biomarkers and Slows Time to Dialysis. J Ren Nutr 2015; 26:1-9. [PMID: 26391566 DOI: 10.1053/j.jrn.2015.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 08/04/2015] [Accepted: 08/07/2015] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To investigate whether medical nutrition therapy (MNT) provided by a registered dietitian experienced in chronic kidney disease (CKD) slows the progression of disease and improves nutrition-related biomarkers. DESIGN Retrospective cohort study. SUBJECTS The cohort included 265 participants from a regional nephrology center in a rural state; 147 of who received MNT were compared to a group that did not receive MNT and had started dialysis over a 10-year period. INTERVENTION MNT by a registered dietitian with expertise in CKD. MAIN OUTCOME MEASURE Average time to dialysis, based on stage of CKD at baseline, was compared between groups. In addition, the effect of MNT on the change in biochemical measures for estimated glomerular filtration rate, blood urea nitrogen, albumin, CKD Mineral and Bone Disorder (MBD) markers (phosphorous, calcium, and intact parathyroid hormone) at baseline and at follow-up (dialysis initiation or most recent laboratories if dialysis was not started) was assessed. RESULTS MNT group had less of a decline in estimated glomerular filtration rate than the non-MNT group (0.3 vs. 9.9 mL/minute/1.73 m(2), respectively) a mean difference of 9.6 (P < 0.001). When adjusted for stage using linear regression, the mean difference was greater (11.4, P < .001). Using survival analysis and Cox proportional hazards regression, the non-MNT group was 3.15 more likely to initiate dialysis. Stratified by Stages 3 and 4 that hazard ratio increased (3.47 and 3.45, respectively). Albumin and markers of CKD-MBD were more likely to be within normal limits in the MNT group. The results indicate that better outcomes occur when MNT is given at CKD Stage 3 or 4 rather than CKD Stage 5. CONCLUSIONS Results suggest that people with CKD who received MNT were less likely to start dialysis and had improved nutritional biomarkers than participants who did not receive MNT.
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Affiliation(s)
- Desirée de Waal
- Department of Nephrology, University of Vermont Medical Center, Burlington, Vermont.
| | - Emily Heaslip
- The Community Health Centers of Burlington, Burlington, Vermont
| | - Peter Callas
- Department of Medical Biostatistics, University of Vermont, Burlington, Vermont
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Kovesdy CP. Malnutrition in Dialysis Patients--The Need for Intervention Despite Uncertain Benefits. Semin Dial 2015; 29:28-34. [PMID: 26190025 DOI: 10.1111/sdi.12410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We are in the midst of an epidemic of overnutrition which has resulted in a widespread increase in obesity rates in modern societies. Yet for patients suffering from serious chronic illnesses such as end stage renal disease (ESRD), malnutrition (encompassing both inadequate quantity and quality of nutrient intake) represents a far more significant danger. Protein-energy wasting has been identified as one of the strongest risk factor for adverse outcomes in ESRD patients, and modeling studies have suggested that improving nutrition could result in substantial lowering of mortality rates and other benefits. To date there is ample evidence that various interventions can have a positive impact on the nutritional status of ESRD patients, yet we still lack randomized controlled clinical trials showing that the same interventions could indeed lead to better survival or other clinical benefits. This knowledge gap, which is all too common for clinical problems encountered in nephrology, should not act as a deterrent, but it should rather incentivize us to continue exploring novel interventions aimed at improving malnutrition in ESRD.
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Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
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Westland GJ, Grootendorst DC, Halbesma N, Dekker FW, Verburgh CA. The Nutritional Status of Patients Starting Specialized Predialysis Care. J Ren Nutr 2015; 25:265-70. [DOI: 10.1053/j.jrn.2014.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 11/11/2022] Open
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The Relationship Among Obesity, Nutritional Status, and Mortality in the Critically Ill*. Crit Care Med 2015; 43:87-100. [DOI: 10.1097/ccm.0000000000000602] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Vejakama P, Ingsathit A, Attia J, Thakkinstian A. Epidemiological study of chronic kidney disease progression: a large-scale population-based cohort study. Medicine (Baltimore) 2015; 94:e475. [PMID: 25634196 PMCID: PMC4602951 DOI: 10.1097/md.0000000000000475] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The prognostic information about CKD progression, particularly for GFR categories 1 and 2, is still limited. This cohort was therefore conducted to determine the CKD progression using a competing risk approach. We conducted a retrospective cohort study linking community health screening with hospitals and death registry data in a province of Thailand, from 1997 to 2011. A competing risk model was applied by treating death as a competing risk factor to estimate 2-, 5-, and 10-year probability of kidney failure and median time for CKD progression from lower to higher GFR category. There were 17,074 non-diabetic and 15,032 diabetic CKD subjects. Diabetic subjects progressed more rapidly through GFR categories with the median times for CKD progression from GFR categories G1 to G2, G2 to G3a, G3a to G3b, G3b to G4, and G4 to G5 of 4.4, 6.1, 4.9, 6.3, and 9.0 years, respectively. Non-diabetic subjects took longer to progress with the corresponding median time of 9.4, 14.0, 11.0, 13.8, and >14.3 years. After adjusting for confounders, diabetic subjects were 49% (cause-specific hazard ratio ((c)HR) = 1.49, 95% CI: 1.37, 1.62) more likely to develop kidney failure than non-diabetic subjects. Albuminuria categories A3 and A2 were, respectively, 3.40 (95% CI: 3.07, 3.76) and 1.71 (95% CI: 1.53, 1.92) higher risk of kidney failure when compared to A1. For each albumin category, death rate increased as albuminuria increased particularly in diabetic subjects, which was approximately 2 times higher in A3 compared to A1. Considering GFR category, it gradually increased from G1 to G4 and sharply increased from G4 to G5 in both non-diabetic and diabetic subjects. This study has quantified CKD progression in an Asian population within ordinary practice. Diabetic subjects progress through GFR and albuminuria categories and reach kidney failure about twice as rapidly as non-diabetic subjects.
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Affiliation(s)
- Phisitt Vejakama
- From the Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok (PV, AI, AT); Department of Medicine, Bundarik Hospital, Bundarik District, Ubon Ratchathani Province, Thailand (PV); and Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, and Hunter Medical Research Institute, Newcastle, NSW, Australia (JA)
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Chan M, Kelly J, Batterham M, Tapsell L. A High Prevalence of Abnormal Nutrition Parameters Found in Predialysis End-Stage Kidney Disease: Is It a Result of Uremia or Poor Eating Habits? J Ren Nutr 2014; 24:292-302. [DOI: 10.1053/j.jrn.2014.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 03/20/2014] [Accepted: 03/27/2014] [Indexed: 01/04/2023] Open
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Cuppari L, Meireles MS, Ramos CI, Kamimura MA. Subjective global assessment for the diagnosis of protein-energy wasting in nondialysis-dependent chronic kidney disease patients. J Ren Nutr 2014; 24:385-9. [PMID: 25106727 DOI: 10.1053/j.jrn.2014.05.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Subjective global assessment (SGA) has been demonstrated to be a reliable method for protein-energy wasting (PEW) evaluation in chronic kidney disease (CKD) patients on dialysis. Few data are available on PEW evaluation in nondialysis stages of CKD, and the validity of SGA has been scarcely investigated in this population. Herein, we aimed to evaluate in nondialysis-dependent CKD patients (NDD-CKD): (1) the prevalence of PEW by SGA; (2) the most common abnormalities of the SGA components; and (3) the agreement of SGA with the traditional anthropometric parameters. DESIGN AND SUBJECTS This is a retrospective cross-sectional study including 922 NDD-CKD patients referred to the renal dietitians in the period of 2001 to 2012. Nutritional status was assessed by 7-point SGA. Body mass index (BMI), midarm circumference, midarm muscle circumference, and triceps skinfold thickness were available from 494 patients. RESULTS From the 922 patients, 58.6% were men, mean age was 63.8 ± 13.6 years, BMI was 27.7 ± 5.3 kg/m(2). The majority of the patients were in CKD Stages 3 (48.9%) or 4 (40.3%). PEW (SGA ≤5) was present in 11% of the patients and 32% had signs of PEW (SGA 6). In the logistic regression analysis, the presence of comorbidities and worse renal function were independently associated with PEW. Among the SGA components, the most frequent abnormality in patients with PEW was muscle and fat wasting (88.6%). BMI, midarm circumference, midarm muscle circumference, and triceps skinfold thickness were lower across the worse SGA scores, and a moderate to good level of agreement was found between the anthropometric parameters and presence of PEW evaluated by SGA. CONCLUSIONS The prevalence of PEW was 11% in our unselected cohort of NDD-CKD patients. The physical examination component (muscle/fat wasting) was the most frequent alteration found in those patients. When compared with anthropometric parameters, 7-point SGA has shown to be a valid tool to assess PEW in NDD-CKD population.
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Affiliation(s)
- Lilian Cuppari
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil; Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil.
| | | | | | - Maria Ayako Kamimura
- Graduation Program on Nutrition, Federal University of São Paulo, São Paulo, Brazil
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Erb ED, Hand RK, Steiber AL. SGA Scores Have Poor Correlation With Serum Albumin in Obese Hemodialysis Patients: A Secondary Analysis. J Ren Nutr 2014; 24:268-71. [DOI: 10.1053/j.jrn.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 11/11/2022] Open
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Smyth A, Glynn LG, Murphy AW, Mulqueen J, Canavan M, Reddan DN, O'Donnell M. Mild chronic kidney disease and functional impairment in community-dwelling older adults. Age Ageing 2013; 42:488-94. [PMID: 23438445 DOI: 10.1093/ageing/aft007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND chronic kidney disease (CKD) has been associated with an increased risk of death and cardiovascular events, but its relationship with non-vascular outcomes, including functional impairment (FI), is less well understood. OBJECTIVE in this study, we review the association between CKD and FI, adjusting for potential confounders and risk factors, with a primary outcome of impairment in any instrumental ADL (IADL) or basic ADL (BADL). DESIGN the Cardiovascular Multimorbidity in Primary Care Study (CLARITY) is a cross-sectional study of community-dwelling adults. SETTING participants were adults living in the West of Ireland attending university-affiliated general practices. SUBJECTS all participants were adults aged ≥50 years living in the community. METHODS CKD was defined as an estimated glomerular filtration rate (eGFR) ≤60 ml/min/1.73 m(2). A standardised self-reported health questionnaire to measure activities of daily living (ADL) was completed by participants. Logistic regression analyses were used to determine the independent association between CKD and FI. RESULTS a total of 3,499 patients were included with a mean age of 66.2 ± 10.3 years. 18.0% (n = 630) had CKD (mean eGFR 50.2 ± 9.2 ml/min/1.73m(2)), 21.9% (n = 138) of which had a diagnosis of CKD documented in medical records. 40.4% (n = 1,413) reported FI and multivariable adjustment showed CKD to be independently associated with FI (OR: 1.43, 1.15-1.78), impairment in IADL (OR: 1.43, 1.15-1.78) and impairment in BADL (OR: 1.39, 1.11-1.75). CONCLUSION our study shows even mild CKD is associated with FI, independent of age, gender, co-morbidities, traditional vascular risk factors and cardiovascular events.
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Affiliation(s)
- Andrew Smyth
- HRB Clinical Research Facility Galway, NUI, Galway, Geata an Eolais, Newcastle Road, Galway, Ireland.
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Kovesdy CP, Kopple JD, Kalantar-Zadeh K. Management of protein-energy wasting in non-dialysis-dependent chronic kidney disease: reconciling low protein intake with nutritional therapy. Am J Clin Nutr 2013; 97:1163-77. [PMID: 23636234 PMCID: PMC3652918 DOI: 10.3945/ajcn.112.036418] [Citation(s) in RCA: 171] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
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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Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN 38104, USA.
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Chan M, Kelly J, Batterham M, Tapsell L. Malnutrition (Subjective Global Assessment) Scores and Serum Albumin Levels, but not Body Mass Index Values, at Initiation of Dialysis are Independent Predictors of Mortality: A 10-Year Clinical Cohort Study. J Ren Nutr 2012; 22:547-57. [DOI: 10.1053/j.jrn.2011.11.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/26/2011] [Accepted: 11/27/2011] [Indexed: 01/04/2023] Open
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Janardhan V, Soundararajan P, Rani NV, Kannan G, Thennarasu P, Chacko RA, Reddy CUM. Prediction of Malnutrition Using Modified Subjective Global Assessment-dialysis Malnutrition Score in Patients on Hemodialysis. Indian J Pharm Sci 2012; 73:38-45. [PMID: 22131620 PMCID: PMC3224408 DOI: 10.4103/0250-474x.89755] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 02/14/2011] [Accepted: 02/15/2011] [Indexed: 01/30/2023] Open
Abstract
Malnutrition is widely prevalent among patients on hemodialysis. Malnutrition can be estimated using a fully quantitative scoring system Subjective Global Assessment-Dialysis Malnutrition Score which is simple, reliable and dynamic. The primary objective of the study was to assess the severity of malnutrition in patients with end stage renal disease and undergoing hemodialysis in a tertiary care teaching hospital in Chennai, using Subjective Global Asses sment-Dialysis Malnutrition Score and correlate it with standard indicators of malnutrition like anthropometric and biochemical parameters of the study population by Pearson's correlation. Anthropometric assessment included height, body weight, triceps skin fold thickness, mid arm circumference, mid arm muscle circumference % and biochemical parameters included serum albumin, transferrin, ferritin, total protein, total cholesterol, blood urea nitrogen and creatinine. Based on the scores, of the 66 patients, 91% were moderately malnourished. There was a significant negative correlation between modified Subjective Global Assessment-Dialysis Malnutrition Score and anthropometric measures such as triceps skin fold thickness, mid arm circumference, mid arm muscle circumference; biochemical markers such as albumin, transferrin and ferritin. The data obtained from this study confirm that a high degree of malnutrition was prevalent in patients on hemodialysis, as shown by anthropometric assessment, biochemical markers of malnutrition and Subjective Global Assessment-Dialysis Malnutrition Score. Nutritional status as determined by Subjective Global Assessment-Dialysis Malnutrition Score is a useful and reliable index for identifying patients at risk for malnutrition and it correlates well with anthropometric and biochemical assessment. may be integrated in regular assessment of malnutrition in patients on maintenance hemodialysis.
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Affiliation(s)
- Vasantha Janardhan
- Department of Pharmacy Practice, Faculty of Pharmacy, Department of Nephrology, Sri Ramachandra University, Porur, Chennai - 600 116, India
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Lawson CS, Campbell KL, Dimakopoulos I, Dockrell ME. Assessing the Validity and Reliability of the MUST and MST Nutrition Screening Tools in Renal Inpatients. J Ren Nutr 2012; 22:499-506. [DOI: 10.1053/j.jrn.2011.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 07/12/2011] [Accepted: 08/09/2011] [Indexed: 01/04/2023] Open
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Leinig CE, Moraes T, Ribeiro S, Riella MC, Olandoski M, Martins C, Pecoits-Filho R. Predictive value of malnutrition markers for mortality in peritoneal dialysis patients. J Ren Nutr 2010; 21:176-83. [PMID: 21193323 DOI: 10.1053/j.jrn.2010.06.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 05/23/2010] [Accepted: 06/13/2010] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Alterations in nutritional status have been described as important predictors of mortality in patients with chronic kidney disease (CKD). However, the association between multiple markers for nutritional status and the mortality rates of patients with CKD on peritoneal dialysis (PD) has not yet been illustrated in previously published data, particularly by using the new definition of protein energy wasting (PEW). OBJECTIVE To evaluate the predictive value of malnutrition markers for mortality rates, on the basis of the PEW definition, of PD patients. MATERIALS AND METHODS At the start of PD treatment, the nutritional status of 199 patients (mean age, 56 ± 13.3 years; 53% females) was evaluated. Body mass index (BMI), arm circumference, mid-arm muscle circumference, protein and caloric intake (by using a 3-day food record), and serum albumin were all recorded, as well as a subjective global assessment (SGA) and presence of PEW. Cut-off points were defined on the basis of the consensus of the International Society for Renal Nutrition and Metabolism (albumin, <3.8 g/dL; BMI, <23 kg/m(2); mid-arm muscle circumference, >10% in comparison with the 50th percentile for the reference population; protein intake, <0.8 g/kg/daily; caloric intake, <25 kcal/kg/daily). The data were obtained retrospectively between the years 2001 and 2008 on the basis of routine nutritional evaluation. Patients were monitored for fatal events from all possible causes. RESULT The mean BMI for the population was 26.6 ± 5.0 kg/m(2). A median protein intake of 0.94 (0.18 to 4.57) g/kg/daily was reported and 60.3% of the patients reported a protein intake of <0.8 g/kg/daily. With respect to caloric intake, 38.7% of the patients consumed <25 kcal/kg/daily. A median of 3.5 (1.4 to 5.3) g/dL for serum albumin was observed and 29.3% of the patients presented values of <3.8 g/dL. PEW was diagnosed in 17.5% of patients. In the univariate model, being of age >65 years (P = .002), cardiovascular disease (P < .001), diabetes mellitus (P = .02), SGA (P = .02), and albumin (P = .002), were all significant markers for mortality. The presence of patients aged >65 years (P = .02), with diabetes mellitus (P = .057), cardiovascular disease (P = .005), and albumin were considered as independent factors for mortality in this study. CONCLUSION SGA, albumin, and PEW were the only nutritional markers found to be associated with mortality in this cohort of PD patients. In the multivariate analysis, after adjusting for classic mortality risk factors, only patients with hypoalbuminemia were found to be at a high risk for mortality at follow-up. These results may be limited by the number of observations and a necessity for confirmation in larger prospective studies.
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Affiliation(s)
- Cyntia Erthal Leinig
- Division of Nephrology, Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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