Nutritional status in stage V dialyzed patient versus CKD patient on conservative therapy across different economic status

Vijayan, Madhusudan; Abraham, Georgi; Alex, Merina E; Vijayshree, N; Reddy, Yuvaram N.V.; Fernando, Edwin; Mathew, Milly; Nair, Sanjeev; Yuvaraj, Anand

doi:10.3109/0886022x.2013.872570

Cited by 9 publications

(6 citation statements)

References 17 publications

(24 reference statements)

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“…Malnutrition has been widely reported in Indian patients on dialysis. 5,6 Malnutrition in CKD is associated with increased morbidity, mortality and poor quality of life. 7,8 However, there is a paucity of multicentric longitudinal data on hydration and nutritional status of Indian dialysis patients and its effect on all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients—a multicenter longitudinal study

et al. 2014

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Hydration and nutritional status of end stage renal disease (ESRD) patients are linked to increased morbidity and mortality. Body composition monitoring (BCM) by multi-frequency bioimpedance spectroscopy (MFBS) is considered to be a superior modality of fluid assessment in chronic kidney disease (CKD) dialysis. We did a longitudinal prospective study in South India on maintenance hemodialysis (MHD) and continuous ambulatory peritoneal dialysis (CAPD) patients over 24 months and looked at impact of baseline nutritional parameters and body composition parameters on 24-month mortality. Ninety-nine patients stable on dialysis for at least 3 months were recruited (MHD 85, CAPD 14) at baseline and at 24 months, 41 were alive and 33 had expired, 12 had undergone renal transplant and 13 were lost to follow-up. BCM and nutritional assessment were done at baseline and at follow-up. Baseline overhydration (OH) differed significantly between surviving and dead patients (p50.05). Receiver operating characteristic (ROC) curve between OH and mortality showed that the best cut-off point to differentiate between survived and expired patients was 3.15 L. ROC curve for BMI showed lower than cut-off of 22.65 kg/m 2 to predict mortality with sensitivity 41.30% and specificity 81.81%. At follow-up, triceps skin fold thickness (TSF), biceps skin fold thickness (BSF) and mid arm circumference (MAC) increased significantly from baseline (p50.001, p ¼ 0.001 and p50.001, respectively). Overhydration and BMI are important predictors of mortality in dialysis patients. Improvement in anthropometric markers TSF, BSF and MAC in MHD patients was associated with survival.

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Section: Introductionmentioning

confidence: 99%

Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients—a multicenter longitudinal study

et al. 2014

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“…Anthropometric measures and serum albumin in the present study were similar to those reported in another Indian study evaluating nutritional status among CKD patients. [ 28 ] In the present study, though not statistically significant, delayed GE group had poorer nutrition (as suggested by lower anthropometric measures and serum albumin) compared to the rest [Tables 4 and 5 ]. Similar findings of more severe malnutrition among CKD patients with delayed GE have been reported in earlier studies.…”

Section: Discussionmentioning

confidence: 48%

Delayed gastric emptying among Indian patients with non-diabetic chronic kidney disease

et al. 2021

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Introduction: Upper gastrointestinal symptoms such as nausea, vomiting, abdominal bloating, and poor appetite are more frequent among chronic kidney disease (CKD) patients and may contribute to poor nutritional intake and malnutrition. Delayed gastric emptying (GE), one of the important contributors to these symptoms, has not been evaluated systematically in different stages of non-diabetic CKD, among Indian patients. Materials and Methods: This hospital-based, cross-sectional analytical study aimed to find out the frequency of delayed GE in non-diabetic CKD (stages: 3,4,5) patients and also to study the correlation between delayed GE and symptoms of gastroparesis, autonomic neuropathy and nutritional parameters. Patients were subjected to evaluation of symptoms of gastroparesis by standardized questionnaire (gastroparesis cardinal symptom index), nutritional status (by anthropometric measures and serum albumin), autonomic function by heart rate variability (HRV) and GE by gastric scintigraphy with a standardized solid rice idli (savory cake) meal labeled with technetium-99m sulfur colloid. Results: Of the 89 non-diabetic CKD (stages-3,4,5) patients evaluated, 22 (≈25%) had delayed GE and 8 (≈9%) rapid GE. Prevalence of delayed GE was higher among stage 5 (15/49, 31%) compared to stages 3 and 4 (7/40, 17.5%), though the difference was statistically insignificant. There was no association between delayed GE and symptoms of gastroparesis and autonomic neuropathy. Though not statistically significant, nutritional parameters (body mass index, skinfold thickness, and serum albumin) were poorer in the delayed GE group compared to the rest. Conclusion: Delayed GE, irrespective of symptoms, may contribute to malnutrition and hence should be looked for in non-diabetic CKD patients with unexplained malnutrition.

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“…The number of AVF creation and patients going for dialysis even in ER groups remained minuscule compared recommended reference [ 17 ]. A majority do not opt for any modality of RRT, only a few renal transplantations, and the high death rate suggests no improvement in CKD care and management over the decades [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with hypocalcemia, high phosphorus, and increased alkaline phosphatase have increased mortality, indicating nonoptimized care for CKD. The low serum albumin, cholesterol, and triglyceride level indicate the poor nutritional status of the patients who died [ 20 ]. It also indicates that many of these patients did not receive appropriate supportive care before referral, either due to late diagnosis or due to late referral.…”

Section: Discussionmentioning

confidence: 99%

Impact of Early versus Late Referral to Nephrologists on Outcomes of Chronic Kidney Disease Patients in Northern India

Dhanorkar

Prasad

Kushwaha

et al. 2022

International Journal of Nephrology

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Background. CKD patients are often asymptomatic in the early stages and referred late to nephrologists. Late referred patients carry a poor prognosis. There is a lack of data on outcomes associated with referral patterns in CKD patients from northern India. Methods. In this observational cohort study, all CKD patients who visited the nephrology OPD of the institute between Nov 1, 2018, and Dec 31, 2020, were classified as early referral (ER) if their first encounter with a nephrologist occurred more than one year before initiation of dialysis and education about dialysis (from a nurse or nephrologist). The remaining others were considered late referrals (LRs). The outcomes impact of early and late referrals was analyzed. Results. A total of 992 (male 656) CKD patients (ER, n = 475 and LR, n = 517) were enrolled. Patients referred early were older and diabetic and had higher BMI, better education, occupation, and socioeconomic status as compared to those referred late. The mean eGFR at first contact with the nephrologist was (25.4 ± 11.5 ml/min) in ER and 9.6 ± 5.7 ml/min in the LR group and had a higher comorbidity score. The CKD-MBD parameters, hemoglobin, and nutritional parameters were worse in LR. Only a few patients had AVF, and the majority required emergency dialysis in the LR group. A total of 91 (9.2%) patients died, 17 (1.7% ER and 74 (7.5%) patients in the LR group patients. There was significantly lower survival at 6 months (ER 97.1% vs. LR 89.7%), 12 months (ER 96.4% vs. LR 85.7%), 18 months (ER 96.4% vs. LR 85.7%), and 24 months (ER 96.4% vs. LR 85.7%) in late referral group as compared to early referral group P = 0.005 . Conclusions. LR to nephrologists has the risk of the emergency start of dialysis with temporary vascular access and had a higher risk of mortality. The timely referral to the nephrologist in the predialysis stage is associated with better survival and reduced mortality.

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Nutritional status in stage V dialyzed patient versus CKD patient on conservative therapy across different economic status

Abstract: Several nutritional parameters were below the recommended international guidelines for all the three groups, though the high income group had better parameters from several indicators. There is an urgent need for nutritional counseling for CKD-D and CKD-ND patients.

Cited by 9 publications

References 17 publications

Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients—a multicenter longitudinal study

Body composition monitoring and nutrition in maintenance hemodialysis and CAPD patients—a multicenter longitudinal study

Delayed gastric emptying among Indian patients with non-diabetic chronic kidney disease

Impact of Early versus Late Referral to Nephrologists on Outcomes of Chronic Kidney Disease Patients in Northern India

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