Associations of Dietary Protein and Energy Intakes With Protein-Energy Wasting Syndrome in Hemodialysis Patients

Beddhu, Srinivasan; Wei, Guo; Chen, Hong; Boucher, Robert; Kiani, Rabia; Raj, Dominic S.; Chonchol, Michel; Greene, Tom; Murtaugh, Maureen A.

doi:10.1016/j.ekir.2017.04.002

Cited by 15 publications

(8 citation statements)

References 30 publications

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“…In this presented study, respondents consuming less protein were simultaneously characterized by a lower intake of energy and most other nutrients. Similarly, in other research, CKD patients in highest baseline DPI and DEI quartiles had 4.11-fold (95% confidence interval: 2.79-6.05) higher odds of having protein energy wasting syndrome at month 12 [21]. These similarities may happen as a result of patients limiting the quantity of all consumed foods in an attempt to limit the level of protein in the diet.…”

Section: Discussionmentioning

confidence: 53%

Patients with chronic kidney disease are not well adhered to dietary recommendations: a cross-sectional study

et al. 2020

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Background: Nutrition and dietary patterns are modifiable factors that can be utilized to prevent or slow the progression of Chronic kidney disease (CKD). Adherence to current dietary recommendations can reduce the incidence, or slow the progression of CKD and reduce mortality. The objectives of this study was to compare the dietary nutrient intake of CKD patients (CKD above stage 3 including hemodialysis) to dietary recommendations and to assess the correlations of those dietary nutrient intakes with each other and with chosen laboratory measurements. Methods: A hospital-based cross-sectional study was conducted among 100 patients with CKD. A consecutive 7 days dietary record supplemented with interviews for data completion was used to assess dietary intake. Recent clinical laboratory measurements were obtained from patients' medical records. The obtained dietary data were analyzed by the Ethiopian food composition database and the nutrisurvey software. Dietary energy and nutrients intake were compared with recommendations for CKD patients. Results: The dietary energy intake (DEI) of almost all patients was below recommended levels. The average Dietary protein intake (DPI) was above the recommended levels (0.95 ± 0.27 g/kg/day) for about 60% of the respondents. Besides, 38% and only two of the respondents had their dietary phosphorus and potassium intakes above recommended levels, respectively. Estimated Glomerular filtration rate (eGFR) was positively correlated with both total and animal protein intakes while blood levels of creatinine and urea were negatively correlated with animal protein intake. Conclusion: Patients with CKD are not well adhered to dietary recommendations and some nutrients showed correlation with chosen clinical laboratory measurements. Besides, DEI and DPI were below and above recommended levels, respectively, for most patients. Besides, more than one-third of the participants had phosphorus intakes above recommendation. These non-optimal dietary nutrient intakes may contribute to fast clinical deterioration and mortality.

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Section: Discussionmentioning

confidence: 53%

Patients with chronic kidney disease are not well adhered to dietary recommendations: a cross-sectional study

et al. 2020

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“…In a study comparing dietary and nutrition status measures in HD patients by time on dialysis, investigators found increased energy and protein intake over time despite deteriorated measures of somatic protein [45]. Consistent with this, a prospective study unexpectedly identified a direct association between dietary protein and energy intake at baseline and PEW prevalence at 12 months, prompting the investigators to recommend excluding dietary measures from the definition of PEW [46].…”

Section: Discussionmentioning

confidence: 55%

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Boaz

Azoulay

Schwartz

et al. 2019

Nephron

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Background: Malnutrition is a frequently observed disorder in patients with chronic kidney disease (CKD) receiving hemodialysis (HD). While variously defined, malnutrition is a frequently observed condition among patients on HD. Prevalence estimates of malnutrition among Israeli HD patients have not been reported. Objectives: To survey nutrition intake in Israeli HD patients; estimate malnutrition risk prevalence; identify risk factors, and characterize malnutrition risk in HD patients. Methods: A representative sample of 378 Israeli HD patients treated in hospital HD centers throughout the country were surveyed. Using the 24-h recall method, dietary intake was estimated and the chronologically corresponding biochemistry, anthropometric, and hemodynamic measures were recorded. Four categories of malnutrition risk were defined: “minimal”: body mass index (BMI) > 23 kg/m² and serum albumin > 3.8 g/dL; “mild”: BMI < 23 kg/m² and albumin > 3.8 g/dL; “moderate”: BMI > 23 kg/m² and albumin < 3.8 g/dL; “severe”: BMI < 23 k/m² and serum albumin < 3.8 g/dL. Results: Elevated malnutrition risk was identified in 175 (46.3%) study participants, who were more likely to require feeding assistance, have major comorbidities, reduced hemoglobin, and elevated C-reactive protein. Oral nutrition supplementation was prescribed to only 14.3% of patients with elevated malnutrition risk. Intradialytic parenteral nutrition was recorded for 6 patients, all of whom had moderate or severe malnutrition risk. Less than one-third of patients met the guidelines for dietary intake of energy or protein, and this did not differ across malnutrition risk groups. Discussion: Elevated malnutrition risk is a frequent finding in HD patients treated in hospital settings in Israel. Dietary intake does not meet guidelines but does not differ across malnutrition risk categories. Nutrition supplements are underused in HD patients with high malnutrition risk. There is a need to expand the survey to community HD centers.

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“…31 Despite these established recommendations, the results of a recent study by Beddhuet al are worthy of comment. 44 In a retrospective analysis of the Hemodialysis (HEMO) study they examined the relationships of baseline dietary protein intake (DPI) and dietary energy intake (DEI) with the PEW syndrome at month 12 using the quartiles of these variables at baseline. Interestingly, those patients in the highest quartile of DPI or DEI had a higher risk of the PEW syndrome.…”

Section: Pe W/c Ache Xia Pre Venti On In Ck Dmentioning

confidence: 99%

Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment

Oliveira

Zheng

Carter

et al. 2019

Seminars in Dialysis

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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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Associations of Dietary Protein and Energy Intakes With Protein-Energy Wasting Syndrome in Hemodialysis Patients

Cited by 15 publications

References 30 publications

Patients with chronic kidney disease are not well adhered to dietary recommendations: a cross-sectional study

Patients with chronic kidney disease are not well adhered to dietary recommendations: a cross-sectional study

Malnutrition Risk in Hemodialysis Patients in Israel: Results of the Status of Nutrition In Hemodialysis Patients Survey Study

Cachexia/Protein energy wasting syndrome in CKD: Causation and treatment

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