Difficulty in Improving Malnutrition and Low‐grade Inflammation in Diabetic Patients on Peritoneal Dialysis

Park, Sung-Won; Seo, Jung-Ju; Bae, Ho-Sang; Kim, Jong-Yeon; Kim, Chan‐Duck; Park, Sun-Hee; Kim, Yong-Lim

doi:10.1111/j.1744-9987.2008.00638.x

Cited by 5 publications

(3 citation statements)

References 24 publications

(32 reference statements)

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“…A well-known peculiarity of patients on PD, compared to patients on HD, is that their albumin values are lower, probably due to losses from peritoneal dialysis fluid (PDF) as well as the chronic inflammation status [ 48 , 49 , 50 ]. This finding is even more pronounced in diabetic patients [ 51 ].…”

Section: Mechanisms Of Inflammation In Ckd and Their Relation To Maln...mentioning

confidence: 99%

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

et al. 2022

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While patient care, kidney replacement therapy, and transplantation techniques for chronic kidney disease (CKD) have continued to progress, the incidence of malnutrition disorders in CKD appears to have remained unchanged over time. However, there is now a better understanding of the underlying pathophysiology according to the disease background, disease stage, and the treatment received. In CKD patients, the increased production of proinflammatory cytokines and oxidative stress lead to a proinflammatory milieu that is at least partially responsible for the increased morbidity and mortality in this patient population. New insights into the pathogenic role of innate immunity and the proinflammatory cytokine profile, characterized, for instance, by higher levels of IL-6 and TNF-α, explain some of the clinical and laboratory abnormalities observed in these patients. In this article, we will explore currently available nutritional–inflammatory biomarkers in distinct CKD populations (hemodialysis, peritoneal dialysis, transplantation) with a view to evaluating their efficacy as predictors of malnutrition and their involvement in the common proinflammatory process. Although there is a direct relationship between inflammatory-nutritional status, signs and symptoms [e.g., protein-energy wasting (PEW), anorexia], and comorbidities (e.g., atheromatosis, atherosclerosis), we are in need of clearly standardized markers for nutritional-inflammatory assessment to improve their performance and design appropriate bidirectional interventions.

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Section: Mechanisms Of Inflammation In Ckd and Their Relation To Maln...mentioning

confidence: 99%

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

et al. 2022

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“…Lower survival rates are also observed in patients with malnutrition, which is a common clinical problem in this group [ 22 ]. Dialysis patients with diabetes are characterized by significantly lower nutritional parameters and a higher incidence of malnutrition compared to patients without diabetes [ 23 , 24 , 25 , 26 , 27 ]. Among hemodialyzed patients, the Geriatric Nutrition Risk Index (GNRI) has been used to assess the nutritional status, as well as all-cause [ 4 , 5 , 28 , 29 ], cardiovascular [ 30 ], and infectious mortality [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Inferior Nutritional Status Significantly Differentiates Dialysis Patients with Type 1 and Type 2 Diabetes

Grzywacz¹,

Lubas²,

Niemczyk³

2023

Nutrients

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Diabetes mellitus is currently the leading cause of end-stage renal disease. Assessing nutritional status is an important component of care in this group. This prospective observational study aimed to assess the nutritional status of type 1 and type 2 diabetes patients on hemodialysis or peritoneal dialysis and its relationship with hospitalizations and all-cause death. Adult patients with end-stage renal disease, treated with dialysis, and suffering from type 1 or type 2 diabetes, being treated with insulin, were included in the study. Exclusion criteria comprised other types of diabetes, the patient’s refusal to participate in the study, and severe disorders impacting verbal-logical communication. The nutritional status based on the Nutritional Risk Index, the Geriatric Nutritional Risk Index, fat distribution measures, and the Charlson Comorbidity Index was estimated for 95 Caucasian dialysis patients with type 1 (n = 25) or type 2 (n = 70) diabetes. Patients with type 1 diabetes exhibited significantly inferior nutritional status and increased nutritional risk than those with type 2 diabetes. Lower values of nutritional indices significantly differentiated patients with type 1 from those with type 2 diabetes, with ≥84% sensitivity and specificity. Inferior nutritional status was related to all-cause hospitalizations, whereas higher comorbidity was associated with a greater likelihood of cardiovascular hospitalizations and all-cause death. The significant difference between patients with type 1 and type 2 diabetes being treated with dialysis indicates that these patients should not be considered as a homogeneous group, while also considering the greater age of patients with type 2 diabetes.

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“…[ 9 10 ] In addition, diabetic patients are more prone to malnutrition relative to nondiabetic patients. [ 11 ] Therefore, we chose patients with diabetic nephropathy as research subjects to evaluate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in this specific population on PD.…”

Section: Introductionmentioning

confidence: 99%

Influence of Peritoneal Transport Characteristics on Nutritional Status and Clinical Outcome in Chinese Diabetic Nephropathy Patients on Peritoneal Dialysis

Guan

Bian

Zhang

et al. 2015

Chinese Medical Journal

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Background:High peritoneal transport status was previously thought to be a poor prognostic factor in peritoneal dialysis (PD) patients. However, its effect on diabetic nephropathy PD patients is unclear in consideration of the adverse impact of diabetes itself. The purpose of this study was to investigate the influence of peritoneal transport characteristics on nutritional status and clinical outcome in diabetic nephropathy patients on PD.Methods:One hundred and two diabetic nephropathy patients on PD were enrolled in this observational cohort study. According to the initial peritoneal equilibration test result, patients were divided into two groups: Higher transport group (HT, including high and high average transport) and lower transport group (LT, including low and low-average transport). Demographic characteristics, biochemical data, dialysis adequacy, and nutritional status were evaluated. Clinical outcomes were compared. Risk factors for death-censored technique failure and mortality were analyzed.Results:Compared with LT group (n = 37), serum albumin was significantly lower and the incidence of malnutrition by subjective global assessment was significantly higher in HT group (n = 65) (P < 0.05). Kaplan–Meier analyses showed that death-censored technique failure and mortality were significantly increased in HT group compared with that in LT group. On multivariate Cox analyses, higher peritoneal transport status and lower residual renal function (RRF) were independent predictors of death-censored technique failure when adjusted for serum albumin and total weekly urea clearance (Kt/V). Independent predictors of mortality were advanced age, anemia, hypoalbuminemia, and lower RRF, but not higher peritoneal transport status.Conclusions:Higher peritoneal transport status has an adverse influence on nutrition for diabetic nephropathy patients on PD. Higher peritoneal transport status is a significant independent risk factor for death-censored technique failure, but not for mortality in diabetic nephropathy patients on PD.

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Difficulty in Improving Malnutrition and Low‐grade Inflammation in Diabetic Patients on Peritoneal Dialysis

Cited by 5 publications

References 24 publications

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease

Inferior Nutritional Status Significantly Differentiates Dialysis Patients with Type 1 and Type 2 Diabetes

Influence of Peritoneal Transport Characteristics on Nutritional Status and Clinical Outcome in Chinese Diabetic Nephropathy Patients on Peritoneal Dialysis

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