Food Intake and Nutritional Status in Stable Hemodialysis Patients

Abstract

This is a cross-sectional, multicenter, controlled study aiming to evaluate changes of actual dietary nutrient intake in 94 stable hemodialysis patients in respect to 52 normal subjects and guideline recommendations, and to assess the prevalence of signs of malnutrition. Energy and nutrients intake assessment was obtained by a three-day period food recall. Anthropometric and biochemical parameters of nutrition, bioelectric impedance vector analysis, and subjective global assessment (SGA) have been performed to assess nutritional status. SGA-B was scored in 5% of the patients. Body mass index < 20 Kg/m(2), serum albumin <35 g/L, nPNA < 1.0 g/Kg, and phase angle <4.0 degrees were detected in 16.3%, 16%, 23%, and 8.0 % of patients, respectively. HD patients showed a lower energy and protein intake in respect to controls, but no difference occurred when normalized per ideal body weight (29.3 +/- 8.4 vs. 29.5 +/- 8.4 Kcal/Kg i.b.w./d and 1.08 +/- 0.35 vs. 1.12 +/- 0.32 Kcal/Kg i.b.w. /d, respectively). Age was the only parameter that inversely correlates with energy (r = -0.35, p < 0.001) and protein intake (r = -0.34, p < 0.001). This study shows that in stable dialysis patients, abnormalities of nutritional parameters are less prevalent than expected by analysis of dietary food intake. Age is the best predictor of energy and protein intake in the dialysis patients who ate less than normal people, but no difference emerged when energy and protein intakes were normalized for body weight. These results recall the attention for individual dietetic counseling in HD patients, and also for a critical re-evaluation of their dietary protein and energy requirements.

Asymmetric dimethyl arginine levels in chronic hemodialysis patients

“…As serum albumin level is a marker of nutritional status, we think that this result suggests an association between nutrition and inflammation in ESRD patients. This result is consistent with the findings of a recent trial studying nutritional status in HD patients (13). Unlike the results of similar studies, we could not find any significant relation between ADMA and BMI (13,19).…”

“…This result is consistent with the findings of a recent trial studying nutritional status in HD patients (13). Unlike the results of similar studies, we could not find any significant relation between ADMA and BMI (13,19). This may be due to the small number of patients in our study.…”

“…Increased levels of ADMA are thought to be associated with the increased frequency of cardiovascular events seen in ESRD patients (10,11), and it is suggested that ADMA might be a novel cardiovascular risk factor for both ESRD patients and the general population (7,12). Additionally, its relation with nutritional status in maintenance HD patients was assessed in a recent trial and a negative correlation was found between ADMA levels and nutritional parameters (13).…”

A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study

“…Nutritional guidelines suggest daily energy intake higher than 30-35 kcal/kg ideal body weight and daily protein intake higher than 1.1-1.2 g/kg ideal body weight, 6,7 mostly because of the catabolic effect and of the losses of amino acids, peptides, and proteins related to the hemodialysis procedure. Many studies reported that these recommendations are far from being fully obtained; [8][9][10] moreover, chronic renal failure is associated with loss of appetite and reduced food intake, especially when toxins removal by hemodialysis is inadequate. 11 Dialysis adequacy and nutritional counseling are the first attempts to ameliorate nutritional status, and then oral nutritional supplements should be employed including energy and protein sources.…”

Adenine-induced hyperphosphatemia in a murine model of renal insufficiency

“…The primary approach to manage hyperphosphatemia in the CKD patient is through oral administration of phosphate binders and dietary phosphate reduction [3,26]. Failure to control the hyperphosphatemic condition in CKD patients significantly increases the risk of cardiovascular disease [27].…”