Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

Bolasco, Piergiorgio

doi:10.3390/nu12061773

Cited by 14 publications

(7 citation statements)

References 139 publications

(143 reference statements)

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“…In order to suit the nutritional needs of CKD patients, FontActiv ® Renal HP is reduced in sodium, potassium, and phosphorus. Sodium intake should be lower than 3–5 g/day, phosphate intake lower than 1000–1200 mg/day, and potassium intake lower than 2000 mg/day [ 30 ]. The content of these elements in FontActiv ® Renal HP is very low, with 50.5 mg of sodium and 28 mg of phosphorus and potassium.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial

Castro‐Barquero

Arias‐Guillén

Pi-Oriol

et al. 2022

JCM

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Chronic kidney disease (CKD) involves heterogeneous diseases that affect the renal structure and function. Malnutrition plays a crucial role during patients with CKD on hemodialysis (HD) treatment and is associated with an increased rate and duration of hospitalizations. The aim of this randomized, parallel, intervention-controlled trial was to assess whether the use of daily supplementation with a new nutritional product developed by the Grand Fontaine Laboratories improves the nutritional status and anthropometric parameters of stage 5 CKD patients, compared with standard renal dietary advice, after three months of follow-up. Dietary intake, anthropometric measurements, physical activity, and blood samples were collected at baseline and after three months of intervention. Significant improvements were observed within the intervention group in body weight (1.5 kg [95% CI: 0.9 to 2.12 kg]) and BMI (0.54 kg/m2 [95% CI: 0.31 to 0.77]; p-value between groups, 0.002 and 0.006, respectively). In the control group, significant decreases were observed in transferrin saturation (−5.04% [95% CI: −8.88 to −1.21]) and alpha-tocopherol levels (−3.31 umol/L [95% CI: −6.30 to −0.32]). We concluded that daily dietary intake of a specific renal nutritional complement in CKD patients with or at risk of malnutrition may prevent deterioration in nutritional parameters.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial

Castro‐Barquero

Arias‐Guillén

Pi-Oriol

et al. 2022

JCM

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“…This loss is representative of the amount of AAs being released in the circulation following ingestion of a normal meal providing ∼20 g protein ( 15 ). As a consequence, AA removal during hemodialysis has been proposed to represent a key factor responsible for the accelerated loss of muscle mass in patients with ESRD ( 6 , 33 , 34 ).…”

Section: Discussionmentioning

confidence: 99%

Amino acid removal during hemodialysis can be compensated for by protein ingestion and is not compromised by intradialytic exercise: a randomized controlled crossover trial

Hendriks

Smeets

Kranenburg

et al. 2021

The American Journal of Clinical Nutrition

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Background Patients with end-stage renal disease (ESRD) undergoing hemodialysis experience a rapid decline in skeletal muscle mass and strength. Hemodialysis removes amino acids (AAs) from the circulation, thereby lowering plasma AA concentrations and stimulating proteolysis. Objectives In the present study, we evaluate the impact of intradialytic protein ingestion at rest and following exercise on AA removal and plasma AA availability in patients with ESRD. Methods Ten patients (age: 65 ± 16 y, male/female: 8/2, BMI: 24.2 ± 4.8 kg/m2, serum albumin: 3.4 ± 0.3 g/dL) with ESRD undergoing hemodialysis participated in this randomized controlled crossover trial. During 4 hemodialysis sessions, patients were assigned to ingest 40 g protein or a placebo 60 min after initiation, both at rest (PRO and PLA, respectively) and following exercise (PRO + EX and PLA + EX, respectively). Spent dialysate and blood samples were collected every 30 min throughout hemodialysis to assess AA removal and plasma AA availability. Results Plasma AA concentrations declined by 26.1 ± 4.5% within 30 min after hemodialysis initiation during all interventions (P < 0.001, η2p > 0.79). Protein ingestion, but not intradialytic exercise, increased AA removal throughout hemodialysis (9.8 ± 2.0, 10.2 ± 1.6, 16.7 ± 2.2, and 17.3 ± 2.3 g during PLA, PLA + EX, PRO, and PRO + EX interventions, respectively; protein effect P < 0.001, η2p = 0.97; exercise effect P = 0.32, η2p = 0.11). Protein ingestion increased plasma AA concentrations until the end of hemodialysis, whereas placebo ingestion resulted in decreased plasma AA concentrations (time effect P < 0.001, η2p > 0.84). Plasma AA availability (incremental AUC) was greater during PRO and PRO + EX interventions (49 ± 87 and 70 ± 34 mmol/L/240 min, respectively) compared with PLA and PLA + EX interventions (–227 ± 54 and –208 ± 68 mmol/L/240 min, respectively; protein effect P < 0.001, η2p = 0.98; exercise effect P = 0.21, η2p = 0.16). Conclusions Protein ingestion during hemodialysis compensates for AA removal and increases plasma AA availability both at rest and during recovery from intradialytic exercise. Intradialytic exercise does not compromise AA removal or reduce plasma AA availability during hemodialysis in a postabsorptive or postprandial state.

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“…Leptin je adipokin srednje molekulske mase (MW -17 kDa), koji smanjuje apetit bolesnika koji se leče redovnom dijalizom (energetski unos  30 Kcal/kg/dan, unos proteina manji od 0,8 g/kg/dan). Indeks telesne mase -BMI  20 kg/m 2 , koncentracija albumina u serumu  35 g/l, koncentracija prealbumina u serumu manja od 0,30 g/l i normalizovan stepen razgradnje proteina -nPCR  1,0 g/kg/dan faktori su rizika za nepovoljan ishod bolesnika koji se leče redovnom dijalizom (36)(37)(38). Ispitivanja pokazuju da visokovolumenska postdiluciona online hemodijafiltracija efikasno uklanja prozapaljenske citokine i leptin, smanjuje mikroinflamaciju, smanjuje koncentraciju leptina u serumu, sprečava razvoj neuhranjenosti i popravlja ishod ovih bolesnika (36)(37)(38).…”

Section: Diskusijaunclassified

Comparison of efficiency of medium molecular weight uremic toxin removal between high-flux hemodialysis and postdilution online hemodiafiltration

Nenadović¹,

Nikolić²,

Kostović³

et al. 2021

Medicinski časopis

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Introduction. Conventional high-flux hemodialysis effectively removes uremic toxins of medium molecular weight of 0.5-15 (20) kDa, while postdilution online hemodiafiltration effectively removes uremic toxins of medium molecular weight in the range of 0.5-60 kDa. AIM. The aim of the study was to compare the efficacy of b2-microglobulin removal from the patient serum during a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. METHOD. Eighty-five patients treated with conventional high-flux hemodialysis and thirty patients treated with postdilution online hemodiafiltration were examined. The main parameter for assessing the removal efficiency of medium molecular weight uremic toxins was serum b2microglobulin concentration before and after a single session of conventional high-flux hemodialysis and postdilution online hemodiafiltration. The following were used for statistical analysis: Kolmogorov-Smirnov test, Student's T test and Mann-Whitney U test. RESULTS. In patients treated with postdilution online hemodiafiltration, the average total convective volume was 21.38 ± 2.97 liters per session. The b2-microglobulin reduction index for the FX CorDiax 600 dialysis membrane was 61.76 ± 7.32%, while for the FX CorDiax 800 dialysis membrane it was 74.69 ± 6.51%. The albumin reduction index for the FX CorDiax 600 membrane was 3.48 ± 1.28%, and for the FX CorDiax 800 dialysis membrane it was 6.01 ± 2.97%. There is a highly statistically significant difference between the reduction index of b2-microglobulin and albumin, for two different dialysis modalities and two different dialysis membranes (p < 0.01). CONCLUSION. Postdilution online hemodiafiltration is more efficient in removing b2-microglobulin from patient serum, compared to conventional high-flux hemodialysis. Albumin loss during a single session of high-flux hemodialysis is lower compared to a single session of postdilution online hemodiafiltration. With both dialysis modalities, albumin loss is less than 4.0 g/4h. High-flux hemodialysis effectively prevents the development of dialysis-related amyloidosis, while postdilution online hemodiafiltration effectively prevents not only the development of dialysis-related amyloidosis, but also the development of resistance to erythropoietin and atherosclerotic cardiovascular diseases in the population treated with regular dialysis.

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Hemodialysis—Nutritional Flaws in Diagnosis and Prescriptions. Could Amino Acid Losses Be the Sharpest “Sword of Damocles”?

Cited by 14 publications

References 139 publications

A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial

A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial

Amino acid removal during hemodialysis can be compensated for by protein ingestion and is not compromised by intradialytic exercise: a randomized controlled crossover trial

Comparison of efficiency of medium molecular weight uremic toxin removal between high-flux hemodialysis and postdilution online hemodiafiltration

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