Improvement in nutritional parameters after initiation of chronic hemodialysis

Pupim, Lara B.; Kent, Pamela; Çağlar, Kayser; Shyr, Yu; Hakim, Raymond M.; İkizler, T. Alp

doi:10.1053/ajkd.2002.33923

Cited by 70 publications

(39 citation statements)

References 23 publications

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“…Most investigators have shown that serum albumin levels increase during the first 6 months of dialysis followed by a decline in values during the second year of maintenance HD [5,6,7,8]. Few are the longitudinal studies that have included prevalent patients and they have led to conflicting results [9,10,11].…”

Section: Discussionmentioning

confidence: 99%

“…The mean serum albumin levels, in a random sample of chronic HD patients in usual clinical practice, did not change appreciably in the 9 years since the Centers for Medicare and Medicaid have conducted the Clinical Performance Measures Project [10]. In the study of Pupim et al [7], serum albumin levels were stable over time. No significant changes in serum albumin level and other biochemical variables were observed over 12 months in the study of Johansen et al [11].…”

Section: Discussionmentioning

confidence: 99%

“…With regard to body weight changes over time, variable findings have been reported: some have reported a decrease [7, 9, 19], others an initial decrease followed by a decrease [20] and others no change [11, 12]. …”

Section: Discussionmentioning

confidence: 99%

“…Few studies have attempted to follow HD patients longitudinally to determine whether nutritional status deteriorates over time and, eventually, if this is influenced by the inflammatory status and/or by other variables. Most of these studies included incident patients and have shown that nutritional status improves immediately after the initiation of HD [5,6,7,8]. With regard to prevalent patients, Rocco et al [9] have shown in the HEMO study that all nutritional parameters, except for dietary protein and energy intake, exhibited a small but statistically significant decline over an average follow-up period of 3 years, suggesting that end-stage renal disease and HD are associated with wasting and deterioration of the nutritional and physical status over time.…”

Section: Introductionmentioning

confidence: 99%

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Serum Albumin, Body Weight and Inflammatory Parameters in Chronic Hemodialysis Patients: A Three-Year Longitudinal Study

et al. 2007

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Backgrounds and Aims: The present study aimed at making prospective longitudinal measurements of nutritional and inflammatory parameters to determine whether nutritional and inflammatory status decline or increase over time in a cohort of prevalent hemodialysis patients, and to evaluate which factors influence eventual changes. Patients: 64 hemodialysis patients were followed at 0, 3, 6, 9, 12, 15, 18, 21, 24, 27, 30, 33, and 36 months. At each follow-up visit, dry body weight, serum albumin, serum total cholesterol, total white blood cells, total lymphocyte count, serum glucose, C-reactive protein, ferritin, fibrinogen, hemoglobin, and weekly erythropoietin dose were assessed. Main Outcome Measures: Changes in nutritional and inflammatory parameters over time. Results: 43 patients completed the study at 36 months. Mean serum albumin levels (g/dl) improved significantly between baseline (3.76 ± 0.24) and 36 months (3.93 ± 0.27) (F = 4.005; p = 0.0009). Dialytic age was significantly associated with changes of serum albumin (F = 2.797; p = 0.028). The mean dry weight slightly remained stable over time (F = 1.473; p = 1.0) as well as the level of total cholesterol (p = 0.77) and lymphocyte count (F = 1.539; p = 0.186). Over time, the levels of C-reactive protein tended to decrease, although the differences were not statistically significant (F = 1.332; p = 0.19). Over time, the serum level of fibrinogen (F = 0.422; p = 0.17) and ferritin (F = 0.314; p = 0.52) remained stable. The number of white blood cells significantly decreased over time (F = 4.691; p = 0.0079) and dialytic age (F = 3.214; p = 0.015) was the variable significantly associated with such decline. The hemoglobin levels (F = 1.423; p = 0.14) and the weekly erythropoietin dose did not change significantly during the study (F = 1.019; p = 0.61), nor did the serum glucose levels (F = 1.231; p = 0.10). Conclusion: These results support the hypothesis that end-stage renal disease and HD are not necessarily associated with deterioration of the nutritional status over time.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum Albumin, Body Weight and Inflammatory Parameters in Chronic Hemodialysis Patients: A Three-Year Longitudinal Study

et al. 2007

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“…The ability to identify the alteration of muscle or fat mass is absolutely important for the diagnosis of PEW and may offer opportunities for timely interventions to retard ongoing catabolic process. Because ESRD patients can accumulate significant amount of adiposity concurrently with muscle mass depletion [29], it is necessary to quantitate fat and lean mass independently. Recently, several tools are available targeting early detection of changes in body composition over time.…”

Section: Methods Of Body Composition Assessmentmentioning

confidence: 99%

Body Composition and Its Clinical Outcome in Maintenance Hemodialysis Patients

Kittiskulnam¹,

Eiam‐Ong²

2018

Aspects in Dialysis

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Previous epidemiological cohorts demonstrated that higher body mass index (BMI) was associated with greater survival in patients treated by hemodialysis. Although BMI is a simple measure of adiposity in general population, it may be an inaccurate indicator of nutritional status, particularly among dialysis patients given that it does not differentiate between muscle mass and fat as well as body fat distribution. This problem might be aggravated in end-stage renal disease patients because of wasting or edema. In addition, individuals with higher BMI usually have both higher muscle and fat mass than those with lower BMI. Therefore, more sophisticated tool of body composition analysis is needed to address the query of which component is associated with mortality outcome among patients receiving hemodialysis. We summarized the current state of body composition, including lean and fat tissue evaluated by bioelectrical impedance analysis, dual X-ray absorptiometry, computerized tomography, or magnetic resonance imaging, and its association with clinical outcomes among hemodialysis patients. The studies using anthropometry for the estimation of muscle mass, either mid-arm muscle circumference as a proxy of muscle mass or skinfold thickness and waist circumference as a surrogate of body fat and visceral fat, respectively, were all included in this review.

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Association Between the Publication of the Initiating Dialysis Early and Late Trial and the Timing of Dialysis Initiation in Canada

et al. 2019

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Initiating Dialysis Early and Late (IDEAL) randomized clinical trial, which randomized patients with an estimated glomerular filtration rate (GFR) between 10 and 15 mL/min/1.73 m 2 to planned initiation of dialysis with an estimated GFR between 10 and 14 mL/min/1.73 m 2 (early start) or an estimated GFR between 5 and 7 mL/min/1.73 m 2 (late start), concluded that early initiation was not associated with improved survival or clinical outcomes. OBJECTIVE To assess the association between the IDEAL trial results and the proportion of early dialysis starts over time. DESIGN, SETTING, AND PARTICIPANTS This interrupted time series analysis used data from the Canadian Organ Replacement Register to study adult (Ն18 years of age) patients with incident chronic dialysis between January 1, 2006, and December 31, 2015, in Canada, which has a universal health care system. Patients from the province of Quebec were excluded because its privacy laws preclude submission of deidentified data without first-person consent. The patients included in the study (n = 28 468) had at least 90 days of nephrologist care before starting dialysis and a recorded estimated GFR at dialysis initiation. Data analyses were performed from November 2016 to January 2019. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of early dialysis starts (estimated GFR >10.5 mL/min/1.73 m 2), and the secondary outcomes included the proportions of acute inpatient dialysis starts, patients who started dialysis using a home modality, and patients receiving hemodialysis who started with an arteriovenous access. Measures included the trend prior to the IDEAL trial publication, the change in this trend after publication, and the immediate consequence of publication. RESULTS The final cohort comprised 28 468 patients, of whom 17 342 (60.9%) were male and the mean (SD) age was 64.8 (14.6) years. Before the IDEAL trial, a statistically significant increasing trend was observed in the monthly proportion of early dialysis starts (adjusted rate ratio, 1.002; 95% CI, 1.001-1.004; P = .004). After the IDEAL trial, an immediate decrease was observed in the proportion of early dialysis starts (rate ratio, 0.874; 95% CI, 0.818-0.933; P < .001), along with a statistically significant change in trend between the pretrial and posttrial periods (rate ratio, 0.994; 95% CI, 0.992-0.996; P < .001). No statistically significant differences were found in acute inpatient dialysis initiations, the proportion of patients receiving home dialysis as the initial modality, or the proportion of arteriovenous access creation at hemodialysis initiation after the IDEAL trial publication. CONCLUSIONS AND RELEVANCE The publication of the IDEAL trial appeared to be associated with an immediate and meaningful change in the timing of dialysis initiation in Canada.

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Improvement in nutritional parameters after initiation of chronic hemodialysis

Cited by 70 publications

References 23 publications

Serum Albumin, Body Weight and Inflammatory Parameters in Chronic Hemodialysis Patients: A Three-Year Longitudinal Study

Serum Albumin, Body Weight and Inflammatory Parameters in Chronic Hemodialysis Patients: A Three-Year Longitudinal Study

Body Composition and Its Clinical Outcome in Maintenance Hemodialysis Patients

Association Between the Publication of the Initiating Dialysis Early and Late Trial and the Timing of Dialysis Initiation in Canada

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