Improving Albumin Levels Among Hemodialysis Patients: A Community-Based Randomized Controlled Trial

León, Janeen B.; Albert, Jeffrey M.; Gilchrist, Gina M.; Kushner, Irving; Lerner, Edith; Mach, Suzanne; Majerle, Angela D.; Porter, David; Ricanati, Edmond S.; Sperry, Laurine; Sullivan, Catherine; Zimmerer, J; Sehgal, Ashwini R.

doi:10.1053/j.ajkd.2006.03.046

Cited by 66 publications

(46 citation statements)

References 23 publications

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“…Recently, Akpele and Bealey [14] clearly demonstrated that, over a relatively short period of time, the serum albumin levels of severely malnourished HD patients were increased to a greater extent by intensive dietary counseling than by provision of a liquid protein and calorie supplement. Similarly, Leon et al [15] have demonstrated that intervention on a number of specific and potentially modifiable nutritional barriers resulted in modest but statistically significant improvement in albumin levels regardless of levels of inflammatory markers.…”

Section: Discussionmentioning

confidence: 99%

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%

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

et al. 2007

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“…Dialysis patients and their providers struggle not only with dietary restrictions but also with nutritional barriers such as poor appetite and needing help with cooking. [12] Convenience and fast foods tend to be palatable and require little or no preparation but often contain phosphorus additives. Instructing dialysis patients to limit their intake of additive containing products would seem to be a reasonable recommendation.…”

Section: Discussionmentioning

confidence: 99%

“…This may not be possible for dialysis patients with physical or social limitations. [12] Phosphorus containing additives may also have an impact on patients with earlier stages of chronic kidney disease and on the general population. Hyperphosphatemia may contribute to cardiovascular and bone disease among the 10 million Americans with moderate kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Phosphorus-Containing Food Additives and the Accuracy of Nutrient Databases: Implications for Renal Patients

Sullivan

León

Sehgal

2007

Journal of Renal Nutrition

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144

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Objective-Phosphorus containing additives are increasingly added to food products. We sought to determine the potential impact of these additives. We focused on chicken products as an example.Methods-We purchased a variety of chicken products, prepared them according to package directions, and performed laboratory analyses to determine their actual phosphorus content. We used ESHA Food Processor SQL Software to determine the expected phosphorus content of each product.Results-Of 38 chicken products, 35 (92%) had phosphorus containing additives listed among their ingredients. For every category of chicken products containing additives, the actual phosphorus content was greater than the content expected from nutrient database. For example, actual phosphorus content exceeded expected phosphorus content by an average of 84 mg/100g for breaded breast strips. There was also a great deal of variation within each category. For example, the difference between actual and expected phosphorus content ranged from 59 to 165 mg/100g for breast patties. Two 100 g servings of additive containing products contain an average of 440 mg of phosphorus, or about half the total daily recommended intake for dialysis patients.Conclusion-Phosphorus containing additives significantly increase the amount of phosphorus in chicken products. Available nutrient databases do not reflect this higher phosphorus content, and the variation between similar products makes it impossible for patients and dietitians to accurately estimate phosphorus content. We recommend that dialysis patients limit their intake of additive containing products and that the phosphorus content of food products be included on nutrition facts labels.

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“…Furthermore, nutritional intervention increases serum albumin levels regardless of inflammatory status 32,33 , and serum albumin increases of 0.2 g/dL or 0.4 g/dL reduce the risk of hospitalization by 25 and 41%, respectively, in hemodialysis patients 24 .…”

Section: Discussionmentioning

confidence: 99%

Association between nutritional indicators and risk of hospitalization among hemodialysis patients

et al. 2016

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Objective To verify the ability of nutritional indicators to predict risk of hospitalization in hemodialysis patients. Methods This prospective cohort study was conducted in two hemodialysis units in Southern Brazil. The following nutritional indicators were evaluated: subjective global assessment, malnutrition-inflammation score, nutritional risk screening 2002, percentage of body fat, mid-upper arm muscle circumference, hand grip strength, phase angle, and serum albumin. The association between nutritional indicators and risk of hospitalization over a period of two years was analyzed. Results One hundred thirty-eight patients (55.4±15.2 years, 61.6% men) were evaluated. The cumulative incidence of hospitalization during the study was 48.0% (95%CI=37.9-58.0). Patients hospitalized during the study period had higher body mass index and lower serum albumin than those who were not hospitalized. Based on the other indicators, malnourished patients did not have a significant risk of hospitalization (p>0.05). Serum albumin was the only predictor of hospitalization. Patients with levels <3.8 g/dL had a density ratio for incidence of hospitalization 2.47 times greater than those with higher levels (p=0.003). Gender was a modifier of the effect (p interaction=0.042), with an effect in women of 7.31 (95%CI=2.34-22.9; p=0.001) and in men of 1.37 (95%CI=0.60-3.12; p=0.448). Conclusion Serum albumin was able to predict the risk of hospitalization over a period of two years in female patients undergoing hemodialysis.

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Improving Albumin Levels Among Hemodialysis Patients: A Community-Based Randomized Controlled Trial

Cited by 66 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

Phosphorus-Containing Food Additives and the Accuracy of Nutrient Databases: Implications for Renal Patients

Association between nutritional indicators and risk of hospitalization among hemodialysis patients

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