Malnutrition in Hemodialysis Patients

Oksa, Heikki; Ahonen, Kirsti; Pasternack, Amos; Marnela, Kirsi-Marja

doi:10.3109/00365599109024551

Cited by 65 publications

(28 citation statements)

References 7 publications

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“…Although the etiology of malnutrition in HD patients is multifactorial, decreased oral intake because of loss of appetite, severe dietary protein restriction and increased catabolism resulting from insufficient HD therapy seem to be the commonest factors [1, 2, 3, 4, 5, 6, 7]. Furthermore, social and economic factors may also play an important role in the development of malnutrition in HD patients [2, 4, 8, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Oral and Parenteral Essential Amino Acid Therapy in Malnourished Hemodialysis Patients

Oğuz

Bulucu²,

Vural³

2001

Nephron

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Background/Aims: Malnutrition has been encountered more frequently than expected and is associated with increased morbidity and mortality in hemodialysis (HD) patients. Until the last few years, only oral and enteral nutritional supplies have been used in the treatment of malnutrition in HD patients. However, intradialytic parenteral essential amino acid (EAA) nutrition has recently been introduced to treat these patients. The present study was conducted to compare both methods of EAA nutrition, oral and parenteral, in malnourished HD patients. Methods: Half of the 20 malnourished HD patients in this study received 0.9 g/kg/week of oral EAA (oral group), while the other half of the patients were treated with the same dose of parenteral EAA (parenteral group) for 4 months. However, at the very beginning of the study, 4 patients from the oral group were transferred to the parenteral group because of complaints such as nausea and vomiting. Therefore, this study was completed with 6 patients in the oral group and 14 patients in the parenteral group. Some biochemical parameters, including blood lymphocyte counts and anthropometric measurements as indicators of the nutritional status, were obtained from both of the groups in the pre- and posttreatment periods. Results: Following the treatment, there were no statistically significant differences between the groups with respect to anthropometric measurements. However, statistically significant increases were observed in serum albumin (p = 0.048) and creatinine (p = 0.006) levels and blood lymphocyte counts (p = 0.006) in the parenteral group, while there were statistically significant increases only in serum calcium (p = 0.028) levels and blood lymphocyte counts (p = 0.038) in the oral group following the treatment when compared to pretreatment values. Conclusion: These results show that parenteral EAA therapy is more comfortable and effective than oral EAA therapy in the treatment of malnourished HD patients.

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Section: Introductionmentioning

confidence: 99%

Oral and Parenteral Essential Amino Acid Therapy in Malnourished Hemodialysis Patients

Oğuz

Bulucu²,

Vural³

2001

Nephron

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“…11,42 The main biochemical parameters suggestive of protein-energy malnutrition in dialysis, such as serum albumin, dietary protein intake (indicated by the protein equivalent of total nitrogen appearance or PCR) and predialysis serum urea nitrogen correlate with morbidity or mortality, 4,5,11 these markers, however, must be interpreted with caution and, more important, alterations of such indexes often become manifest only late in the course of the deteriorating nutritional status in dialysis, that is, after severe malnutrition is established. 6,11,12 Bioelectrical impedance analysis (BIA) allows a fast and sensitive bedside assessment of human body composition. 14,21 The tetrapolar bioelectrical impedance analysis described by Shizgal and Jodin et al refers to a three-compartment model body cell mass (BCM), body fat (FM), and extracellular mass (ECM).…”

Section: Discussionmentioning

confidence: 99%

“…In dialysis, mild to moderate malnutrition is not revealed by abnormalities of the common nutritional markers that become manifest only in the advanced stage of disease; 6,11,12 consequently, practical and sensible indicators of body composition are needed for clinical purposes. Most of the available methods for evaluating body composition, even though accurate, cannot easily be used in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

et al. 2001

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BACKGROUND:The body composition in overweight and obese hemodialyzed patients (HD) remains ill-de®ned. This study evaluates in HD patients the in¯uence of body size, as indicated by body mass index (BMI, kgam 2 ), on body composition by measuring bioimpedance analysis (BIA)-derived variables (phase angle (PA), fat-free mass (FFM) and body cell mass (BCM). METHODS: We studied 50 Caucasian patients (mean age 62.8 AE 9.2 y) on standard bicarbonate hemodialysis for at least 12 months who regularly achieved dry weight in post-HD, received similar dialysis doses and were free from in¯ammationainfec-tion. Thirty-eight gender-and age-matched healthy subjects were included as controls (CON). Both HD and CON were divided into three groups on the basis of their BMI(kgam 2 ) 18.5 ± 24.9, normal-weight (NW); 25 ± 29.9, overweight (OW); and !30, obese (OB). In HD patients, BIA was performed 30 min after the end of dialysis. RESULTS: Seven patients were obese (12%) while 16 were overweight (32%); in CON, 12 were obese (31%) and 12 overweight (31%). BIA-measured extracellular water was comparable in all groups. PA, which was similar in normal-weight HD and CON (6.2 AE 0.9 and 6.3 AE 0.8 ), decreased in OW-and OB-HD patients (5.3 AE 1.0 and 5.2 AE 0.6 , respectively; P`0.05 vs NW-HD) while it was unchanged in OW-and OB-CON (6.1 AE 0.8 and 5.9 AE 0.5 , P`0.05 vs respective HD groups). In OW and OB patients, the lower PA values were coupled with a major reduction of BIA-derived percentage BCM and FFM (P`0.05 vs NW-HD, and vs OW-and OB-CON). In patients, PA and BCM correlated with anthropometry-measured FFM. Of note, serum albumin and protein catabolic rate were signi®cantly reduced in OB patients. CONCLUSION: In overweight and obese HD patients, BIA-derived FFM, BCM and PA are signi®cantly lower with respect to normal-weight patients and BMI-matched controls. These abnormalities of body composition are coupled with reduction of anthropometric measures of lean mass and a decrease of protein intake that, however, becomes signi®cant only in the obese. We therefore suggest that overweight and obese HD patients are at risk of protein malnutrition in spite of excessive energy intake. BIA may be considered as a useful diagnostic tool to detect such a condition early.

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“…Serum transthyretin, also known as thyroxine-binding prealbumin or prealbumin, has been proposed as an early indicator of nutritional status in hemodialysis patients (4,6,13,14). In studies involving hemodialysis patients, transthyretin levels have been found to correlate Goldwasser et a.…”

Section: Transthyretin Levels and Nutritional Statusmentioning

confidence: 99%

“…These findings are in agreement with Vehe et al (21) where transthyretin correlated significantly with cumulative intakes of both protein and energy, in chronic renal failure patients receiving nutrition support. Transthyretin has been found to correlate with other markers of body mass such as the midarm muscle circumference (4,13,20) and triceps skinfold thickness (4,20).…”

Section: And 2 4 Nfdltmentioning

confidence: 99%

Serum transthyretin in hemodialysis patients : relationship to nutritional status

Duggan¹

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ii ACKNOWLEDGEMENTS I wish to thank the members of my committee for their helpful comments and patience.I would also like to thank the nurses and dialysis technicians at Complete Dialysis Care, Inc.for their help in obtaining timely and accurate laboratory specimens; Dr. Paulette Johnson for her statistical assistance; REN Laboratories for their support of this project; and especially the hemodialysis patients at Complete Dialysis Care, Inc. for agreeing to participate in this study. The validity of serum transthyretin as a nutrition assessment parameter in hemodialysis patients was investigated. Fifty-one subjects (39% male and 61 % female; 53% black, 28% white, 12% Hispanic, 7% Other) receiving hemodialysis for 30 24 months (mean SD) and a total of 36 26 months of renal replacement therapy were followed for six months. Serum transthyretin, albumin, BUN, creatinine, cholesterol, normalized protein catabolic rate (nPCR), KT/V, weight and 24 hour urine analysis were determined monthly. Etiologies of end stage renal disease were diabetic nephropathy (37%), hypertensive nephrosclerosis (37%). glomerulonephritis (12%), polycystic kidney disease (4%), lupus nephritis (4%), other causes (6%). A significant correlation was found between transthyretin and creatinine, albumin and loss of dry weight (p<0.05). Transthyretin levels <30 mg/dl were found to correlate with urine outputs > 240 cc/24 hours, predialysis BUN < 50 mg/dl and nPCR

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Malnutrition in Hemodialysis Patients

Cited by 65 publications

References 7 publications

Oral and Parenteral Essential Amino Acid Therapy in Malnourished Hemodialysis Patients

Oral and Parenteral Essential Amino Acid Therapy in Malnourished Hemodialysis Patients

Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

Serum transthyretin in hemodialysis patients : relationship to nutritional status

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