Nutritional Aspects in Diabetic CKD Patients on Tertiary Care

Abstract

Background and objectives: Diabetes is largely prevalent in the chronic kidney disease (CKD) population. Both conditions have metabolic and nutritional abnormalities that affect body composition and the presence of diabetes makes the dietary management of CKD patients more difficult. The aim of this study was to assess peculiar nutritional and functional aspects of diabetic patients in an adult/elderly CKD population, and their predictive significance. Materials and methods: This prospective cohort study included 144 out-patients aged >55 years, affected by stage 3b-4 CKD, on tertiary care clinic; 48 (40 males) were type 2 diabetics and 96 (80 males) were nondiabetics. The two groups have similar age, gender, and residual renal function (30 ± 9 vs. 31 ± 11 mL/min×1.73). All patients underwent a comprehensive nutritional and functional assessment and were followed for 31 ± 14 months. Results: Diabetic CKD patients showed higher waist circumference and fat body mass, lower muscle mass, and lower number of steps per day and average daily METs. Meanwhile, resting energy expenditure (REE), as assessed by indirect calorimetry, and dietary energy intake were similar as well as hand-grip and 6 min walking test. Diabetic patients did not show a greater risk for all-cause mortality and renal death with respect to nondiabetics. Middle arm muscle circumference, phase angle, serum cholesterol, and serum albumin were negatively related to the risk of mortality and renal death after adjustment for eGFR. Conclusions: CKD diabetic patients differed from nondiabetics for a greater fat mass, lower muscle mass, and lower physical activity levels. This occurred at the same REE and dietary energy intake. The outcome of diabetic or nondiabetic CKD patients on tertiary care management was similar in terms of risk for mortality or renal death. Given the same residual renal function, low levels of muscle mass, phase angle, serum albumin, and cholesterol were predictive of poor outcome. Overall, a malnutrition phenotype represents a major predictor of poor outcome in diabetic and nondiabetic CKD patients.

Effects of Nutrition Intervention on Blood Glucose, Body Composition, and Phase Angle in Obese and Overweight Patients with Diabetic Foot Ulcers

“…Although the change in PA did not reach statistical significance for the duration of the study, scientific evidence has shown that one grade increase in PA is associated with a 33% reduction in the risk of mortality or renal death in diabetic patients [35]; therefore, the observed lower decrease in PA in the treatment group relative to the control group is clinically relevant. Our results showed that HbA1c decreased in both groups during the study and there were no significant differences between the two groups during the study.…”

Daily Step Counts in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies

“…When results were described in terms of median, quartiles (or range) (12)(13)(14)(15)(16)(17)(18)(19)(20), data were calculated using the formula proposed by Luo et (21,22). If data were reported for subgroups (e.g., male vs. female) (23)(24)(25), we calculated a pooled mean (standard deviation) by pooling the data of the two different subgroups (26). Furthermore, if a study reported results for different stages of CKD separately, both data were included in the meta-analysis.…”

<p>Age, Pulse, Urea and Albumin (APUA) Model: A Tool for Predicting in-Hospital Mortality of Community-Acquired Pneumonia Adapted for Patients with Type 2 Diabetes</p>

“…19 Low albumin levels increase the risk of mortality in diabetic patients with diabetic foot and chronic kidney disease. 20,21 Low serum albumin was also associated with the risk of mortality in T2DM patients with infection. In T2DM, low albumin levels increase the risk of mortality in patients with community-onset bacterial bloodstream infections.…”