Physical methods for evaluating the nutrition status of hemodialysis patients

Marcelli, Daniele; Wabel, Peter; Wieskotten, Sebastian; Ciotola, Annalisa; Grassmann, Aileen; Benedetto, Attilio Di; Canaud, Bernard

doi:10.1007/s40620-015-0189-x

Cited by 23 publications

(16 citation statements)

References 55 publications

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“…The trend in conventional indicators of nutrition [ 24 ] was not uniform in this study. Indeed, at the end of the study phase there were significant increases in mean blood level of triglycerides and albumin, but not in total cholesterol and serum phosphorus.…”

Section: Discussioncontrasting

confidence: 55%

Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis

et al. 2017

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BackgroundPatients on standard dialysis, in particular those on high-flux and high-efficiency dialysis, are exposed to hundreds of liters of dialysis-water per week. The quality of dialysis-water is a factor responsible for inflammation in dialysis patients. Inflammation is a potent trigger of atherosclerosis and a pathogenetic factor in anemia, increasing mortality and morbidity in dialysis patients. Current systems for water treatment do not completely eliminate bacteria and endotoxins. This prospective study tested whether improved dialysis-water purity by an additional ultrafilter can reduce inflammation and ameliorate hemoglobin levels, with a consequent reduction in erythropoietin-stimulating agents (ESA).MethodsAn ultrafilter, composed of two serially positioned devices with polysulfone membranes of 2.0 and 1.0 m2, respectively, was positioned within the fluid pathway before the dialysis machine. Prevalent dialysis patients were assigned either to continue dialysis with conventional dialysis-water (control phase) or to initiate dialysis sessions with improved dialysis-water purity (study phase). After 6 months, patients were crossed over. Total study duration was 1 year. Routine chemistry, bacterial count, endotoxin levels in dialysis-water as well as blood levels of pro- and anti-inflammatory cytokines, human serum amyloid A, C-reactive protein and fraction 5 of complement were measured.ResultsThirty-two patients completed the study. Mean bacterial count was lower and endotoxin levels were absent in dialysis-water obtained with the ultrafilter. At the end of the study-phase, C-reactive protein and pro-inflammatory cytokines decreased while anti-inflammatory ones increased. Hemoglobin levels were improved with lower ESA doses.ConclusionsAn additional ultrafilter improved dialysis-water purity, reduced levels of inflammation markers, ameliorated hemoglobin concentration with reduced ESA doses. These results remain speculative but they may generate studies to assess whether improved dialysis-water quality with an ultrafilter can reduce inflammation and improve survival of dialysis patients.Electronic supplementary materialThe online version of this article (doi:10.1007/s40620-017-0422-x) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 55%

Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis

et al. 2017

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“…However, a value below 15% was considered a risk factor for mortality, 12 and a value below 12% led to a risk ratio for mortality that was 4 times higher compared with a group with %FM between 24 and 36 15 . Assuming that detectable alterations in body composition may be developed late in the evolution of malnutrition, 27 a value of FM < 10% established as part of the diagnosis of malnutrition could be questionable.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Body Mass Index, Skinfold Thickness, and Bioelectrical Impedance Analysis With Dual‐Energy X‐Ray Absorptiometry in Hemodialysis Patients

2020

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Background: Malnutrition is a consistent finding in hemodialysis (HD) patients and is associated with high mortality. The aim was to compare nutrition status indicators using dual-energy x-ray absorptiometry (DXA) as reference in HD patients. Methods: Observational cross-sectional study with 42 patients, 55.8 years (±14.6) old, 60% male, HD 2-3 times per week for ≥3 months. HD ranged from 3 months to 28 years (median, 17.3; interquartile range, 8.73-39.0). We used body mass index (BMI) and fat mass (FM) by skinfold thickness (SFT), bioelectrical impedance analysis (BIA), and DXA. Statistical analyses used Bland-Altman plots, Lin's concordance correlation coefficient, the paired t-test, and Pearson or Spearman correlation. P < .05 was significant. Results: SFT and DXA presented the lowest prevalence of malnutrition (2.4%) and BMI the highest (28.6%). BMI, BIA FM, and SFT FM presented strong positive correlations with DXA FM (r = 0.915; r = 0.976; r = 0.910, P < .001, respectively). BIA FM and fat-free mass (FFM) demonstrated substantial agreement with DXA values (ρ = 0.974 and 0.960, P < .001). Thus, the measurement procedures used, SFT and BIA, underestimated %FM (−4.65% and −2.13%) and overestimated FFM (3.12 kg and 1.0 kg) according to DXA. No differences were found between mean values of BIA FM and DXA (P = .178). Conclusions: Compared with DXA, BIA was the most appropriate nutrition indicator for measuring body composition.

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“…However, it should be mentioned that abdominal obesity, specifically when BMI is more than 35, is associated with increased cardiovascular mortality 28 . The human body consists of both fat and nonfat tissues 29 . Lean body mass is the combination of TBW, skeletal muscle mass, and the fat‐free portion of organ mass 30…”

Section: Discussionmentioning

confidence: 99%

Effect of high bicarbonate hemodialysis solution on biochemical parameters and anthropometric indices

Hefzollah

Boushehri

Mahmudpour

2020

Hemodialysis International

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Introduction Protein energy wasting is an adverse consequence of renal failure, which is correlated with increased mortality and morbidity. Metabolic acidosis has a major role in the development of protein energy wasting in hemodialysis patients. Every effort that could ameliorate this catabolic state would be beneficial to stabilize body composition. The aim of this study was to investigate the possible beneficial effects of high bicarbonate dialysis on anthropometric indices and biochemical parameters of nutrition. Methods Fifty‐six hemodialysis patients were randomly enrolled in two groups: an intervention group that underwent hemodialysis for 6 months with high bicarbonate dialysate concentration (36 mmol/L, N = 26) and a control group that underwent hemodialysis using a bicarbonate dialysate concentration of 30 mmol/L (N = 30). Biochemical parameters of nutrition and weight, body mass index (BMI), total body water, percent body fat, and other anthropometric indices were measured at the beginning and the end of the trial. Findings At the end of the 6 month evaluation period, plasma levels of albumin, phosphorus, K, calcium, and bicarbonate showed no significant changes. Body weight and BMI increased significantly in high bicarbonate arm but did not change significantly in the control group. Percent body fat in the arms and legs did not change in intervention arm, but decreased significantly in the controls. Discussion The results suggest that higher bicarbonate dialysis can have beneficial effects on nutritional status and might protect against loss of fat mass.

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Physical methods for evaluating the nutrition status of hemodialysis patients

Cited by 23 publications

References 55 publications

Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis

Ultrapure dialysis water obtained with additional ultrafilter may reduce inflammation in patients on hemodialysis

Comparison of Body Mass Index, Skinfold Thickness, and Bioelectrical Impedance Analysis With Dual‐Energy X‐Ray Absorptiometry in Hemodialysis Patients

Effect of high bicarbonate hemodialysis solution on biochemical parameters and anthropometric indices

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