Uremic malnutrition is a predictor of death independent of inflammatory status

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

doi:10.1111/j.1523-1755.2004.00978.x

Cited by 153 publications

(121 citation statements)

References 31 publications

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“…serum phosphate levels), not hard outcomes (20 -24). Considering that phosphate-rich foods tend to be good sources of dietary protein (25,26) concern exists that long-term phosphate restriction may exacerbate protein energy malnutrition (27)(28)(29)(30), which is both common and potently associated with mortality among hemodialysis patients (31)(32)(33)(34).…”

Section: Introductionmentioning

confidence: 99%

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Lynch¹,

Lynch²,

Curhan³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

102

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SummaryBackground and objectives Hyperphosphatemia is common among hemodialysis patients. Although prescribed dietary phosphate restriction is a recommended therapy, little is known about the long-term effects on survival.Design, setting, participants, & measurements We conducted a post hoc analysis of data from the Hemodialysis Study (n ϭ 1751). Prescribed dietary phosphate was recorded at baseline and annually thereafter. Marginal structural proportional hazard models were fit to estimate the adjusted association between dietary phosphate restriction and mortality in the setting of time-dependent confounding.Results At baseline, prescribed daily phosphate was restricted to levels Յ870, 871 to 999, 1000, 1001 to 2000 mg, and not restricted in 300, 314, 307, 297, and 533 participants, respectively. More restrictive prescribed dietary phosphate was associated with poorer indices of nutritional status on baseline analyses and a persistently greater need for nutritional supplementation but not longitudinal changes in caloric or protein intake. On marginal structural analysis, there was a stepwise trend toward greater survival with more liberal phosphate prescription, which reached statistical significance among subjects prescribed 1001 to 2000 mg/d and those with no specified phosphate restriction: hazard ratios (95% CIs) 0.73 (0.54 to 0.97) and 0.71 (0.55 to 0.92), respectively. Subgroup analysis suggested a more pronounced survival benefit of liberal dietary phosphate prescription among nonblacks, participants without hyperphosphatemia, and those not receiving activated vitamin D.Conclusions Prescribed dietary phosphate restriction is not associated with improved survival among prevalent hemodialysis patients, and increased level of restriction may be associated with greater mortality particularly in some subgroups.

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Section: Introductionmentioning

confidence: 99%

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Lynch¹,

Lynch²,

Curhan³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

102

View full text Add to dashboard Cite

show abstract

“…This initially enhances the patients' appetite and improves their nutritional status. However, when patients continue to undergo haemodialysis over a longer period of time, there is an increased risk of malnutrition because of the loss of appetite stemming from uraemia and the haemodialysis technique (19,20).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Nutritional Biochemical Parameters in Haemodialysis Patients Over a Ten-Year Period

Castillo

et al. 2015

West Indian Med J

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INTRODUCTION Protein-energy malnutrition affects a high percentage of patients with chronic kidney failure and is associated with increased morbidity and mortality rates. Factors that directly contribute to malnutrition in these patients are mainly alterations in protein-energy metabolism, hormonal derangements, infections, and a reduction in food ingestion because of anorexia, nausea and vomiting produced by uraemic toxicity. After beginning renal replacement therapy, patients usually find that most of the evident symptoms of uraemia abate or disappear altogether. As a result, their appetite improves and they begin to feel better. However, various studies show that the prevalence of protein-energy malnutrition in haemodialysis patients still remains high. In fact, 23−76% of patients undergoing haemodialysis generally suffer from malnutrition (1−3). In recent years, research on haemodialysis patients has pinpointed an association between signs of malnutrition, particularly a decrease in plasma albumin and an increase in morbidity and mortality (4, 5). Moreover, predictors of the low survival of these patients include atherosclerosis (aggravated by high blood pressure and smoking), oxidative stress, inflammation and malnutrition (6, 7), combined with a low body mass index (BMI), altered lipoprotein profiles and high lowdensity lipoprotein (LDL) levels (8−11).The objective of this research study was to assess the nutritional state of the patients at a haemodialysis unit by evaluating biochemical parameters (total proteins, albumin, cholesterol and plasma transferrin) and anthropometric parameters of weight, height and BMI. The patients were monitored over a period of ten years in order to determine whether they suffered disorders that could be caused by a state of malnutrition directly related to the length of the haemodialysis treatment.

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“…However, Pupim's group concluded that "the nutrition status of CHD patients predicts mortality independent of concomitant presence or absence of inflammatory response." 7 Dwyer et al found that increases in albumin at any level were associated with reduced short-term relative risk of mortality in CHD patients, even after adjusting for case mix, treatment assignments, protein catabolic rate, total cholesterol, and serum creatinine. 8 The combination of inflammation and protein malnutrition leads to decreased physical function, nutrient malabsorption, anorexia, weight loss, and impaired immune function.…”

Section: Methodsmentioning

confidence: 99%

Can oral supplementation with a collagen‐casein‐based liquid protein improve serum albumin levels in hemodialysis patients?

Pittaoulis¹,

Phillips

2007

Dialysis & Transplantation

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BACKGROUNDDecreased synthesis of albumin (Alb) results in hypoalbuminemia and occurs because of the interrelationship of inflammation and malnutrition (uremic malnutrition) observed in chronic hemodialysis (CHD) patients. Improving the nutrition status of CHD patients is necessary to prevent and treat uremic malnutrition. The issue remains of how to achieve this goal in CHD patients given the barriers to adequate and appropriate intake such as anorexia, impaired nutrient absorption, and necessary diet modifications.OBJECTIVETo determine if oral supplementation with a collagen‐casein‐based hydrolyzed liquid protein can improve Alb levels in hypoalbuminemic CHD patients.PATIENTS AND METHODSThe study patients were adult outpatients on hemodialysis for at least 1 year whose serum Alb was between 2.8 and 3.7 g/dL and who had given written consent. Patients (age = 31–90 years) were divided into 2 groups according to days they had dialysis. Controls ( n = 21; dialysis days Tuesday, Thursday, Saturday) received standard nutritional counseling. The study group ( n = 29; dialysis days Monday, Wednesday, Friday) received 30 mL of liquid protein at the beginning and end of treatment. The main outcome measures were baseline and monthly Alb for 3 months and a subjective assessment of tolerance.RESULTSFive subjects in the control group (final n = 16 [49%]) and 12 subjects in the study group (final n = 17 [51%]) did not complete the study. There was not a statistically significant correlation between baseline Alb and baseline CRP, r = − 0.30 (p = 0.093), or between baseline Alb and baseline URR, r = 0.27 (p = 0.14). Average Alb of the control group did not differ between the baseline (3.43 g/dL) and final (3.44 g/dL) measurements, t = − 0.54; df = 15; p = 0.60. In the study group, however, the final average Alb (SD) of 3.73 (0.28) was statistically significantly greater than the baseline average of 3.49 (0.20), t = − 4.19; df = 16; p = 0.001.CONCLUSIONThese statistically significant results indicate that oral supplementation with a collagen‐casein‐based hydrolyzed liquid protein can improve serum albumin levels of hypoalbuminemic CHD patients.

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Uremic malnutrition is a predictor of death independent of inflammatory status

Cited by 153 publications

References 31 publications

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Prescribed Dietary Phosphate Restriction and Survival among Hemodialysis Patients

Evaluation of Nutritional Biochemical Parameters in Haemodialysis Patients Over a Ten-Year Period

Can oral supplementation with a collagen‐casein‐based liquid protein improve serum albumin levels in hemodialysis patients?

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