Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall

Protein-energy wasting is prevalent in peritoneal dialysis patients, which causes a heavy burden for individuals and healthcare systems. We aimed to investigate the effect of nutritional education, and/or protein supplementation on nutritional biomarkers in hypoalbuminemic peritoneal dialysis patients. A quasi-experimental study was conducted in two dialysis centers at Taipei Tzu Chi Hospital and Shin Kong Wu Ho-Su Memorial Hospital. Patients were allocated in three groups including control (n = 12), milk protein (n = 21) and soy protein (n = 20). All patients received dietary guidelines from dietitians and completed 3-day dietary records during monthly visits for consecutive three months. Nutrients were analyzed using Nutritionist Professional software. Blood urea nitrogen (BUN), creatinine, albumin, total protein, hemoglobin, serum calcium, phosphorus, sodium, and potassium were assessed monthly. Total cholesterol and triglycerides were measured every three months. After three-month intervention, protein intake (percent of total calories), and serum albumin were significantly increased in three groups. Protein, phosphorus intake, and BUN were increased in two intervention groups. Total serum protein increased in control and milk protein groups, and creatinine increased the control group. Serum phosphorus was not significantly changed. Nutritional education alone, or combined with protein supplementation, significantly improve protein intake, and nutritional status by increasing serum albumin, but not serum phosphorus in hypoalbuminemic peritoneal dialysis patients.

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Dietary Protein Intake of recently admitted vs stable Peritoneal Dialysis Patients

Journal of Renal Nutrition ◽

10.1053/j.jrn.2008.03.021 ◽

2008 ◽

Vol 18 (3) ◽

pp. S6

Keyword(s):

Peritoneal Dialysis ◽

Dietary Protein ◽

Protein Intake ◽

Dietary Protein Intake ◽

Dialysis Patients

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Longitudinal changes in nutritional parameters and resting energy expenditure in end-stage renal disease

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0169 ◽

2020 ◽

Vol 42 (1) ◽

pp. 24-30 ◽

Cited By ~ 1

Author(s):

Mariana Cassani Oliveira ◽

Marina Nogueira Berbel Bufarah ◽

Daniela Ponce ◽

André Balbi

Keyword(s):

Peritoneal Dialysis ◽

Energy Expenditure ◽

Serum Albumin ◽

Protein Intake ◽

Handgrip Strength ◽

Resting Energy Expenditure ◽

Repeated Measurements ◽

Dialysis Patients ◽

Significant Difference ◽

Resting Energy

Abstract Aims: To evaluate the nutritional status, resting energy expenditure, caloric and protein intake, and evolution of biochemical parameters in three stages of chronic kidney disease: pre-dialytic, at the beginning of the dialysis treatment, and 30 days after starting treatment. Methods: The chi-square and Student’s t tests were used to compare the variables, and analysis of repeated measurements was used to compare the data obtained in the three moments evaluated. The results were discussed at the 5% level of significance. Results: We evaluated 35 patients, 60% female and 60% with diabetes mellitus. There was a decrease in midarm circumference and serum albumin. Inflammatory state and caloric and protein intake increased. There was no significant difference in resting energy expenditure in the three moments. The serum urea and serum albumin, handgrip strength, and protein consumption after 30 days from the start of dialysis were greater in the peritoneal dialysis patients, when compared to the hemodialysis population. Conclusion: there was a decrease in midarm circumference and serum albumin and an increase in protein intake after dialysis. The peritoneal dialysis patients had higher muscle strength, even with lower protein intake. Resting energy expenditure was not different between dialysis methods and the moments evaluated.

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Estimating Dietary Protein Intake in Peritoneal Dialysis Patients: The Effect of Ethnicity

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00260 ◽

2018 ◽

Vol 38 (5) ◽

pp. 384-387 ◽

Cited By ~ 2

Author(s):

Surachet Vongsanim ◽

Andrew Davenport

Keyword(s):

Body Composition ◽

Peritoneal Dialysis ◽

Muscle Mass ◽

South Asian ◽

Dietary Protein ◽

Protein Intake ◽

South Asians ◽

Dietary Protein Intake ◽

Dialysis Patients ◽

Multifrequency Bioimpedance

Kidney dialysis patients with sarcopenia have increased mortality. Clinical guidelines recommend peritoneal dialysis (PD) patients have a target daily protein intake to prevent sarcopenia. Protein intake is estimated from total daily urea losses in urine and peritoneal dialysate to assess the protein equivalent of nitrogen appearance rate adjusted for body weight (nPNA). Dietary habits differ among ethnic groups, so we reviewed nPNA and body composition in a multi-ethnic PD population. Body composition was measured with multifrequency bioimpedance in 598 patients (301 white, 136 black, 123 South-Asian, and 38 Asian-Pacific). South-Asians had a lower nPNA compared with white and black individuals (Randerson 0.80 ± 0.21 vs 0.88 ± 0.24 and 0.85 ± 0.24 g/kg/ day, Blumenkrantz 0.97 ± 0.14 vs 1.04 ± 0.22 and 0.99 ± 0.22 g/kg/ day, Bergström 0.87 ± 0.4 vs 0.95 ± 0.24 and 0.92 ± 0.24 g/kg/day all p < 0.001). South-Asians had lower weights (68.9 ± 14.9 vs 74.4 ± 16.6 and 73.5 ± 16.3 kg, p < 0.001), and although of similar body mass index (25.9 ± 4.9 vs 28.5 ± 4.9 and 26.5 ± 5.2 kg/m2), had both lower skeletal muscle and appendicular muscle mass indexed for height (9.08 ± 1.45 vs 9.89 ± 1.62 and 10.1 ± 1.85, p < 0.001; and 6.95 ± 1.39 vs 7.68 ± 1.48 and 7.67 ± 1.58 kg/m2p < 0.01). South-Asian patients had a lower calculated basal metabolic rate (BMR) (1,358 ± 218 vs 1,487 ± 257 and 1,489 ± 271 kcal/day, p < 0.001).Asian PD patients, particularly South-Asians, have lower dietary protein intakes when calculated by nPNA. However, South-Asians had lower measured muscle mass and calculated BMR. As such, dietary protein intake targets derived from studies in 1 ethnic group are not necessarily applicable for all patients, as those with less muscle mass and lower BMR may well need less daily protein intake to maintain homeostasis.

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IMPACTS ON PROTEIN INTAKE IN PERITONEAL DIALYSIS PATIENTS

Kidney Research and Clinical Practice ◽

10.1016/j.krcp.2012.04.606 ◽

2012 ◽

Vol 31 (2) ◽

pp. A87

Author(s):

Valerie Young ◽

Linda Orazio ◽

Sunil V Badve ◽

Annerley Bates ◽

David W Johnson ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Protein Intake ◽

Dialysis Patients

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Prevalence of abnormalities in electrocardiogram conduction in dialysis patients: a comparative study

Brazilian Journal of Nephrology ◽

10.1590/10.1590/2175-8239-jbn-2020-0018 ◽

2020 ◽

Author(s):

Firas Ajam ◽

Arda Akoluk ◽

Anas Alrefaee ◽

Natasha Campbell ◽

Avais Masud ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cardiac Conduction ◽

Future Research ◽

Dialysis Patients ◽

Bundle Branch Block ◽

Conduction Abnormality ◽

Ckd Stage ◽

Stage 1 ◽

Electrocardiogram Ecg ◽

Ecg Abnormalities

ABSTRACT Background: The electrocardiogram (ECG) can aid in identification of chronic kidney disease (CKD) patients at high risk for cardiovascular diseases. Cohort studies describe ECG abnormalities in patients on hemodialysis (HD), but we did not find data comparing ECG abnormalities among patients with normal kidney function or peritoneal dialysis (PD) to those on hemodialysis. We hypothesized that ECG conduction abnormalities would be more common, and cardiac conduction interval times longer, among patients on hemodialysis vs. those on peritoneal dialysis and CKD 1 or 2. Methods: Retrospective review of adult inpatients’ charts, comparing those with billing codes for “Hemodialysis” vs. inpatients without those charges, and an outpatient peritoneal dialysis cohort. Patients with CKD 3 or 4 were excluded. Results: One hundred and sixty-seven charts were reviewed. ECG conduction intervals were consistently and statistically longer among hemodialysis patients (n=88) vs. peritoneal dialysis (n=22) and CKD stage 1 and 2 (n=57): PR (175±35 vs 160±44 vs 157±22 msec) (p=0.009), QRS (115±32 vs. 111±31 vs 91±18 msec) (p=0.001), QT (411±71 vs. 403±46 vs 374±55 msec) (p=0.006), QTc (487±49 vs. 464±38 vs 452±52 msec) (p=0.0001). The only significantly different conduction abnormality was prevalence of left bundle branch block: 13.6% among HD patients, 5% in PD, and 2% in CKD 1 and 2 (p=0.03). Conclusion: To our knowledge, this is the first study to report that ECG conduction intervals are significantly longer as one progresses from CKD Stage 1 and 2, to PD, to HD. These and other data support the need for future research to utilize ECG conduction times to identify dialysis patients who could potentially benefit from proactive cardiac evaluations and risk reduction.

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