Loneliness: An Overlooked Contributing Factor in Anorexia of Older Patients With End-Stage Renal Disease and Focal Point for Interventions to Enhance Nutritional Status—An Overview of Evidence and Areas of Suggested Research

Abstract Background and Aims Over the last decade, the age of dialysis patients has been increasing steadily worldwide. The benefits of dialysis in older people with end stage renal disease (ESRD) are not clear. We will try to evaluate whether dialysis in older has survival advantage compared to younger people. Method It is a prospective descriptive and analytic study including 229 patients who initiated chronic hemodialysis during the period between January and June 2017. Patients were classified into two groups by age at dialysis initiation. Patients above 75 years of age were considered old (old group OG). Patients aged less then 75 years old were considered young (young group YG). Primary outcome was old patient’s survival during the first 3 and 12 months from the dialysis initiation. Results Among a total of 229 new patients who began dialysis treatment, 41 (17,9%) ESRD were above 75 years of age.The sex ratio was 0,95 and 1,54 in respectively in OG and YG (p = 0,167). Diabetes was present in 56% of the elderly and in 59% of the younger group (p = 0,72) and was more frequently the cause of ESRD in the two groups. The average of modified Charlson Comorbidity Index was 6,7 ± 2,3 and 3,9 ± 2,6 respectively in OG and YG(p = 10-3). Younger patients had been referred earlier to nephrologists than the older ones. In fact, glomerular filtration rate at the beginning of the follow up was 18,7 ± 8,9 ml/min/1,73 in OG and 25,4 ± 16,2 in YG (p = 0,004). There was no statically significant difference between the two groups in the frequency of the use of temporary catheters at dialysis initiation (p = 0,778) and the urgent or planned initiation of dialysis (p = 0,298). Younger patients required hospitalization to organize dialysis initiation more than older patients (51,6% VS 26,8%; p = 0,005). Compared with the group of younger patients, Cox model showed an incremental increase in mortality associated with older patients’ group during the first year of HD (p = 0,036). However, there was no difference between OG and YG in the mortality rate during the first 3 months of HD (p = 0,102). Conclusion We may conclude that life expectancy of patients who began dialysis above 75 years is significantly shorter than younger patients in the first year of HD. In the other hand, the difference between the 2 groups wasn’t significant regarding the conditions of dialysis initiation.

Download Full-text

Predialysis Nephrology Care of Older Patients Approaching End-stage Renal Disease

Yearbook of Medicine ◽

10.1016/j.ymed.2011.09.027 ◽

2011 ◽

Vol 2011 ◽

pp. 245-248

Author(s):

R. Garrick

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage

Download Full-text

Predialysis Nephrology Care of Older Patients Approaching End-stage Renal Disease

Archives of Internal Medicine ◽

10.1001/archinternmed.2011.360 ◽

2011 ◽

Vol 171 (15) ◽

pp. 1371 ◽

Cited By ~ 42

Author(s):

Wolfgang C. Winkelmayer

Keyword(s):

Renal Disease ◽

End Stage Renal Disease ◽

Older Patients ◽

Nephrology Care ◽

Stage Renal Disease ◽

End Stage

Download Full-text

Redox Balance Correlates with Nutritional Status among Patients with End-Stage Renal Disease Treated with Maintenance Hemodialysis

Oxidative Medicine and Cellular Longevity ◽

10.1155/2019/6309465 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Małgorzata Maraj ◽

Beata Kuśnierz-Cabala ◽

Paulina Dumnicka ◽

Katarzyna Gawlik ◽

Dorota Pawlica-Gosiewska ◽

...

Keyword(s):

Nutritional Status ◽

Renal Disease ◽

Antioxidant Capacity ◽

End Stage Renal Disease ◽

Maintenance Hemodialysis ◽

Sod Activity ◽

Antioxidant Power ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Over 50% of end-stage renal disease (ESRD) patients die of cardiovascular disease. ESRD patients treated with maintenance hemodialysis are repeatedly exposed to oxidative stress. The aim of the study was to find the relationship between lifestyle factors, nutritional status, calcium-phosphate metabolism, and selected redox parameters such as glutathione peroxidase (GPx), glutathione reductase (GR), superoxide dismutase (SOD), uric acid (UA), and total antioxidant capacity expressed as ferric reducing antioxidant power (FRAP). The study included 97 ESRD hemodialysis patients and 42 controls with no renal disease. Patients were asked to complete a questionnaire which gathered information on their physical activity, hours of sleep, smoking, and frequency of fruit and vegetable intake; the blood samples were then drawn before the midweek dialysis session. The ESRD patients had lower levels of GR, GPx, and SOD activity, a lower level of FRAP, and a higher UA concentration than the control group. The FRAP value decreased with age (ρ=−0.32, p=0.001); smokers had a significantly lower SOD activity in comparison to nonsmokers (p=0.03). In the ESRD patients, FRAP and UA correlated with both albumin (ρ=0.26, p=0.011; ρ=0.41, p=0.006, respectively) and prealbumin (ρ=0.34, p≤0.001; ρ=0.28, p=0.006, respectively), whereas UA, GR, GPx, and SOD correlated with calcium, UA, GR, and GPx with phosphate level. Based on the findings, there are weak associations between nutritional status and selected redox parameters in hemodialyzed patients. Further studies are needed to establish if diet modifications and adequate nutritional status can positively impact the antioxidant capacity in this group of patients.

Download Full-text