Nutritional screening and nutritional management in dialysis patients

2015 ◽  
Author(s):  
Carla Maria Avesani ◽  
Juan Jesús Carrero ◽  
Bengt Lindholm ◽  
Peter Stenvinkel
Keyword(s):  
Nutritional Status ◽  
Dietary Intervention ◽  
Nutritional Management ◽  
Dialysis Patients ◽  
Nutritional Screening ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Phosphorus And Potassium ◽  
Nutritional Disturbances

Patients on dialysis are prone to nutritional disturbances, that is, protein-energy wasting, obesity, and imbalance in body fluids and in serum phosphorus and potassium equilibrium. Hence, specialized nutritional care is highly important and include (a) a carefully assessment of the nutritional status, (b) prescription of diet with adequate energy and nutrients to treat and prevent the development of nutritional disturbances often observed in these patients, and (c) periodic follow-up to check adherence of the prescribed diet as well as to evaluate the nutritional status and efficacy of the dietary intervention. This chapter discusses these three aspects in detail and will guide nephrologists and dieticians when treating dialysed patients.

scholarly journals NT-proBNP, Cardiometabolic Risk Factors, and Nutritional Status in Hemodialysis Patients

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Jacques Ducros ◽  
Laurent Larifla ◽  
Henri Merault ◽  
Lydia Foucan
Keyword(s):  
Nutritional Status ◽  
Cross Sectional Study ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Wasting Syndrome ◽  
Protein Energy ◽  
Catabolic Rate ◽  
Dialysis Vintage

Background.We aimed to evaluate the association between NT-proBNP and malnutrition in HD patients while taking into account the four established categories of parameters for diagnosis of protein energy wasting (PEW).Methods. A cross-sectional study was performed in Afro-Caribbean dialysis patients. One component in each of the 4 categories for the wasting syndrome was retained: serum albumin ≤ 38 g/L, BMI ≤ 23 Kg/m2, serum creatinine ≤ 818 µmol/L, and normalized protein catabolic rate (nPCR) ≤ 0.8 g/kg/day. NT-proBNP was assessed using a chemiluminescence immunoassay. Two multivariate logistic regression models were performed to determine the parameters associated with high NT-proBNP concentrations.Results.In 207 HD patients, 16.9% had PEW (at least three components). LVEF lower than 60% was found in 13.8% of patients. NT-proBNP levels ranged from 125 to 33144 pg/mL. In model 1, high levels of NT-proBNP (≥6243 pg/mL) were independently associated with PEW OR 14.2 (3.25–62.4), male gender 2.80 (1.22–6.57), hsCRP > 5 mg/L 3.90 (1.77–8.57), and dialysis vintage > 3 years 3.84 (1.35–10.8). In model 2, LVEF OR was 0.93 (0.88–0.98). NT-proBNP concentrations were significantly higher when the PEW component number was higher.Conclusion.In dialysis patients, high NT-proBNP levels must draw attention to cardiac function but also to nutritional status.

scholarly journals Nutritional Status of Maintenance Dialysis Patients: Low Lean Body Mass Index and Obesity Are Common, Protein-Energy Wasting Is Uncommon

PLoS ONE ◽  
2016 ◽  
Vol 11 (2) ◽  
pp. e0150012 ◽  
Author(s):  
Mette Koefoed ◽  
Charles Boy Kromann ◽  
Sophie Ryberg Juliussen ◽  
Danni Hvidtfeldt ◽  
Bo Ekelund ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Nutritional Status ◽  
Lean Body Mass ◽  
Body Mass ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Maintenance Dialysis

scholarly journals Relationship between Vascular Calcification, Protein-Energy Wasting Syndrome, and Sarcopenia in Maintenance Automated Peritoneal Dialysis

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 666
Author(s):  
Gustavo Leal-Alegre ◽  
Claudia Lerma ◽  
Gabriela Leal-Escobar ◽  
Bernardo Moguel-González ◽  
Karen Belén Martínez-Vázquez ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Wasting Syndrome ◽  
Protein Energy ◽  
Inflammation Score

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

MO847PREVALENCE OF FATIGUE REPORTED BY PATIENTS ON HEMODIALYSIS THERAPY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Mauricio Sanabria ◽  
Cesar Mauricio Doria ◽  
Edward Martinez ◽  
Carlos Simon ◽  
Jasmin Vesga ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Chronic Hemodialysis ◽  
Multicenter Cohort Study ◽  
Care Services ◽  
Protein Energy ◽  
Confounding Variables ◽  
Patient Reported ◽  
High Prevalence ◽  
One Year

Abstract Background and Aims Fatigue is a symptom with a high prevalence in patients on hemodialysis therapy due to uremic toxins, anemia, associated comorbidity, and hemodialysis treatment per se. Our objective is to evaluate the prevalence of fatigue reported by patients and their association with the nutritional status. Method This was a prospective observational, multicenter cohort study. Prevalent patients on HD therapy for at least 90 days, older than 18, at the Baxter Renal Care Services were included between September 1, 2017, to November 30, 2017 with one-year follow-up. Socio-demographic and clinical characteristics of all patients were summarized descriptively, the nutritional status was evaluated by protein Energy waste (PEW). Patient reported fatigue was measured with high flux membrane and medium cut-off membrane (Theranova). A generalized linear binomial multivariable model was conducted to assess the effect of PEW on fatigue symptom controlling for some confounding variables. Results We found that the fatigue reported by the patients has a prevalence of 55% [95% CI: 52.2 to 57.7] in our population, there are no statistical differences due to the use of different types of membranes p= 0.911, and neither did we find that the nutritional status is an independent factor that explains this symptom. If we find that women and diabetics have a higher risk of fatigue; RR=1.17 [95% CI: 1.06 to 1.29] and RR= 1.19 [95% CI: 1.00 to 1.42] respectively. Conclusion The fatigue is a prevalent symptom in the chronic hemodialysis population; being a woman and the diagnosis of diabetes are risk factors associated with this outcome. PEW and the type of dialysis membrane used were not associated with this symptom. Studies evaluating the recovery time from post-dialysis symptoms and its relationship with the type of membrane are necessary.

scholarly journals The Diagnosis of Protein Energy Wasting in Chronic Peritoneal Dialysis Patients Is Influenced by the Method of Calculating Muscle Mass. A Prospective, Multicenter Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Cristina Techy Roth-Stefanski ◽  
Naiane Rodrigues de Almeida ◽  
Gilson Biagini ◽  
Natália K. Scatone ◽  
Fabiana B. Nerbass ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Muscle Mass ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Multifrequency Bioimpedance ◽  
Study Population ◽  
The Mean ◽  
Main Factor

Objective: To analyze the concordance and agreement between bioimpedance spectroscopy (BIS) and anthropometry for the diagnosis of protein energy wasting (PEW) in chronic peritoneal dialysis patients.Methods: Prospective, multi-center, observational study using multifrequency bioimpedance device (Body Composition Monitor -BCM®- Fresenius Medical Care) and anthropometry for the diagnosis of PEW as recommended by the International Society of Renal Nutrition and Metabolism (ISRNM). Cohen's kappa was the main test used to analyze concordance and a Bland-Altmann curve was built to evaluate the agreement between both methods.Results: We included 137 patients from three PD clinics. The mean age of the study population was 57.7 ± 14.9, 47.8% had diabetes, and 52.2% were male. We calculated the scores for PEW diagnosis at 3 and 6 months after the first collection (T3 and T6) and on average 40% of the study population were diagnosed with PEW. The concordance in the diagnosis of PEW was only moderate between anthropometry and BIS at both T3 and T6. The main factor responsible for our results was a low to moderate correlation for muscle mass in kilograms, with an r-squared (R2) of 0.35. The agreement was poor, with a difference of more than 10 kg of muscle mass on average and with more than a quarter of all cases beyond the limits of agreements.Conclusion: Current diagnosis of PEW may differ depending on the tools used to measure muscle mass in peritoneal dialysis patients.

Protein-Energy Wasting and Mortality Risk Prediction Among Peritoneal Dialysis Patients

2021 ◽  
Author(s):  
Piyawan Kittiskulnam ◽  
Piyatida Chuengsaman ◽  
Talerngsak Kanjanabuch ◽  
Sirarat Katesomboon ◽  
Somkanya Tungsanga ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Protein Energy

Association of subjective global assessment of nutritional status with gut microbiota in hemodialysis patients: a case–control study

2020 ◽  
Author(s):  
Ting-Yun Lin ◽  
Szu-Chun Hung
Keyword(s):  
Nutritional Status ◽  
Gut Microbiota ◽  
Global Assessment ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Subjective Global Assessment ◽  
Protein Energy Wasting ◽  
Β Diversity ◽  
Protein Energy ◽  
Α Diversity

Abstract Background Protein-energy wasting (PEW) is prevalent and associated with adverse outcomes in patients with chronic kidney disease (CKD). However, the pathogenesis of PEW in CKD patients has not been fully identified. The gut microbiota has been implicated in the regulation of host metabolism and energy balance. Therefore, we aimed to explore the association between nutritional status and the composition of the gut microbiota in hemodialysis patients. Methods Gut microbial diversity and taxonomy were examined in 88 hemodialysis patients with PEW (n = 22) and normal nutritional status (n = 66) who were matched 1:3 for age and sex. Nutritional status was assessed by using the 7-point subjective global assessment (SGA) score (1–3 = severe PEW; 4–5 = moderate PEW and 6–7 = normal nutrition). The gut microbiota was assessed by 16S ribosomal RNA gene sequencing. Results Patients with normal nutritional status had a significantly higher body mass index and physical activity and serum albumin levels, but significantly lower levels of inflammatory cytokines than patients with PEW. The most striking finding was that the α-diversity of the gut microbiota was significantly lower in patients with PEW. In a multivariate analysis, the SGA score was independently and positively associated with α-diversity (P = 0.049). Patients with or without PEW were different with respect to the principal coordinate analysis of β-diversity. Notably, the relative abundance of Faecalibacterium prausnitzii, a butyrate-producing bacteria, was markedly reduced in patients with PEW. Conclusion In hemodialysis patients, PEW assessed with the SGA was associated with gut dysbiosis.

scholarly journals Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1715 ◽  
Author(s):  
Thomas Kiebalo ◽  
Jacqueline Holotka ◽  
Ireneusz Habura ◽  
Krzysztof Pawlaczyk
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Positive Impact ◽  
Protein Energy Wasting ◽  
Innovative Strategies ◽  
Nutritional Recommendations ◽  
Protein Energy ◽  
Accessible Information ◽  
Concise Information ◽  
Treatment Adequacy

The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.

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