P0952NEUTROPHIL GELATINASE - ASSOCIATED LIPOCALIN LEVEL AS A MARKER OF MALNUTRITION IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Among hemodialysis patients, malnutrition is a common health problem, it is a marker of poor prognosis in these patients, associated with increased risk of hospitalization and mortality. NGAL is an iron transporting factor which increases in the serum in acute and chronic kidney disease. The aim of our study is to assess the use of NGAL as a marker of malnutrition in patients with stage 5 CKD maintained on hemodialysis. Method This is a cross-sectional study of 80 regular hemodialysis (HD) patients (51 males and 29 females). All cases of this study were subjected to: Anthropometric measurements . Biochemical measurements: Neutrophil Gelatinase-associated Lipocalin Level in blood using commercially available ELIZA kits, Serum albumin, Blood urea, Complete blood count, Serum electrolytes . Results According to the result we found in our study 100% of CKD having malnutrition according to SGA, MIS and our data however most of our patients are mild malnutrition. We found also a significant decrease in some anthropometric parameters including BMI, fat mass, TSF, MAC, MAMC and MAMA with advanced malnutrition in hemodialysis patients. In this study, we use Twenty-four hours dietary recall and we found most of patients were with low protein (96.2%) and calorie (68.8%) contents. Dialysis adequacy (Kt/V) can affect the nutritional status of patients Kt/V was adequate in all malnutrition groups. These findings are consistent with an earlier report in which HD patients with Kt/V>1.4 had a significantly higher rate of malnutrition than patients with Kt/V ≤1.4. in this study NGAL serum levels were significantly (P=0.018) reduced with the severity of malnutrition. In this study, Spearman correlation analysis revealed that NGAL serum levels were significantly correlated with SGA (r =o,247 P =0.027) and albumin serum levels (r =0.402, P <0.001). NGAL serum levels were significantly (P=0.018) reduced with the severity of malnutrition. Using ROC curve analysis, NGAL serum levels had a good ability (AUC=0.845) to predict severe malnutrition with good sensitivity (83.3%) and specificity (78.4%). Conclusion NGAL is well correlated with other standard markers used routinely in assessment of nutritional status of hemodialysis patients. Patients with high NGAL levels were closely related to good nutritional status. Its serum levels had a good diagnostic power for severe-malnourished patients, as it helps us for early prediction to malnutrition.

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Simple methods for nutritional status assessment in patients treated with repeated hemodialysis

Medicinski pregled ◽

10.2298/mpns0410439t ◽

2004 ◽

Vol 57 (9-10) ◽

pp. 439-444 ◽

Cited By ~ 3

Author(s):

Biserka Tirmenstajn-Jankovic ◽

Nada Dimkovic

Keyword(s):

Nutritional Status ◽

Body Mass ◽

Body Fat ◽

Protein Energy Malnutrition ◽

Hemodialysis Patients ◽

Anthropometric Measurements ◽

Severe Malnutrition ◽

Dialysis Patients ◽

Fat Percentage ◽

Anthropometric Parameters

Introduction Protein-energy malnutrition is common in chronic hemodialysis patients and is strongly associated with increased morbidity and mortality. While determination of the nutritional status is often based on objective measurements such as biochemical parameters and anthropometric measurements, there is no single measurement that can reliably identify risk for malnutrition. Material and methods A subjective global assessment (SGA) was performed to evaluate the nutritional status in 43 chronic dialysis patients (27 men and 16 women). Anthropometric measurements including body weight (BW), body mass index (BMI), skin-fold thickness (triceps-TS, biceps-BS, subscapular-SSS, suprailiac-SIS), mid-arm circumference (MAC); mid-arm muscle circumference (MAMC); body fat percentage (%BF); total body fat (TBF); lean body mass (LBM) and laboratory parameters (total proteins, albumins, transferrin, hemoglobin, lymphocytes. Results According to SGA, patients were divided into three groups: first group of 23 pts with a normal nutritional status, second group of 11 pts with mild malnutrition and third group of 9 pts with moderate or severe malnutrition. In examined groups there was a significant decrease in total protein (p = 0.02), serum albumin (p = 0.000) and hemoglobin (p = 0.04) levels with an increase in SGA scores (oneway ANOVA). In the same way, SGA was correlated with the number of anthropometric parameters (BW, BMI, TS, SSS, SIS, MAC, MAMC, % BF, TBF, LBM). Conclusion Our data confirmed a high prevalence of malnutrition in hemodialysis patients and showed that SGA closely correlated with more objective measures. Being an inexpensive method of well-proven realibility, SGA can be recommended for a more frequent assessment of nutritional status in dialysis patients.

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Body Composition Findings by Computed Tomography in SARS-CoV-2 Patients: Increased Risk of Muscle Wasting in Obesity

International Journal of Molecular Sciences ◽

10.3390/ijms21134670 ◽

2020 ◽

Vol 21 (13) ◽

pp. 4670 ◽

Cited By ~ 7

Author(s):

Paola Gualtieri ◽

Carmela Falcone ◽

Lorenzo Romano ◽

Sebastiano Macheda ◽

Pierpaolo Correale ◽

...

Keyword(s):

Computed Tomography ◽

Body Composition ◽

Nutritional Status ◽

Bed Rest ◽

Nutritional Therapy ◽

The Body ◽

Low Grade ◽

Anthropometric Parameters ◽

Imaging Diagnostics ◽

Increased Risk

Obesity is a characteristic of COVID-19 patients and the risk of malnutrition can be underestimated due to excess of fat: a paradoxical danger. Long ICU hospitalization exposes patients to a high risk of wasting and loss of lean body mass. The complex management precludes the detection of anthropometric parameters for the definition and monitoring of the nutritional status. The use of imaging diagnostics for body composition could help to recognize and treat patients at increased risk of wasting with targeted pathways. COVID-19 patients admitted to the ICU underwent computed tomography within 24 h and about 20 days later, to evaluate the parameters of the body and liver composition. The main results were the loss of the lean mass index and a greater increase in liver attenuation in obese subjects. These could be co-caused by COVID-19, prolonged bed rest, the complex medical nutritional therapy, and the starting condition of low-grade inflammation of the obese. The assessment of nutritional status, with body composition applied to imaging diagnostics and metabolic profiles in COVID-19, will assist in prescribing appropriate medical nutritional therapy. This will reduce recovery times and complications caused by frailty.

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Eating during the Hemodialysis Session: A Practice Improving Nutritional Status or a Risk Factor for Intradialytic Hypotension and Reduced Dialysis Adequacy?

Nutrients ◽

10.3390/nu12061703 ◽

2020 ◽

Vol 12 (6) ◽

pp. 1703 ◽

Cited By ~ 2

Author(s):

Eleni Fotiadou ◽

Panagiotis I. Georgianos ◽

Michail Chourdakis ◽

Pantelis E. Zebekakis ◽

Vassilios Liakopoulos

Keyword(s):

Nutritional Status ◽

Caloric Intake ◽

Intradialytic Hypotension ◽

Protein Energy Wasting ◽

Dialysis Adequacy ◽

Hemodialysis Treatment ◽

Protein Energy ◽

Increased Risk ◽

Related Quality ◽

Inflammatory State

Historically, eating during the hemodialysis treatment has been associated with increased risk for adverse intradialytic symptoms and events, risks that have resulted in the implementation of restrictive in-center nutrition policies. Recent studies, however, have recorded a shift in clinical practice with a higher proportion of physicians following the view that administration of intradialytic meals and supplements represents a simple and effective approach to enhance caloric intake and improve nutritional status among patients on hemodialysis. This shift towards less restrictive in-center nutrition practices is mainly supported by evidence from observational studies associating intradialytic nutritional supplementation with improvements in protein-energy wasting, inflammatory state, and health-related quality of life. In sharp contrast, earlier and recent interventional studies have documented that feeding during the hemodialysis treatment provokes a rapid postprandial decline in blood pressure and raises the incidence of symptomatic intradialytic hypotension. Furthermore, other studies have shown that postprandial redistribution in intravascular volume and enhanced blood supply to the gastrointestinal circulation may interfere with the adequacy of the delivered hemodialysis. Those who defend the position that intradialytic nutritional support is beneficial do not dispute the physiology of postprandial hemodynamic response, but they argue against its clinical significance. In this article, we provide an overview of studies that explored the effect of eating during the hemodialysis treatment on intradialytic hemodynamic stability and adequacy of the delivered hemodialysis. We reason that these risks have important clinical implications that are not counteracted by anticipated benefits of this strategy on caloric intake and nutritional status.

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The severity of malnutrition in children with epidermolysis bullosa correlates with disease severity

Scientific Reports ◽

10.1038/s41598-021-96354-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seema Manjunath ◽

Rahul Mahajan ◽

Dipankar De ◽

Sanjeev Handa ◽

Savita Attri ◽

...

Keyword(s):

Nutritional Status ◽

Disease Severity ◽

Epidermolysis Bullosa ◽

Receiver Operating Curve ◽

Severe Malnutrition ◽

Second Phase ◽

Anthropometric Parameters ◽

Indian Children ◽

Z Scores ◽

Bivariate Regression Analysis

AbstractWHO defines malnutrition as severe if the z-scores are less than − 3 Standard deviation (SD), moderate if between − 2 and − 3 SD and mild if between − 2 SD to – 1 SD. This study was aimed to assess nutritional aspects of Indian children suffering from EB and to evaluate the effect of severity of EB on the severity of malnutrition. In this study, pediatric EB patients were evaluated prospectively for baseline nutritional status using anthropometric parameters and WHO growth charts, and its correlation with disease severity using instrument for Scoring Clinical Outcomes for Research of Epidermolysis Bullosa-iscorEB. In second phase, an individualized diet chart was given to meet the energy, protein and micronutrients needs and its effects were observed after 6 months. The median age of participants was 3 years (IQR-9). Of 57 patients, malnutrition was seen in 40.35% patients (22.81%-moderate and 17.54%-severe), and significantly correlated with iscorEB (r = 0.45, p < 0.0001). On bivariate regression analysis, iscorEB was independently associated with moderate-to-severe malnutrition (p = 0.047; OR 1.038, CI 1.011–1.066). iscorEB enabled the identification of patients with moderate-to-severe malnutrition with an Area Under Receiver Operating Curve (AUROC) of 0.72 (95%CI 0.58–0.85; p < 0.005). In phase 2, there was significant improvement in nutritional status in children with recessive dystrophic EB (RDEB) and dominant dystrophic EB (DDEB) subtype (p < 0.0001). The severity of malnutrition in EB children significantly correlates with disease severity, and is an independent predictor of moderate-to-severe malnutrition.

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Factors related to under nutrition among children in a rural area in Patan district of Gujarat, India

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20185104 ◽

2018 ◽

Vol 6 (1) ◽

pp. 142

Author(s):

Punit Patel ◽

Shreyashkumar J. Gandhi ◽

Pushti Vachhani ◽

Nishant Bhimani

Keyword(s):

Nutritional Status ◽

Rural Area ◽

Gender Discrimination ◽

Rural Areas ◽

Maternal Education ◽

Family Income ◽

Occupational Status ◽

Secondary Data ◽

Severe Malnutrition ◽

Anthropometric Parameters

Background: Malnutrition is defined as ‘undernutrition’ resulting from inadequate consumption, poor absorption or excessive loss of nutrients and also includes ‘overnutrition’, resulting from excessive intake of specific nutrients. Infant-feeding practices play a major role in child caring practices apart from socio-cultural, demographic and economic factors. The present study was conducted to assess socio-demographic and other factors associated with undernutrition in rural areas of Patan.Methods: This present study was conducted at 6 Anganwadi centers of Kungher rural area of Patan during 2017-2018. Total 293 of 1 to 5 year children were included in the study. Secondary data was collected through study of records and reports from AWW. Mothers of selected children were interviewed for collecting desired information. The children were examined for anthropometric parameters (weight and height) and nutritional status.Results: Out of 293 children 159 (54.2%) subjects were males. Total 190 (64.8%) children were ICDS beneficiaries. More than half of children (55.6%) were undernourished. Severe malnutrition was more distributed among unregistered (54.5%). Two third of illiterate mothers had undernourished children (69.8%). More than half of children (59.9%) belonging to lower socio economic class were undernourished. More than 2/3rd of low birth weight (LBW) children were found to be undernourished.Conclusions: Child’s nutritional status had significantly affected by maternal education and occupational status. Many other key factors such as family income, gender discrimination and LBW are playing an important role in nutritional status children.

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Nutritional Status of Patients on Maintenance Hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross-Sectional Study

Journal of Nutrition and Metabolism ◽

10.1155/2021/6672185 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Puneet Bramania ◽

Paschal Ruggajo ◽

Rimal Bramania ◽

Muhiddin Mahmoud ◽

Francis Furia

Keyword(s):

Nutritional Status ◽

Total Cholesterol ◽

Hemodialysis Patients ◽

Dar Es Salaam ◽

Maintenance Hemodialysis ◽

Diabetic Patients ◽

Muhimbili National Hospital ◽

National Hospital ◽

Cross Sectional ◽

Increased Risk

Background. Patients on hemodialysis therapy are at high risk of malnutrition which is attributed to multiple factors. Protein-energy malnutrition in these patients confers poor clinical outcomes. This study investigated the nutritional status of patients on maintenance hemodialysis at Muhimbili National Hospital in Dar es Salaam, Tanzania. Methods. A cross-sectional descriptive study was done among 160 adult patients on maintenance hemodialysis therapy. Data concerning patients’ personal, medical, dietary, and hemodialysis-related information were collected. Patients’ anthropometric and laboratory tests (complete blood count, albumin, total cholesterol, creatinine, and urea) were measured. The quantitative Subjective Global Assessment (SGA) dialysis malnutrition score (DMS) was used to assess their nutritional status. Data analysis was done using the SPSS software version 20. Results. Among the 160 hemodialysis patients, 49 (30.6%) were female. Patients’ mean age was 52.2 ± 13.3 years. The median duration on hemodialysis was 18 (8.25–29.75) months. Malnutrition was present in 98 (61.2%) of the patients. Severe malnutrition was found in only 3 (1.9%) patients and 16.9% were underweight. The longer duration on hemodialysis, having diabetes mellitus, and being single were associated with increased risk for malnutrition in multivariate logistic regression. Malnourished patients had significantly lower dry weight, body mass index, mid-upper arm circumference, waist circumference, albumin, total cholesterol, and creatinine levels. Conclusion. Malnutrition is very common among hemodialysis patients at Muhimbili National Hospital, especially those on longer duration of hemodialysis, and diabetic patients. We recommend that hemodialysis patients should be regularly assessed for malnutrition and appropriately treated which if left unattended heralds worse outcomes.

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Impact of residual renal function on the evaluation of dialysis adequacy and nutritional status in hemodialysis patients.

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.33.261 ◽

2000 ◽

Vol 33 (4) ◽

pp. 261-266

Author(s):

Kenji Takashima ◽

Tomoko Shohji ◽

Yoshitaka Maeda ◽

Sumiko Miura ◽

Akiko Mizuno ◽

...

Keyword(s):

Renal Function ◽

Nutritional Status ◽

Residual Renal Function ◽

Hemodialysis Patients ◽

Dialysis Adequacy

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Study of Serum Levels of Leptin, C-Reactive Protein and Nutritional Status in Hemodialysis Patients

Iranian Red Crescent Medical Journal ◽

10.5812/ircmj.26880 ◽

2015 ◽

Vol 17 (8) ◽

Cited By ~ 3

Author(s):

Farzaneh Montazerifar ◽

Mansour Karajibani ◽

Zahra Hassanpour ◽

Mahla Pourmofatteh

Keyword(s):

Nutritional Status ◽

Serum Levels ◽

Hemodialysis Patients ◽

C Reactive Protein ◽

Reactive Protein

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The Relationship between Serum Procalcitonin and Dialysis Adequacy in Peritoneal Dialysis Patients

Iranian Journal of Public Health ◽

10.18502/ijph.v50i3.5591 ◽

2021 ◽

Author(s):

Benyong WANG ◽

Chan GAO ◽

Qi CHEN ◽

Ming WANG ◽

Xiao FEI ◽

...

Keyword(s):

Peritoneal Dialysis ◽

High Sensitivity ◽

Serum Levels ◽

Control Group ◽

C Reactive Protein ◽

Dialysis Patients ◽

Roc Curve Analysis ◽

Dialysis Adequacy ◽

Reactive Protein ◽

The Relationship

Background: To detect the serum procalcitonin (PCT) levels of peritoneal dialysis (PD) patients. Methods: We analyzed the relationship between the PCT Level and dialysis adequacy. We studied 120 peritoneal dialysis patients without signs of infection in Affiliated Hangzhou First People's Hospital and 120 controls from Jan 2014 to Apr 2016. PCT and high sensitivity C-reactive protein (hs-CRP) were detected. 120 PD patients were divided into two groups according to the dialysis adequacy. A correlation analysis was processed between the PCT level and the total solute clearance (Kt/V). The value of PCT for identifying the dialysis adequacy in PD patients was assessed by ROC curve analysis. Results: PCT level in serum of PD group (0.29±0.24 ng/ml) was higher than that of the control group (0.02±0.01 ng/ml) (P<0.01). Compared with the inadequate dialysis group (0.5±0.37 ng/ml), the PCT Level of the adequate dialysis group (0.23±0.15 ng/ml) was lower (P<0.01). There were negative correlations between PCT and Kt/v(r=- 0.451), Prealbumin (PA) (r=-0.258), Glomerular Filtration Rate (eGFR; r=-0.280), while there was positive correlation between PCT and Hypersensitive c-reactive protein (r=0.458) (P<0.01). At a serum PCT cut-off value of 0.283 ng/ml, the sensitivity and specificity for identifying the dialysis adequacy in PD patients were 0.913 and 0.805 respectively. The serum levels of PCT in peritoneal dialysis patients were significantly higher than the levels in healthy controls. Conclusion: The serum level of PCT can be used as an indirect maker to evaluate the adequacy of dialysis.

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