Identification and Treatment of Protein-energy Malnutrition in Renal Disease

2010 ◽  
Vol 71 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Kari Mcknight ◽  
Anna Farmer ◽  
Lyn Zuberbuhler ◽  
Diana Mager
Keyword(s):  
Clinical Practice ◽  
Renal Disease ◽  
Practice Guidelines ◽  
Protein Energy Malnutrition ◽  
Treatment Strategies ◽  
Web Based ◽  
Medication Therapy ◽  
Protein Energy ◽  
Stage Renal Disease ◽  
End Stage

A web-based cross-country survey of renal registered dietitians (RRDs) was launched. It was used to assess whether or not their clinical practice in identifying and treating proteinenergy malnutrition (PEM) in adults with end-stage renal disease (ESRD) and dialysis was based on current nutrition practice guidelines (NPGs). The survey included questions on strategies, timelines, and markers used for the identification and treatment of PEM. Fifty-nine RRDs responded (21%). Sixty-seven percent did not base clinical practice on NPGs, while 33% indicated they followed the guidelines. Of those who followed guidelines, 76% use the National Kidney Foundation— Kidney Disease Outcomes Quality Initiative nutrition guidelines. Strategies used to identify and treat PEM were not related to duration of RRD experience in nephrology, but were significantly different between guidelines users and non-users. Guideline users commonly used key nutrition treatment strategies that included enteral/parenteral nutrition and medication therapy. The clinical practice of RRD is typically based on expert opinion/consensus, rather than on evidence-based practice guidelines (EBPG). It remains unclear if differences in RRDs’ adoption of clinical guidelines influences patient outcomes, particularly in the treatment of PEM. Up-to-date EBPG need to be developed for the identification and treatment of PEM in patients with ESRD.

Progressive Resistance Training in End-Stage Renal Disease: Systematic Review

2016 ◽  
Vol 44 (1) ◽  
pp. 32-45 ◽  
Author(s):  
Danwin Chan ◽  
Birinder S. Cheema
Keyword(s):  
Systematic Review ◽  
Resistance Training ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Protein Energy Malnutrition ◽  
Control Period ◽  
Progressive Resistance Training ◽  
Stage Renal Disease ◽  
End Stage ◽  
Progressive Resistance

Background: This systematic review provides an overview of the extant literature on progressive resistance training (PRT) in patients with end-stage renal disease (ESRD) and outlines recommendations for future trials. Methods: A systematic review of all published literature evaluating the chronic (>6 weeks) application of PRT in patients with ESRD using electronic databases. Results: The search yielded 16 clinical trials, including 11 randomized controlled trials (RCT), 4 uncontrolled trials and one trial involving a within-subjects control period plus RCT. RCT quality, assessed via the CONSORT statement, ranged from low (4/10) to high (10/10) with a mean score of 7.3/10; 7/11 RCT had a quality score ≥7.5. All trials evaluated chronic adaptation to PRT across a range of important outcomes. PRT can induce muscle hypertrophy and improve aspects of physical functioning and health-related quality of life in ESRD. There is preliminary evidence that PRT may reduce protein-energy malnutrition and cardiovascular disease risk factors, including C-reactive protein, total cholesterol, triglyceride, and measures of insulin resistance in patients with or at-risk of comorbid type 2 diabetes. The evidence base for PRT adapting some of the endpoints investigated to date remains inconsistent (e.g. physical performance tests, obesity outcomes), and many other pertinent clinical outcomes remain to be investigated. Conclusion: RCT are required to investigate a range of novel research questions related to the benefits and application of PRT in this cohort and its patient subgroups (e.g. diabetes, depression, dyslipidemia, etc.). Future studies must be of high methodological quality to inform clinical practice guidelines.

Experimental and clinical rationale for use of MMF in nontransplant progressive nephropathies

2002 ◽  
Vol 283 (6) ◽  
pp. F1167-F1175 ◽  
Author(s):  
Roberto Zatz ◽  
Irene Lourdes Noronha ◽  
Clarice Kazue Fujihara
Keyword(s):  
Mycophenolate Mofetil ◽  
Clinical Practice ◽  
Renal Disease ◽  
Renal Injury ◽  
End Stage Renal Disease ◽  
Allograft Rejection ◽  
Immune Mediated ◽  
Stage Renal Disease ◽  
End Stage ◽  
Inflammatory Action

The incidence of progressive nephropathies and, consequently, the population suffering from end-stage renal disease have increased steadily in recent years, posing an ever-growing cost, in both human and financial terms, to society. There is mounting evidence that, in both immune-mediated and nonimmune-mediated chronic nephropathies, renal inflammatory events are key to the propagation and perpetuation of renal injury. Mycophenolate mofetil (MMF) is an antilymphocyte agent recently introduced in clinical practice for the prevention of allograft rejection. The present review discusses clinical and experimental evidence that the anti-inflammatory action of MMF can be advantageously used to arrest immune- and nonimmune-mediated progressive injury of native kidneys as well.

scholarly journals Chronic Renal Failure, Cachexia, and Ghrelin

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
A. Laviano ◽  
Z. Krznaric ◽  
K. Sanchez-Lara ◽  
I. Preziosa ◽  
A. Cascino ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Food Intake ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Contributing Factors ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Stage Renal Disease ◽  
End Stage

Protein energy wasting is frequently observed in patients with advanced chronic renal failure and end-stage renal disease. Anorexia and reduced food intake are critical contributing factors and negatively impact on patients' survival. Ghrelin is a prophagic peptide produced by the stomach and acting at the hypothalamic level to increase the activity of orexigenic neurons. In patients with chronic renal disease, plasma levels are increased as a likely effect of reduced renal clearance. Nevertheless, patients' food intake is significantly reduced, suggesting inflammation-mediated resistance of hypothalamic nuclei to peripheral signals. A number of forms of evidence show that ghrelin resistance could be overcome by the administration of exogenous ghrelin. Therefore, ghrelin has been proposed as a potential strategy to improve food intake in chronic renal failure patients with protein energy wasting. Preliminary data are encouraging although larger prospective clinical trials are needed to confirm the results and to identify those patients who are likely to benefit most from the administration of exogenous ghrelin.

Disaster management of chronic dialysis patients

2007 ◽  
Vol 2 (2) ◽  
pp. 96-106 ◽  
Author(s):  
Richard Zoraster, MD ◽  
Raymond Vanholder, MD, PhD ◽  
Mehmet S. Sever, MD
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Chronically Ill ◽  
Dialysis Patients ◽  
Dietary Restrictions ◽  
Stage Renal Disease ◽  
End Stage ◽  
Do So

The chronically ill are often the hardest hit by dis-ruptions in the healthcare system—they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in dis-aster response should be prepared to care for individu-als suffering from the complications of chronic illness, and they must have some idea of how to do so with lim-ited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters. Infrastructure damage may make dialysis impossible for days, and few physicians have experience or train-ing in the nondialytic management of end-stage renal disease. Nondialytic management strategies include dietary restrictions, aggressive attempts at potassium removal via resins and cathartics, and adaptations of acute treatment strategies. Appropriate planning and stockpiling of medications such as Kayexalate are crit-ical to minimizing morbidity and mortality

Associations of adiponectin and leptin levels with protein-energy wasting, in end stage renal disease patients

2016 ◽  
Vol 63 (9) ◽  
pp. 449-457 ◽  
Author(s):  
Anastasia Markaki ◽  
Maria G. Grammatikopoulou ◽  
Maria Venihaki ◽  
John Kyriazis ◽  
Kostas Perakis ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Protein Energy Wasting ◽  
Protein Energy ◽  
Stage Renal Disease ◽  
End Stage
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