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Protein energy wasting hemodialysis

Lea Katalinic, Vedran Premuzic, Nikolina Basic-Jukic, Ivan Barisic, Bojan Jelakovic
Series of studies have described malnutrition as one of the main non-traditional risk factors associated with poor prognosis and treatment outcome in patients on hemodialysis (HD). The aims of this study were to evaluate the link between HD treatment quality and the nutritional status and to additionally investigate the association of malnutrition and overall survival. A total of 134 adult out-patients (56.4% male, mean age 60.8 ± 16.15 years) were enrolled in the study. Clinical and laboratory data were obtained from the medical records...
March 9, 2019: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Michelle M Y Wong, Stephan Thijssen, Yuedong Wang, Len A Usvyat, Qingqing Xiao, Peter Kotanko, Franklin W Maddux
OBJECTIVE(S): Malnutrition and protein-energy wasting are associated with morbidity and mortality in hemodialysis patients. Existing nutritional scores rely primarily on cross-sectional data. Using readily available nutritional indicators, we developed models to predict the risk of mortality and hospitalization in prevalent hemodialysis patients. DESIGN AND METHODS: In this retrospective study, we constructed prediction models of 1-year mortality and hospitalization using generalized linear models, generalized additive models (GAM), classification tree, and random forest models...
March 6, 2019: Journal of Renal Nutrition
S S Hu, C M Zhou, Q Li, F X Su, S Chen, J J Da, Y Zha
Objective: To explore the association of platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with protein energy wasting (PEW) in maintenance hemodialysis (MHD) patients. Methods: A multicenter cross-sectional study was conducted in eleven hemodialysis centers of Guizhou province from June to August, 2017. Clinical data, physical parameters, body composition data and laboratory values of MHD patients were collected. PLR and NLR were calculated according to routine blood test. All patients were divided into four groups (Q1-Q4) according to the median and quartile of PLR and NLR...
February 26, 2019: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Takahiro Yajima, Maiko Arao, Kumiko Yajima, Hiroshi Takahashi, Keigo Yasuda
Protein-energy wasting, which involves loss of fat and muscle mass, is prevalent and is associated with mortality in hemodialysis (HD) patients. We investigated the associations of fat tissue and muscle mass indices with all-cause mortality in HD patients. The study included 162 patients undergoing HD. The fat tissue index (FTI) and skeletal muscle mass index (SMI), which represent respective tissue masses normalized to height squared, were measured by bioimpedance analysis after dialysis. Patients were divided into the following four groups according to the medians of FTI and SMI values: group 1 (G1), lower FTI and lower SMI; G2, higher FTI and lower SMI; G3, lower FTI and higher SMI; and G4, higher FTI and higher SMI...
2019: PloS One
Hee-Sook Lim, Hee-Seon Kim, Jin Kuk Kim, Mooyong Park, Soo Jeong Choi
As the incidence of chronic diseases such as diabetes and hypertension increases, complications such as decreased renal function are also increasing in many patients. Nutritional management in hemodialysis patients is a very important factor for prognosis and quality of life. The purpose of this study was to investigate the differences in nutritional status and dietary management according to hemodialysis duration. A total of 145 patients were divided into 4 groups according to hemodialysis duration: less 1 year (D1), 1-5 years (D2), and above 5 years (D3)...
January 2019: Clinical Nutrition Research
Johanna Anderson, Kim Peterson, Donald Bourne, Erin Boundy
Intradialytic parenteral nutrition (IDPN) is commonly requested before recommended therapies in malnourished patients on hemodialysis. This review provides updated critical synthesis of the evidence on the use of IDPN in patients on hemodialysis. We searched MEDLINE, CINAHL, and other sources to identify evidence. Two reviewers sequentially selected studies, abstracted data, rated study quality, and synthesized evidence using predefined criteria. IDPN did not improve clinically relevant outcomes compared with dietary counseling or oral supplementation and had varied results compared with usual care in 12 studies...
January 24, 2019: Journal of Renal Nutrition
Jiachuan Xiong, Min Wang, Ying Zhang, Ling Nie, Ting He, Yiqin Wang, Yunjian Huang, Bing Feng, Jingbo Zhang, Jinghong Zhao
BACKGROUND/AIMS: Geriatric nutritional risk index (GNRI) was developed as a "nutrition-related" risk index and was reported in different populations as associated with the risk of all-cause and cardiovascular morbidity and mortality. Therefore, GNRI can be used to classify patients according to a risk of complications in relation to conditions associated with protein-energy wasting (PEW). However, not all reports pointed to the prognostic ability of the GNRI. The purpose of this study was to assess the associations of GNRI with mortality in chronic hemodialysis patients...
2018: Kidney & Blood Pressure Research
Rong-Shao Tan, Dan-Hua Liang, Yan Liu, Xiao-Shi Zhong, Dong-Sheng Zhang, Jing Ma
OBJECTIVE(S): To explore the validity of using bioelectrical impedance analysis (BIA)-derived 50 kHz phase angle (PhA) in predicting protein-energy wasting (PEW) in Chinese maintenance hemodialysis (MHD) patients. DESIGN AND METHODS: The design was a cross-sectional study. A total of 173 of MHD patients and 173 healthy adults were enrolled in the study. The prevalence of PEW in patients was performed by the International Society of Renal Nutrition and Metabolism criteria...
November 13, 2018: Journal of Renal Nutrition
F X Su, J Wu, C M Zhou, Q Li, S S Hu, X Lin, J J Da, Y Zha
Objective: To examine the relationship between low serum parathyroid hormone (PTH) and protein-energy wasting (PEW) in patients who underwent maintenance hemodialysis (MHD) treatment. Methods: A cross-sectional study was conducted in MHD patients between June 2015 and August 2017 in 11 MHD centers from Guizhou province. Body composition and physical parameters were measured, clinical data and other related laboratory values were collected according to the medical record system. Participants were assigned to low serum PTH group (PTH<150 ng/L), target PTH group (150 ng/L≤ PTH ≤300 ng/L) and high serum PTH group (PTH>300 ng/L)...
November 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Y Zha, F Sun
No abstract text is available yet for this article.
November 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Anaïs Bouchara, Dan Yi, Myriam Pastural, Samuel Granjon, Jean-Christophe Selag, Maurice Laville, Walid Arkouche, Solenne Pelletier, Denis Fouque, Christophe O Soulage, Laetitia Koppe
Wasting has been associated with increased cardiovascular and all-cause mortality in chronic kidney disease (CKD). We investigated whether serum zinc-alpha2-glycoprotein (ZAG), a potent cachectic and lipid-mobilizing factor that is increased in patients with CKD, predicts clinical outcomes in patients on chronic hemodialysis. We quantified serum ZAG at baseline in a prospective cohort of 252 patients undergoing maintenance hemodialysis. Serum ZAG concentrations were inversely associated with serum albumin, creatinine, and triglycerides and, conversely, positively associated with age...
November 2018: Kidney International
Carola-Ellen Kleine, Hamid Moradi, Elani Streja, Kamyar Kalantar-Zadeh
Obesity is a major risk factor for cardiovascular disease and worse survival in the general population. However, in patients with end-stage renal disease (ESRD), higher body mass index and indexes of body fat and muscle are associated with better survival. Furthermore, these associations, which some have described as the obesity paradox, are more consistent in African American patients being treated with hemodialysis when compared with other racial-ethnic groups. This is in view of data indicating that although the rate of progression to ESRD is faster in African American patients, they have a survival advantage after transition to ESRD when compared with their white counterparts...
November 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Stefano Murtas, Roberto Aquilani, Maria Luisa Deiana, Paolo Iadarola, Romina Secci, Mariella Cadeddu, Stefano Salis, Doriana Serpi, Piergiorgio Bolasco
OBJECTIVE: The objective of the study was to quantify the loss of total amino acids (TAAs), nonessential amino acids, essential amino acids, and branched chain amino acids (BCAAs) produced by high-efficiency hemodialysis (HEHD), postdilution hemodiafiltration (HDFpost), and predilution hemodiafiltration (HDFpre) using high ultrafiltration volumes; and to define the specific AA losses registered in HEHD, HDFpost, and HDFpre; to identify a potential metabolic and nutritional decline into protein energy wasting; to compare AA analysis of arterial blood samples taken from healthy controls and patients with end-stage renal disease undergoing hemodialysis...
October 16, 2018: Journal of Renal Nutrition
Sylwia Małgorzewicz, Grażyna Gałęzowska, Monika Cieszyńska-Semenowicz, Joanna Ratajczyk, Lidia Wolska, Przemysław Rutkowski, Magdalena Jankowska, Bolesław Rutkowski, Alicja Dębska-Ślizień
OBJECTIVES: Protein-energy wasting (PEW) is highly prevalent in patients on hemodialysis (HD). Oral nutritional supplementation (ONS) is recommended for malnourished patients on HD. The aim of this study was to evaluate ONS on plasma amino acid in HD patients with PEW. METHODS: Thirty-two HD patients with a mean age 59.1 ± 9.5 y with PEW were enrolled into the study. Patients were prescribed ONS (125 mL twice a day for 3 mo) together with dietary advice. The nutritional status was evaluated by means of body mass index, Subjective Global Assessment, and serum albumin and prealbumin levels...
January 2019: Nutrition
Mun Sun Choi, Brandon Kistler, Gretchen N Wiese, Elizabeth R Stremke, Amy J Wright, Ranjani N Moorthi, Sharon M Moe, Kathleen M Hill Gallant
OBJECTIVE: Patients undergoing hemodialysis (HD) have high protein and energy requirements, and protein-energy wasting is common and associated with poor outcomes. Eating during dialysis may improve nutritional status by counteracting the catabolic effects of HD treatment; but eating during HD may be discouraged because of concerns of postprandial hypotension. However, little data are available to support this practice. In this study, we hypothesized that high-protein meals during HD do not lead to symptomatic intradialytic hypotension events...
March 2019: Journal of Renal Nutrition
Richard A Ward, Werner Beck, Angelito A Bernardo, Filipa C Alves, Peter Stenvinkel, Bengt Lindholm
Hemodiafiltration (HDF) increases the removal of middle-molecular-weight uremic toxins and may improve outcomes in patients with end-stage kidney disease (ESKD), but it requires complex equipment and comes with risks associated with infusion of large volumes of substitution solution. New high-flux hemodialysis membranes with improved diffusive permeability profiles do not have these limitations and offer an attractive alternative to HDF. However, both strategies are associated with increased albumin loss into the dialysate, raising concerns about the potential for decreased serum albumin concentrations that have been associated with poor outcomes in ESKD...
August 8, 2018: Nephrology, Dialysis, Transplantation
Kenichi Akiyama, Norio Hanafusa
According to the current status of chronic dialysis therapy in Japan 2016, the average age at the time of dialysis initiation is 68.57 years for males and 71.19 years for females, which has been rising continuously. Frailty is a geriatric syndrome that is frequently seen in the elderly. It is known that frailty among dialysis patients are more common than the general population of the same age, and that frailty is associated with life prognosis. As eGFR decreases, BMD decreases and fracture risk increase, and dialysis patients are at the highest risk of fracture in CKD patients...
2018: Clinical Calcium
Lea Katalinic, Branimir Krtalic, Bojan Jelakovic, Nikolina Basic-Jukic
BACKGROUND/AIMS: There is a growing body of evidence that the long-term hemodialysis (HD) treatment leads to disturbances of carnitine homeostasis but the results of L-carnitine supplementation in HD patients have been conflicting. In the present prospective study, we investigated the effectiveness of intravenous L-carnitine in mitigating dialysis-related protein-energy wasting (PEW) based on pre-treatment albumin levels. METHODS: Fifty patients (46% male, mean age 63±18...
2018: Kidney & Blood Pressure Research
David E St-Jules, David S Goldfarb, Collin J Popp, Mary Lou Pompeii, Scott E Liebman
Protein-energy wasting (PEW) is a major diet-related complication in hemodialysis (HD) patients. Nutrient-based dietary guidelines emphasize animal-based protein foods for preventing and managing PEW in HD patients. Although dietary protein intake is important for protein anabolism, other dietary factors contribute to PEW. In this article, we examine the diet-related etiologies of PEW in HD patients, and discuss how they may be affected differently by animal- and plant-based protein foods. In general, animal foods are superior sources of protein, but may contribute more to metabolic derangements that cause PEW...
July 15, 2018: Seminars in Dialysis
Gloria Antón-Pérez, Ángelo Santana-Del-Pino, Fernando Henríquez-Palop, Tania Monzón, Ana Y Sánchez, Francisco Valga, Adelaida Morales-Umpierrez, Cesar García-Cantón, Jose C Rodríguez-Pérez, Juan J Carrero
OBJECTIVE: To study whether the score proposed by the International Society of Renal Nutrition and Metabolism to define the protein energy wasting (PEW) syndrome has diagnostic validity in patients undergoing dialysis. DESIGN AND METHODS: Cross-sectional study including 468 prevalent hemodialysis patients from Canary Islands, Spain. Individual PEW syndrome criteria and the number of PEW syndrome categories were related to other objective markers of PEW using linear and logistic regression analyses: subjective global assessment, handgrip strength, bioimpedance-assessed body composition, and levels of high-sensitivity C-reactive protein...
July 5, 2018: Journal of Renal Nutrition
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