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Acidosis malnutrition hemodialysis

Feray Gencer, Hilal Yıldıran, Yasemin Erten
OBJECTIVE: Hemodialysis patients may be at risk for malnutrition due to catabolic effects caused by dialysis, loss of amino acids, inadequate nutrient intake, acidosis, and inflammation. Malnutrition may have negative effects on quality of life, mortality, and disease prognosis. This study was conducted to determine the relationship between anthropometric parameters, depression, and quality of life with Malnutrition Inflammation Score (MIS) on 55 patients aged between 18 and 65 years (36 males and 19 females) who have dialysis treatment for 3 days per week for at least 3 months due to end-stage renal disease...
December 27, 2018: Journal of the American College of Nutrition
Vaia D Raikou, Despina Kyriaki
Background: Intradialytic hypertension was associated with a high mortality risk. We examined the relationship between intradialytic hypertension and metabolic disorders in hemodialysis treatment patients. Methods: We studied 76 patients in online hemodiafiltration. Dialysis adequacy was defined by Kt / V for urea. Normalized protein catabolic rate (nPCR), as a marker of protein intake, was calculated. Sodium removal was determined as percent sodium removal. Metabolic acidosis was determined by serum bicarbonate less than 22 mmol/L...
2018: International Journal of Hypertension
Francesco Locatelli, Lucia Del Vecchio, Valeria Aicardi
A gentle start of dialysis is a welcome possibility for both patients and physicians. Incident dialysis patients often maintain residual kidney function (RKF) for a considerable period of time; the start of dialysis is often driven mainly by uremic symptoms. Recently, the combination of a low-protein diet, along with a less-frequent dialysis schedule, has regained interest as an alternative option in selected and motivated patients. In addition, there is renewed interest in a low-protein diet in patients with moderate to advanced chronic kidney disease (CKD)...
May 2017: Seminars in Dialysis
Claudia Maria Costa de Oliveira, Caroline Lustosa da Costa Vidal, Eurinice Fontenele Cristino, Francisco Marto Leal Pinheiro, Marcos Kubrusly
INTRODUCTION: Metabolic acidosis is a common problem in dialysis patients and plays an important role in the pathogenesis of protein-energy malnutrition in these patients. OBJECTIVES: To assess the prevalence of metabolic acidosis in hemodialysis and search their association with nutritional status. METHODS: A cross-sectional study was performed in hemodialysis patients at a single center. Nutritional status was assessed by anthropometric, biochemical and multifrequency bioelectrical impedance analysis...
October 2015: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
S Luyasu, M M C Wamelink, L Galanti, A Dive
High anion gap metabolic acidosis due to pyroglutamic acid (5-oxoproline) is a rare complication of acetaminophen treatment (which depletes glutathione stores) and is often associated with clinically moderate to severe encephalopathy. Acquired 5-oxoprolinase deficiency (penicillins) or the presence of other risk factors of glutathione depletion such as malnutrition or sepsis seems to be necessary for symptoms development. We report the case of a 55-year-old women who developed a symptomatic overproduction of 5-oxoproline during flucloxacillin treatment for severe sepsis while receiving acetaminophen for fever control...
June 2014: Acta Clinica Belgica
Ho-Jung Kim, Sang-Woong Han
Metabolic acidosis has been considered as one of the reverse epidemiologic factors for the morbidity and mortality in maintenance hemodialysis patients (MHP). Expectedly, in the recent large scale epidemiologic study (The Dialysis Outcome Practice Pattern Study, DOPPS), a mild to moderate degree of predialysis metabolic acidosis has shown better nutritional status and lower relative risk for mortality and hospitalization in MHP. Similarly, another recent study of the largest sample size of MHP of more than 55,000 revealed the lowest unadjusted mortality with mild to moderate degree of predialysis HCO3 levels (17 to 23 mEq/L)...
June 2007: Electrolyte & Blood Pressure: E & BP
Zerrin Bicik, Abdurrahman Coskun, Mustafa Serteser, Atilla Bulur, Meral Mese, Ibrahim Unsal
BACKGROUND: Acidosis is associated with protein-energy malnutrition, inflammation, and bone disease, and low bicarbonate levels have been implicated in higher mortality rates in chronic kidney disease. Recently, the concentration of serum pregnancy-associated plasma protein-A (PAPP-A) has become accepted as a prognostic marker in hemodialysis patients. This study determined the relationship between PAPP-A and bicarbonate levels in these patients. METHODS: The study enrolled 65 hemodialysis patients (41 males, 24 females) and 26 control subjects (11 males, 15 females)...
March 2014: Journal of Clinical Laboratory Analysis
Rajnish Mehrotra
It is important to understand the unique aspects vis-à-vis protein-energy wasting for patients undergoing PD. As a result of obligatory protein losses with the therapy, the serum albumin levels of patients undergoing PD are lower, as is the threshold serum albumin at which the risk for death is increased. Consequently, it is prudent to consider a lower threshold for serum albumin for the diagnosis of protein-energy wasting for patients undergoing PD. Likewise, it is important to consider the energy intake from obligatory nutrient absorption in the form of carbohydrates when estimating total energy intake (diet and dialysate) when evaluating patients for protein-energy wasting...
May 2013: Journal of Renal Nutrition
T Alp Ikizler
Protein-energy wasting (PEW) is highly prevalent in patients undergoing maintenance hemodialysis (MHD). It is important to note that there is a robust association between the extent of PEW and the risk of hospitalization and death in these patients, regardless of the nutritional marker used. The multiple etiologies of PEW in advanced kidney disease are still being elucidated. Apart from the multiple mechanisms that might lead to PEW, it appears that the common pathway for all of the derangements is related to exaggerated protein degradation along with decreased protein synthesis...
March 2013: Advances in Chronic Kidney Disease
Takahiro Kuragano, Minoru Furuta, Mana Yahiro, Aritoshi Kida, Yoshinaga Otaki, Yukiko Hasuike, Akihide Matsumoto, Takeshi Nakanishi
BACKGROUND: Recently, acetate-free citrate containing dialysate (A(-)D) was developed. We have already reported about the significant effect of A(-)D on metabolic acidosis, anemia, and malnutrition in maintenance hemodialysis (MHD) patients. In this study, we compared the effect of A(-)D and acetate containing dialysate (A(+)D) on serum calcium and intact-parathyroid hormone (int-PTH) levels. METHOD: Single session study: Seventeen patients were treated with A(+)D in one session and also treated with A(-)D in another session...
2013: BMC Nephrology
Christian Verger
20-70% of peritoneal dialysis patients have some signs of malnutrition. Anorexia, protein and amino acid losses in dialysate, advanced age of elderly patients, inflammation and cardiac failure are among the main causes. Modern dialysis solutions aim to reduce these causes, but none of them is without side effects: glucose is relatively safe and brings additional energy but induces anorexia and lipid abnormalities, amino acids compensate dialysate losses but may increase uremia and acidosis, icodextrin helps control hyperhydration and chronic heart failure and minimizes glucose side effects, but may sometimes cause inflammation, and poly chamber bags allow the replacement of lactate by bicarbonate and are more biocompatible, decrease GDP, induce less inflammation and have a better effect on nutritional status...
2012: Contributions to Nephrology
Seung-Hyeok Han, Dae-Suk Han
Protein-energy wasting (PEW) is prevalent among patients on dialysis and has emerged as an important risk factor for morbidity and mortality in these patients. Numerous factors, including inflammation, inadequate dialysis, insufficient nutrient intake, loss of protein during dialysis, chronic acidosis, hypercatabolic illness and comorbid conditions, are involved in the development of PEW. The causes and clinical features of PEW in patients on peritoneal dialysis and hemodialysis are comparable; assessment of the factors that lead to PEW in patients receiving peritoneal dialysis is important to ensure that PEW is managed correctly in these patients...
February 7, 2012: Nature Reviews. Nephrology
Tayebeh Soleymanian, Ahad Ghods
One of the main causes of protein-energy malnutrition in patients on maintenance hemodialysis (MHD) is metabolic acidosis. The aim of this study was to evaluate the effect of metabolic acidosis on nutritional status in a group of MHD patients with adequately delivered dialysis treatment. Of 165 eligible anuric MHD outpatients with Kt/V ≥ 1 and no underlying inflammatory diseases, 47 subjects were enrolled. In order to evaluate the effect of different parameters on serum albumin, we measured the pre-dialysis serum albumin, blood pH, serum bicarbonate (HCO 3‾ ), Kt/V, normalized protein catabolic rate (nPCR) and body mass index (BMI) in these patients...
November 2011: Saudi Journal of Kidney Diseases and Transplantation
Takahiro Kuragano, Aritoshi Kida, Minoru Furuta, Mana Yahiro, Rie Kitamura, Yoshinaga Otaki, Hiroshi Nonoguchi, Akihide Matsumoto, Takeshi Nakanishi
Previously, dialysate contained small amounts of acetate as an alkaline buffer. Recently, acetate-free dialysate (A[-]D) has been available. We evaluated the clinical effect of A(-)D over acetate-containing dialysate (A(+)D) on acid-base balance, anemia, and nutritional status in maintenance hemodialysis (MHD) patients. Twenty-nine patients on MHD were treated with A(+)D for 4 months (first A(+)D), switched to A(-)D for 4 months, and returned to A(+)D for the next 4-month period (second A(+)D). Metabolic acidosis: Serum bicarbonate (HCO3(-) ) levels did not change in patients with normal HCO3(-) levels (≥20 mEq/L) throughout the study...
March 2012: Artificial Organs
F John Gennari
Adjustment of bath [HCO(3)(-)] to "normalize" predialysis serum [HCO(3)(-)] in patients receiving intermittent hemodialysis has been advocated to prevent the adverse effects of metabolic acidosis. However, when mortality risk has been evaluated in hemodialysis patients in relation to their nadir serum [HCO(3)(-)], an increase in risk is noted both with very low values (<18 mmol/l) and very high values (>27 mmol/l). If mortality risk is adjusted for comorbidity, age and effectiveness of dialysis, as well as for nutritional and inflammatory factors, very low predialysis values remain an independent risk factor, but the risk for high values virtually disappears...
May 2010: Seminars in Dialysis
Laurent Juillard, Fitsum Guebre-Egziabher, Denis Fouque
Nutritional guidelines are scarce for patients receiving maintenance hemodialysis. In this review, we address the recent European guidelines released in 2007. They include diagnosis and follow-up criteria for malnutrition to be performed routinely. They provide new values for protein and energy requirements, based on physical activity. Vitamins and trace elements requirements are proposed. The renutrition therapies are addressed, i.e., oral supplement, enteral and intradialytic parenteral nutrition. Finally, androgens, quotidian dialysis and acidosis treatment are also considered...
February 2010: Néphrologie & Thérapeutique
Vincenzo Savica, Domenico Santoro, Paolo Monardo, Agostino Mallamace, Guido Bellinghieri
Sevelamer carbonate is an anion exchange pharmaceutical, developed to improve on the performance of the non-absorbable, non-calcium, and metal-free phosphate binder sevelamer hydrochloride. Sevelamer carbonate is expected not to worsen metabolic acidosis, as previously reported during long-term treatment with sevelamer hydrochloride in hemodialysis (HD) patients. Carbonate is the alternate counterion to chloride on the sevelamer polymeric backbone, but the active poly(allylamine) responsible for phosphate (PO₄) binding remains unaltered...
August 2008: Therapeutics and Clinical Risk Management
Michel Fischbach, Céline Dheu, Laure Seuge, Nadia Orfanos
Malnutrition is a common state in chronic hemodialyzed children. More than malnutrition, which infers that dietary supplementation would be curative, cachexia, which implies loss of protein stores, are combined factors of impaired linear growth and reduced muscle mass in uremic patients. Adequate diet to prevent malnutrition is of major importance. But to avoid cachexia in children on chronic hemodialysis, the management of acidosis, inflammation, abnormal metabolic rate, and endocrine disturbances should not, be forgotten...
January 2009: Journal of Renal Nutrition
Yi-Wen Chiu, Joel D Kopple, Rajnish Mehrotra
Metabolic acidosis is an important cause of protein-energy wasting, commonly observed in chronic kidney disease (CKD). This wasting is, in part, a result of the imbalance between protein degradation and synthesis induced by metabolic acidosis. The increase in protein degradation seen with metabolic acidosis is largely secondary to increased activities of the adenosine triphosphate-dependent, ubiquitin-proteasome system and branched-chain ketoacid dehydrogenase. Studies consistently have shown increased protein degradation with lower serum bicarbonate levels and/or arterial pH; however, the evidence for the anti-anabolic effects of metabolic acidosis is less consistent...
January 2009: Seminars in Nephrology
G Triolo, S Savoldi
The incidence and prevalence of chronic renal failure (CKD), defined according to the NFK-KDOQI guidelines as a glomerular filtration rate less than 60 mL/min/1.73 m2 or the presence of microalbuminuria, is increasing worldwide, leading to an increased risk of cardiovascular disease. There is general agreement about the importance of early referral to the nephrologist and predialysis educational programs because this strategy prevents the progression (by the use of renin-angiotensin system blockers, low-protein diet) and complications (arterial hypertension, anemia, malnutrition, osteodystrophy, acidosis) of renal disease...
May 2008: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
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