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Chen ZQ, Luo L, Chen XX, Zhang XY, Yin SQ, Xiao GH, Xu N, Liu Q, Su CY. Dietary nutrient intake and nutritional status in maintenance hemodialysis patients: a multicenter cross-sectional survey. Ren Fail 2024; 46:2363589. [PMID: 38874093 PMCID: PMC11182067 DOI: 10.1080/0886022x.2024.2363589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To investigate the dietary nutrient intake of Maintenance hemodialysis (MHD) patients, identify influencing factors, and explore the correlation between dietary nutrient intake and nutritional and disease control indicators. METHODS This was a multicenter cross-sectional study. A dietary survey was conducted using a three-day dietary record method, and a self-designed diet management software was utilized to calculate the daily intake of dietary nutrients. The nutritional status and disease control indicators were assessed using subjective global assessment, handgrip strength, blood test indexes, and dialysis adequacy. RESULTS A total of 382 MHD patients were included in this study. Among them, 225 (58.9%) and 233 (61.0%) patients' protein and energy intake did not meet the recommendations outlined in the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Nutrition in Chronic Kidney Disease (2020 update). The average protein and energy intake for these patients were 0.99 ± 0.32 g/kg/d and 29.06 ± 7.79 kcal/kg/d, respectively. Multiple linear regression analysis showed that comorbidity-diabetes had a negative influence on normalized daily energy intake (nDEI = DEI / ideal body weight) (B = -2.880, p = 0.001) and normalized daily protein intake (nDPI = DPI / ideal body weight) (B = -0.109, p = 0.001). Pearson correlation analysis revealed that dietary DPI (r = -0.109, p < 0.05), DEI (r = -0.226, p < 0.05) and phosphorus (r = -0.195, p < 0.001) intake were statistically correlated to Kt/V; dietary nDPI (r = 0.101, p < 0.05) and sodium (r = -0.144, p < 0.001) intake were statistically correlated to serum urea nitrogen; dietary DPI (r = 0.200, p < 0.001), DEI (r = 0.241, p < 0.001), potassium (r = 0.129, p < 0.05), phosphorus (r = 0.199, p < 0.001), and fiber (r = 0.157, p < 0.001) intake were statistically correlated to serum creatinine; dietary phosphorus (r = 0.117, p < 0.05) and fiber (r = 0.142, p < 0.001) intake were statistically correlated to serum phosphorus; dietary nDPI (r = 0.125, p < 0.05), DPI (r = 0.135, p < 0.05), nDEI (r = 0.116, p < 0.05), DEI (r = 0.125, p < 0.05), potassium (r = 0.148, p < 0.001), and phosphorus (r = 0.156, p < 0.001) intake were statistically correlated to subjective global assessment scores; dietary nDPI (r = 0.215, p < 0.001), DPI (r = 0.341, p < 0.001), nDEI (r = 0.142, p < 0.05), DEI (r = 0.241, p < 0.001), potassium (r = 0.166, p < 0.05), phosphorus (r = 0.258, p < 0.001), and fiber (r = 0.252, p < 0.001) intake were statistically correlated to handgrip strength in males; dietary fiber (r = 0.190, p < 0.05) intake was statistically correlated to handgrip strength in females. CONCLUSIONS The dietary nutrient intake of MHD patients need improvement. Inadequate dietary nutrient intake among MHD patients could have a detrimental effect on their blood test indexes and overall nutritional status. It is crucial to address and optimize the dietary intake of nutrients in this patient population to enhance their health outcomes and well-being.
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Affiliation(s)
- Zhi-Qian Chen
- Nursing Department, Peking University Third Hospital, Beijing, China
| | - Li Luo
- Renal Department, Peking University International Hospital, Beijing, China
| | - Xin-Xin Chen
- Renal Department, Peking University Third Hospital, Beijing, China
| | - Xiao-Yu Zhang
- Renal Department, Peking University Third Hospital, Beijing, China
| | - Shu-Qing Yin
- Hemodialysis Center, Fengtai Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | | | - Na Xu
- Renal Department, Peking University Third Hospital Yanqing Hospital, Beijing, China
| | - Qun Liu
- Department of Nephrology, Fuxing Hospital, The Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Chun-Yan Su
- Renal Department, Peking University Third Hospital, Beijing, China
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Shaaker H, Davenport A. Assessment of Nutritional Intake in Patients With Kidney Failure Treated by Haemodialysis on Dialysis and Non-dialysis Days. J Ren Nutr 2024:S1051-2276(24)00163-8. [PMID: 38992516 DOI: 10.1053/j.jrn.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 05/24/2024] [Accepted: 07/05/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION/AIMS/OBJECTIVE Inadequate nutritional intake in haemodialysis (HD) patients increases the risk of muscle wasting, nutrient deficiencies, leading to an increased risk of additional morbidity and mortality. We aimed to assess nutritional intake on the dialysis day and nondialysis day (NDD) of patients established on HD. METHODS We employed a 2-day dietary record, one on the day of dialysis and one on the NDD, and then determined nutritional intake using the Nutritics software. Muscle strength was assessed by hand grip strength, and the body composition was determined using multifrequency bioelectrical impedance recorded postdialysis. RESULTS We recruited 51 established HD patients dialysing between May 2022 and July 2022, of mean age 60 ± 15 years, 52.9% male, and 51% diabetic. Only 25% achieved the calorie and protein intake recommended by Kidney Disease Outcomes Quality Initiative. Most patients had inadequate consumption of fiber (96%), calcium (86%), iron (80%), zinc (82%), selenium (92%), folate (82%), vitamin A (88%), and (100%) vitamin D. On the other hand, the great majority followed the restriction guidelines for potassium (96%), phosphorus (86%), and sodium (84%), respectively. However, consumption was greater for potassium (P = .007), phosphorus (P = .015), and zinc (P = .032) on NDDs versus dialysis days, but there was no difference in protein or calorie intake between days. CONCLUSION Our results suggest that many of our HD patients do not achieve the recommended nutritional targets. Patient compliance with restricting sodium, potassium, and phosphate limits protein and calorie intake. HD patients are at increased risk of sarcopenia, so failure to achieve dietary protein intake will further increase this risk.
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Affiliation(s)
- Haalah Shaaker
- Division of Medicine, University College London, London, United Kingdom; Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, University College London, London, United Kingdom
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Aygül RD, Mercanligil SM, Bardak Demir S. Evaluation of the relationship between dietary energy and protein intakes and anthropometric measurements in hemodialysis patients. Medicine (Baltimore) 2024; 103:e38307. [PMID: 38787990 PMCID: PMC11124671 DOI: 10.1097/md.0000000000038307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
This study evaluated the relationship between dietary energy, and protein (animal and plant based) intakes and anthropometric measurements in maintenance hemodialysis (MHD) patients. Individuals between the ages of 19 to 65 who received MHD treatment for more than 3 months from October 2021 to February 2022 in the state hospitals were included in the study. Body mass index (BMI) (kg/m2) was calculated for each patient, and anthropometric measurements including upper middle arm circumference, triceps skinfold thickness (TST) and hand grip strength (HGS) were carried out. 3-day food records and Subjective Global Assessment (SGA) were used to assess nutritional status of the patients. Of the 51 MHD patients included in the study, 33 (64.7%) were male and 18 (35.3%) were female. The mean age of the patients was 50.37 ± 11.55 years, and length of time on MHD was 39.49 ± 51.68 months. The mean energy intake of female and male MHD patients was 20.01 ± 6.94 and 17.26 ± 6.24 kcal/kg/d, respectively. The mean dietary protein intake of female and male MHD patients were 0.84 ± 0.35 and 0.78 ± 0.30 g/kg/d, respectively. Dry weight (P = .048), BMI (P = .020), TST (P = .013), and HGS (P = .026) of well-nourished and moderately malnourished female MHD patients according to SGA results were found to be lower than in male patients. While the majority of the patients receiving MHD treatment appeared to be well-nourished according to the SGA results, energy and protein intakes obtained from the food records were below the recommended daily dietary intake. These evaluations affected the anthropometric measurements including HGS, BMI, and TST. Therefore, there is a need for more comprehensive clinical studies in which anthropometric measurements, food consumption, biochemical findings and nutritional screening tools are used all together to evaluate nutritional status in MHD patients.
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Affiliation(s)
- Rojina Deniz Aygül
- Department of Nutrition and Dietetics, Cyprus International University, Faculty of Health Sciences, Nicosia, Cyprus
| | - Seyit Mehmet Mercanligil
- Department of Nutrition and Dietetics, Cyprus International University, Faculty of Health Sciences, Nicosia, Cyprus
| | - Simge Bardak Demir
- Department of Nephrology, Ankara Yildirim Beyazit University Yenimahalle Education and Research Hospital, Ankara, Turkey
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Quan Z, Li C, Zhao L, Cui D, Liu S, Yin Y, Tang Q, Zeng D, Song L, Fu X. Effect of banana intake on serum potassium level in patients undergoing maintenance hemodialysis: A randomized controlled trial. Int J Nurs Sci 2024; 11:197-204. [PMID: 38707694 PMCID: PMC11064587 DOI: 10.1016/j.ijnss.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/05/2024] [Accepted: 03/12/2024] [Indexed: 05/07/2024] Open
Abstract
Objective This study aimed to assess the effect of banana intake during hemodialysis on serum potassium levels in maintenance hemodialysis (MHD) patients. Methods This study was a single-center, randomized controlled clinical trial conducted from September 15 to December 15, 2021, at a tertiary hospital in southern China. A total of 126 MHD patients were randomly assigned to either the intervention group (n = 64) or the control group (n = 62). Patients in the intervention group consumed approximately 250 g of bananas during hemodialysis, while those in the control group did not consume any food during hemodialysis. Demographic information and hemodialysis-related parameters were collected through case information collection before hemodialysis. Laboratory indicators (such as complete blood count, biochemical indicators, inflammation markers, liver function, kidney function, etc.) were evaluated by collecting pre-hemodialysis blood samples from patients. Serum potassium and blood glucose levels were measured at 2 h and 4 h of hemodialysis, as well as before the next hemodialysis session, and hemodialysis-related complications were recorded. The blood potassium and blood glucose indicators during hemodialysis were compared using repeated measures analysis. Results A total of 122 MHD patients completed the study (61 in each group). The results showed that there was no significant interaction between group and time on serum potassium levels. However, serum potassium levels in the intervention group were higher than those in the control group at 2 h (3.9 ± 0.5 mmol/L vs. 3.6 ± 0.3 mmol/L, P < 0.01) and 4 h (3.5 ± 0.4 mmol/L vs. 3.3 ± 0.3 mmol/L, P < 0.01) of hemodialysis. There was no interaction between group and time on blood glucose levels. The incidence of arrhythmias (8.2% vs. 29.5%, P = 0.003) and hypokalemia (52.5% vs. 80.3%, P = 0.002) during hemodialysis was significantly lower in the intervention group compared to the control group. Conclusion Consuming approximately 250 g of bananas at the start of hemodialysis does not lead to hyperkalemia. It can effectively reduce the incidence of hypokalemia and arrhythmias, and prevent a rapid decline in serum potassium levels during hemodialysis.
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Affiliation(s)
- Zilin Quan
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Caixia Li
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Liyan Zhao
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dongmei Cui
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuangxin Liu
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yan Yin
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qi Tang
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Dehan Zeng
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Li Song
- The Department of Nephrology, The Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xia Fu
- The Department of Nursing, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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Evenepoel P, Jørgensen HS, Bover J, Davenport A, Bacchetta J, Haarhaus M, Hansen D, Gracia-Iguacel C, Ketteler M, McAlister L, White E, Mazzaferro S, Vervloet M, Shroff R. Recommended calcium intake in adults and children with chronic kidney disease-a European consensus statement. Nephrol Dial Transplant 2024; 39:341-366. [PMID: 37697718 DOI: 10.1093/ndt/gfad185] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Indexed: 09/13/2023] Open
Abstract
Mineral and bone disorders (MBD) are common in patients with chronic kidney disease (CKD), contributing to significant morbidity and mortality. For several decades, the first-line approach to controlling hyperparathyroidism in CKD was by exogenous calcium loading. Since the turn of the millennium, however, a growing awareness of vascular calcification risk has led to a paradigm shift in management and a move away from calcium-based phosphate binders. As a consequence, contemporary CKD patients may be at risk of a negative calcium balance, which, in turn, may compromise bone health, contributing to renal bone disease and increased fracture risk. A calcium intake below a certain threshold may be as problematic as a high intake, worsening the MBD syndrome of CKD, but is not addressed in current clinical practice guidelines. The CKD-MBD and European Renal Nutrition working groups of the European Renal Association (ERA), together with the CKD-MBD and Dialysis working groups of the European Society for Pediatric Nephrology (ESPN), developed key evidence points and clinical practice points on calcium management in children and adults with CKD across stages of disease. These were reviewed by a Delphi panel consisting of ERA and ESPN working groups members. The main clinical practice points include a suggested total calcium intake from diet and medications of 800-1000 mg/day and not exceeding 1500 mg/day to maintain a neutral calcium balance in adults with CKD. In children with CKD, total calcium intake should be kept within the age-appropriate normal range. These statements provide information and may assist in decision-making, but in the absence of high-level evidence must be carefully considered and adapted to individual patient needs.
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Affiliation(s)
- Pieter Evenepoel
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Department of Medicine, Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Hanne Skou Jørgensen
- Department of Microbiology, Immunology and Transplantation, Nephrology and Renal Transplantation Research Group, KU Leuven, Leuven, Belgium
- Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - Jordi Bover
- Department of Nephrology, University Hospital Germans Trias i Pujol, Barcelona, Catalonia, Spain
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute, Can Ruti Campus, Barcelona, Catalonia, Spain
| | - Andrew Davenport
- Department of Renal Medicine, Royal Free Hospital, University College London, London, UK
| | - Justine Bacchetta
- Pediatric Nephrology Rheumatology and Dermatology Unit, Reference Center for Rare Renal Diseases, ORKID and ERK-Net networks, Lyon University Hospital, Bron, France
- Lyon Est Medical School, INSERM1033 Research Unit, Claude Bernard Lyon 1 University, Lyon, France
| | - Mathias Haarhaus
- Division of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Diaverum Sweden, Malmö, Sweden
| | - Ditte Hansen
- Department of Nephrology, Copenhagen University Hospital-Herlev, Copenhagen
- Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - Carolina Gracia-Iguacel
- Department of Renal Medicine, IIS-Fundación Jiménez Díaz UAM University Hospital, Madrid, Spain
| | - Markus Ketteler
- Department of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Louise McAlister
- Dietetic Team, UCL Great Ormond Street Hospital for Children and University College London, London, UK
| | - Emily White
- Dietetic Team, Royal Free Hospital, University College London, London, UK
| | - Sandro Mazzaferro
- Department of Translation and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Marc Vervloet
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, The Netherlands
- Department of Nephrology, Amsterdam UMC, The Netherlands
| | - Rukshana Shroff
- Renal Unit, UCL Great Ormond Street Hospital for Children, London, UK
- Institute of Child Health, University College London, London, UK
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Fatani AMN, Suh JH, Auger J, Alabasi KM, Wang Y, Segal MS, Dahl WJ. Pea hull fiber supplementation does not modulate uremic metabolites in adults receiving hemodialysis: a randomized, double-blind, controlled trial. Front Nutr 2023; 10:1179295. [PMID: 37457968 PMCID: PMC10349378 DOI: 10.3389/fnut.2023.1179295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023] Open
Abstract
Background Fiber is a potential therapeutic to suppress microbiota-generated uremic molecules. This study aimed to determine if fiber supplementation decreased serum levels of uremic molecules through the modulation of gut microbiota in adults undergoing hemodialysis. Methods A randomized, double-blinded, controlled crossover study was conducted. Following a 1-week baseline, participants consumed muffins with added pea hull fiber (PHF) (15 g/d) and control muffins daily, each for 4 weeks, separated by a 4-week washout. Blood and stool samples were collected per period. Serum p-cresyl sulfate (PCS), indoxyl sulfate (IS), phenylacetylglutamine (PAG), and trimethylamine N-oxide (TMAO) were quantified by LC-MS/MS, and fecal microbiota profiled by 16S rRNA gene amplicon sequencing and specific taxa of interest by qPCR. QIIME 2 sample-classifier was used to discover unique microbiota profiles due to the consumption of PHF. Results Intake of PHF contributed an additional 9 g/d of dietary fiber to the subjects' diet due to compliance. No significant changes from baseline were observed in serum PCS, IS, PAG, or TMAO, or for the relative quantification of Akkermansia muciniphila, Faecalibacterium prausnitzii, Bifidobacterium, or Roseburia, taxa considered health-enhancing. Dietary protein intake and IS (r = -0.5, p = 0.05) and slow transit stool form and PCS (r = 0.7, p < 0.01) were significantly correlated at baseline. PHF and control periods were not differentiated; however, using machine learning, taxa most distinguishing the microbiota composition during the PHF periods compared to usual diet alone were enriched Gemmiger, Collinsella, and depleted Lactobacillus, Ruminococcus, Coprococcus, and Mogibacteriaceae. Conclusion PHF supplementation did not mitigate serum levels of targeted microbial-generated uremic molecules. Given the high cellulose content, which may be resistant to fermentation, PHF may not exert sufficient effects on microbiota composition to modulate its activity at the dose consumed.
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Affiliation(s)
- Asmaa M. N. Fatani
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL, United States
- Food and Nutrition Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Joon Hyuk Suh
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL, United States
| | - Jérémie Auger
- Rosell Institute for Microbiome and Probiotics, Lallemand Health Solutions, Montréal, QC, Canada
| | - Karima M. Alabasi
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL, United States
- Foods and Nutrition Department, School of Health Science and Wellness, Northwest Missouri State University, Maryville, MO, United States
| | - Yu Wang
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL, United States
| | - Mark S. Segal
- Department of Nephrology, Hypertension and Renal Transplantation, College of Medicine, University of Florida, Gainesville, FL, United States
- North Florida South Georgia VHS, Gainesville, FL, United States
| | - Wendy J. Dahl
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL, United States
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Muniz GAS, Ramos CI, Claudino G, Cuppari L. Development and Validation of a Food Frequency Questionnaire to Assess Potassium Intake of Patients on Hemodialysis. J Ren Nutr 2023; 33:386-392. [PMID: 36270482 DOI: 10.1053/j.jrn.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/02/2022] [Accepted: 10/09/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To develop and to validate a food frequency questionnaire (FFQ) to assess potassium intake of patients on hemodialysis. METHODS This is a cross-sectional study that included 41 patients in the FFQ development step and 53 patients in the FFQ validation step. In the FFQ development step, the patients completed a 3-day food record (used as a reference method). Total potassium intake and potassium from each food item were calculated. Food items that contributed up to 90% of the total potassium intake were considered to be included in the FFQ food list. Then the FFQ was applied in person through the google-forms platform. The result of potassium intake obtained by the FFQ was compared with that obtained by the 3-day food record. RESULTS A total of 94 patients were included: 53.2% women; age 55.7 ± 15.0 years; 47.9% had diabetes; body mass index 25.0 ± 4.5 kg/m2; and dialysis vintage 34.5 (17.0-68.2) months. Demographic, clinical, and laboratory parameters did not differ between the development and validation groups. From the 255 registered food items, 85 comprised the FFQ. The standardized Cronbach's alpha obtained was 0.71. No difference was found between the potassium intake obtained by the FFQ and by the 3-day food record (1,438.5 ± 659.4 mg/d vs. 1,464.8 ± 529.4 mg/d; P = .753, respectively) with an intraclass correlation coefficient of 0.66 (P = .001). No systematic bias or proportionality bias between the methods was observed in the Bland-Altman graphical analysis. CONCLUSION The quantitative FFQ presented strong relative validity and may constitute a practical tool in the analysis of potassium intake of patients on hemodialysis.
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Affiliation(s)
| | | | | | - Lilian Cuppari
- Division of Nephrology, Universidade Federal de São Paulo, Brazil; Nutrition Program, Universidade Federal de São Paulo, Brazil.
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Ju SH, Lee EJ, Sim BC, Nga HT, Lee HY, Tian J, Cho KJ, Park H, Choi DE, Ham YR, Yi HS. Leucine-enriched amino acid supplementation and exercise to prevent sarcopenia in patients on hemodialysis: a single-arm pilot study. Front Nutr 2023; 10:1069651. [PMID: 37187878 PMCID: PMC10176607 DOI: 10.3389/fnut.2023.1069651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
Background Sarcopenia, which is strongly associated with mortality and quality of life, occurs in up to 40% of hemodialysis patients. Here, we investigated the preventive effects of leucine-enriched amino acid supplementation and resistance exercise in non-sarcopenic hemodialysis patients, and characterized the biochemical and immunophenotypic profiles of those who benefited from the intervention. Methods Twenty-two patients on maintenance hemodialysis at our hospital were enrolled in this single center, prospective, single-arm pilot trial. For the first 12 weeks, the subjects were administered a total of 6 g of leucine per day. Three grams were supplied via capsules, and the remaining three grams were provided via beverages containing macro- and micro- nutrients, such as 10 μg of vitamin D and 290 mg of calcium. The supplements were not provided for the next 12 weeks. Muscle mass, grip strength, and physical performance were measured using the bioimpedance analyzer (BIA), handgrip strength (HGS), and short physical performance battery (SPPB) protocols, respectively, at baseline, 12 weeks, and 24 weeks. In addition, serum biochemistry, immunophenotype of peripheral blood mononuclear cells, and nutritional status was assessed at the three time points. Those who showed 5% or more improvement in parameters were defined as responders, otherwise, as non-responders (ClinicalTrials.gov identification number: NCT04927208). Results Twenty-one out of twenty-two patients (95.4%) showed improvement in at least one or more parameters among muscle mass, grip strength, and physical performance. After 12 weeks of intervention, skeletal muscle index was increased in 14 patients (63.6%), and grip strength was improved in 7 patients (31.8%). Baseline grip strength lower than 35.0 kg was the strongest predictor of improvement in grip strength (AUC 0.933 from ROC curve). Grip strength showed a significant increase in females than males (7.6 ± 8.2 vs. -1.6 ± 7.2%, p = 0.03), in age over 60 than under 60 (5.3 ± 6.2 vs. -1.4 ± 9.1%, p = 0.04), and in higher (≥95%) than lower (<95%) exercise compliance (6.8 ± 7.7 vs. -3.2 ± 6.4%, p = 0.004). In SPPB study, gait speed and sit-to-stand time was improved in 13 patients (59.1%) and 14 patients (63.6%), respectively. Baseline hemoglobin lower than 10.5 g/dl and hematocrit lower than 30.8% were predictor of improvement in the sit-to-stand time (AUC 0.862 and 0.848, respectively). Serum biochemistry results showed that, compared to non-responders, responders in muscle mass had lower baseline monocyte fraction (8.4 ± 1.9 vs. 6.9 ± 1.1%, p = 0.03), and responders in grip strength had lower baseline total protein (6.7 ± 0.4 vs. 6.4 ± 0.3 g/dL, p = 0.04). Immunophenotypic analysis found that the intervention tended to increase the naïve/memory CD8+ T cell ratio (from 1.2 ± 0.8 to 1.4 ± 1.1, p = 0.07). Conclusion Leucine-enriched amino acid supplementation and resistance exercise induced significant improvement in muscle mass, strength, and physical function in subpopulation of the non-sarcopenic hemodialysis patients. Those who benefited from the intervention were old-age females with lower baseline grip strength or lower hemoglobin or hematocrit, and who have good exercise compliance. Therefore, we propose that the intervention will help to prevent sarcopenia in selected patients on maintenance hemodialysis.
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Affiliation(s)
- Sang-Hyeon Ju
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Eu Jin Lee
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Byeong Chang Sim
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ha Thi Nga
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Ho Yeop Lee
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jingwen Tian
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Kyu Jeong Cho
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Hyoungsu Park
- R&D Group, Maeil Health Nutrition Co., Ltd., Pyeongtaek, Republic of Korea
| | - Dae Eun Choi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Young Rok Ham
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Young Rok Ham,
| | - Hyon-Seung Yi
- Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Laboratory of Endocrinology and Immune System, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- Department of Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
- *Correspondence: Hyon-Seung Yi,
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Adherence to Caloric and Protein Recommendations in Older Hemodialysis Patients: A Multicenter Study. Nutrients 2022; 14:nu14194160. [PMID: 36235812 PMCID: PMC9572412 DOI: 10.3390/nu14194160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Hemodialysis (HD) patients are characterized by malnutrition, which adversely affects their survival. The development of malnutrition is influenced, among other factors, by improper diet and the advanced age of patients. The study aimed to assess the nutritional status and adherence to dietary recommendations among older patients. The multicenter study included 179 stable HD patients. The nutritional status was assessed by a 7-point Subjective Global Assessment (SGA). Anthropometry and body composition was analyzed. The diet was assessed based on the 3-day food diary and the Food Frequency Questionnaire with 6 answers (FFQ-6). Blood laboratory tests were performed. Based on the 7-point SGA, malnutrition was diagnosed in 38.5% of HD patients. The decreased content of the muscle tissue (LTI < 14 kg/m2) was observed in 70.4% of the examined patients and the decreased concentration of s-albumin was observed in 44.1% of patients. Older patients had significantly lower LTI. 26% of patients consumed less than 25 kcal/kg body weight and less than 0.8 g protein/kg body weight. Older patients’ diets contained significantly fewer calories. There were significant differences between nutrient intake on a weekday with dialysis, a weekday without dialysis, and a weekend day without dialysis. The lowest intake of nutrients was observed on the day of dialysis. Nutritional education and the determination of whether food is permitted during hemodialysis are necessary to improve patients’ nutrition.
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Kolak E, Radić J, Vučković M, Bučan Nenadić D, Begović M, Radić M. Nutritional and Hydration Status and Adherence to Dietary Recommendations in Dalmatian Dialysis Patients. Nutrients 2022; 14:nu14173553. [PMID: 36079811 PMCID: PMC9460881 DOI: 10.3390/nu14173553] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Protein-energy wasting (PEW) is considered one of the major complications of chronic kidney disease (CKD), particularly in dialysis patients. Insufficient energy and protein intake, together with clinical complications, may contribute to the onset and severity of PEW. Therefore, the aim of the study was to analyze the differences in nutritional and hydration status and dietary intake among Dalmatian dialysis patients. Fifty-five hemodialysis (HD) and twenty peritoneal dialysis (PD) participants were included. For each study participant, data about body composition, anthropometric, laboratory, and clinical parameters were obtained. The Malnutrition Inflammation Score (MIS) and two separate 24-h dietary recalls were used to assess nutritional status and dietary intake. The Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) were calculated to compare actual dietary intake with recommended intake. Additionally, the estimated 10-year survival was calculated using the Charlson Comorbidity Index. The prevalence of malnutrition according to MIS was 47.3% in HD and 45% in PD participants. Significant differences in fat tissue parameters were found between HD and PD participants, whereas significant differences in hydration status and muscle mass parameters were not found. A significant difference in NAR between HD and PD participants was noticed for potassium and phosphorus intake, but not for MAR. MIS correlated negatively with anthropometric parameters, fat mass, visceral fat level and trunk fat mass, and iron and uric acid in HD participants, whereas no significant correlations were found in PD participants. The estimated 10-year survival correlated with several parameters of nutritional status in HD and PD participants, as well as nutrient intake in HD participants. These results indicate a high prevalence of malnutrition and inadequate dietary intake in the Dalmatian dialysis population which, furthermore, highlights the urgent need for individualized and structural nutritional support.
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Affiliation(s)
- Ela Kolak
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Josipa Radić
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Correspondence:
| | - Marijana Vučković
- Department of Nephrology and Dialysis, University Hospital Centre Split, 21000 Split, Croatia
| | - Dora Bučan Nenadić
- Department of Nutrition and Dietetics, University Hospital Centre Split, 21000 Split, Croatia
| | - Mirna Begović
- Student of School of Medicine, University of Split, 21000 Split, Croatia
| | - Mislav Radić
- Department of Internal Medicine, School of Medicine, University of Split, 21000 Split, Croatia
- Department of Clinical Immunology and Rheumatology, University Hospital Centre Split, 21000 Split, Croatia
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11
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Vijay VR, Kang HK. The worldwide prevalence of non-adherence to diet and fluid restrictions among hemodialysis patients: A systematic review and meta-analysis. J Ren Nutr 2021; 32:658-669. [PMID: 34923113 DOI: 10.1053/j.jrn.2021.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-adherence to diet and fluid restrictions in hemodialysis (HD) patients can lead to undesired health outcomes. This systematic review and meta-analysis aim to estimate the pooled prevalence of non-adherence to diet and fluid restrictions in HD patients. METHODS Research papers from PubMed, CINAHL, and Google Scholar on non-adherence to diet and fluid restrictions in HD patients published between 2000 and 2020 were selected for this study. The methodological quality of each study was graded, and the estimates were pooled using the random-effects model of meta-analysis. Analyses of subgroups and meta-regression were carried out. Egger's test and visual analysis of the symmetry of funnel plots were used to assess the publication bias. RESULTS Eight hundred sixty-eight potential records were identified during the search. Twenty-three studies that met inclusion criteria were considered for meta-analysis and comprised 11,209 HD patients (mean age 55.85 years± SD 6.86, males 57.74%). The estimated worldwide prevalence of non-adherence to diet and fluid restrictions was 60.2% (95% CI: 47.3- 72.5) and 60.6% (95% CI: 50- 70.7), respectively. The meta-regression found that the income category was negatively, and the risk of bias score was positively associated with the prevalence of non-adherence to fluid restrictions (p<0.05). The funnel plot of studies included pooling the prevalence of non-adherence to fluid restrictions revealed asymmetry, and a significant publication bias was also noted as assessed by Egger's test (P = 0.004). However, the pooled estimate should be interpreted with caution because the prevalence of individual studies varies considerably due to methodological or measurement discrepancies. CONCLUSION The pooled prevalence of non-adherence to diet (47.3 - 72.5%) and fluid (50 - 70.7%) restrictions were substantially high. The health care team must recognize the factors and barriers influencing adherence behavior and develop holistic interventions to improve it.
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Affiliation(s)
- V R Vijay
- Tutor, College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, India.
| | - Harmeet Kaur Kang
- Professor cum Principal, Chitkara School Of Health Sciences,Chitkara University, Punjab, India
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