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Liu PJ, Guo J, Zhang Y, Wang F, Yu K. Effects of oral nutritional supplements on the nutritional status and inflammatory markers in patients on maintenance dialysis: a systematic review and meta-analysis of randomized clinical trials. Clin Kidney J 2023; 16:2271-2288. [PMID: 37915917 PMCID: PMC10616451 DOI: 10.1093/ckj/sfad130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Indexed: 11/03/2023] Open
Abstract
Background and aims Patients on hemodialysis (HD) or peritoneal dialysis (PD) often have insufficient energy and protein intake, resulting in poor nutritional status and adverse outcomes. Oral nutritional supplements (ONSs) are the most commonly used to increase such patients' energy and protein intakes. Methods In this systematic review and meta-analysis, we analyzed studies on nutritional status, inflammatory markers, and electrolyte levels in patients on dialysis receiving ONSs. We searched four electronic databases from inception until 31 December 2022, for randomized controlled trials comparing ONS treatment versus placebo or routine care. Results 22 studies with 1185 patients on dialysis were included in our meta-analysis. Compared with the control group, the ONS group exhibited significantly increased serum albumin levels [1.26 g/l (95%CI, 0.50-2.02, P < 0.0001; I2 = 80.4%)], body mass indexes (BMIs) [0.30 kg/m2 (95%CI, 0.09-0.52, P = 0.005; I2 = 41.4%)], and handgrip strength (HGS) [0.96 kg (95%CI, 0.07-1.84, P = 0.034; I2 = 41.4%)] from baseline to the end of intervention. No significant differences were observed between the groups in lean body mass, phase angle, C-reactive protein, and serum phosphorus and potassium levels. In terms of improving albumin, the subgroup analyses show that ONS use seems to be more inclined to three variations: HD patients, short-term use, and non-intradialytic supplementation. Conclusion In conclusion, ONS use can improve the nutritional status of patients on dialysis in terms of their serum albumin, BMI, and HGS without significant effects on serum phosphorus, potassium, and C-reactive protein levels. However, it remains uncertain whether these results translate to improvement in clinically relevant outcomes. Large-scale high-quality studies are still required in this population.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China
| | - Jiayu Guo
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China
| | - Yu Zhang
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China
| | - Fang Wang
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China
| | - Kang Yu
- Department of Clinical Nutrition, Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, PR China
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Abstract
The prevalence of obesity in peritoneal dialysis (PD) populations has risen dramatically since the mid-1980s. This epidemic has been driven by the increased prevalence of obesity in the general population, the increased risk of progression of chronic kidney disease to end-stage renal failure (ESRF) in obese subjects, the reduced probability of listing obese dialysis patients for renal transplantation, a paradoxical enhanced survival in at least some obese populations on dialysis as compared with non-obese ESRF patients, and a possible adipogenic effect of excessive peritoneal glucose absorption in PD. Although obesity has consistently been associated with improved outcomes in hemodialysis, conflicting results have been seen in PD. In general, an elevated body mass index (BMI) has been associated with a neutral or deleterious impact on PD outcomes, and the relationship appears to be explained predominantly by fat mass. Risk is also elevated in patients with a low BMI, such that the “optimal BMI” appears to lie between 20 kg/m2 and 25 kg/m2. The mechanisms underpinning the harmful effect of obesity appear to include increased peritonitis rate, proinflammatory effects, and a more rapid decline of residual renal function in obese patients. No proof exists that weight reduction engenders an improvement in outcome in PD patients, but the available studies suggest that cautious weight reduction is advisable. A few studies have demonstrated that clinically important and sustained weight reduction can be successfully achieved through a combination of individual meal plans, regular exercise, and substitution of icodextrin for dextrose in the once-daily long dwell.
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Affiliation(s)
- David W. Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Rahimlu M, Shab-Bidar S, Djafarian K. Body Mass Index and All-cause Mortality in Chronic Kidney Disease: A Dose-response Meta-analysis of Observational Studies. J Ren Nutr 2018. [PMID: 28625526 DOI: 10.1053/j.jrn.2017.01.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This article provides a dose-response meta-analysis to evaluate the relationship between body mass index (BMI) and all-cause and disease-specific mortality in chronic kidney disease (CKD) by pooling together early stage, hemodialysis, and peritoneal dialysis patients. We evaluated eligible studies that published between 1966 and December 2014 by searching in PubMed, Object View and Interaction Design (OVID), and the Scopus databases. We used random-effects generalized least squares spline models for trend estimation to derive pooled dose-response estimates. Nonlinear associations of BMI with all-cause mortality were observed (P-nonlinearity < .0001), with an increased rate of mortality with BMIs > 30 kg/m2 in all stages of CKD together. However, reanalysis of data separately by stage of CKD (hemodialysis and peritoneal dialysis) showed that the risk of all-cause mortality decreased with a steep slope in individuals with BMIs > 30 kg/m2. This meta-analysis indicates that higher BMI has protective effects with respect to all-cause mortality in patients with both type of dialysis.
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Affiliation(s)
- Mehran Rahimlu
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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Ladhani M, Craig JC, Irving M, Clayton PA, Wong G. Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis. Nephrol Dial Transplant 2017; 32:439-449. [PMID: 27190330 DOI: 10.1093/ndt/gfw075] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/12/2016] [Indexed: 01/18/2023] Open
Abstract
Background Obesity is a risk factor for cardiovascular disease and death in people without chronic kidney disease (CKD), but the effect of obesity in people with CKD is uncertain. Methods Medline and Embase (from inception to January 2015) were searched for cohort studies measuring obesity by body mass index (BMI), waist:hip ratio (WHR) and/or waist circumference (WC) and all-cause and cardiovascular mortality or events in patients with any stage of CKD. Data were summarized using random effects models. Meta-regression was conducted to assess sources of heterogeneity. Results Of 4065 potentially eligible citations, 165 studies ( n = 1 534 845 participants) were analyzed. In studies that found a nonlinear relationship, underweight people with CKD (3-5) on hemodialysis experienced an increased risk of death compared with those with normal weight. In transplant recipients, excess risk was observed at levels of morbid obesity (>35 kg/m 2 ). Of studies that found the relationship to be linear, a 1 kg/m 2 increase in BMI was associated with a 3 and 4% reduction in all-cause and cardiovascular mortality in patients on hemodialysis, respectively {adjusted hazard ratio [HR] 0.97 [95% confidence interval (CI) 0.96-0.98] and adjusted HR 0.96 (95% CI 0.92-1.00)}. In CKD Stages 3-5, for every 1 kg/m 2 increase in BMI there was a 1% reduction in all-cause mortality [HR 0.99 (95% CI 0.0.97-1.00)]. There was no apparent association between obesity and mortality in transplanted patients or those on peritoneal dialysis. Sparse data for WHR and WC did not allow further analyses. Conclusions Being obese may be protective for all-cause mortality in the predialysis and hemodialysis populations, while being underweight suggests increased risk, but not in transplant recipients.
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Affiliation(s)
- Maleeka Ladhani
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michelle Irving
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Philip A Clayton
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia.,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Renal and Transplant Research, Westmead Hospital, Westmead, NSW, Australia
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Borow KM, Mason RP, Vijayaraghavan K. Eicosapentaenoic Acid as a Potential Therapeutic Approach to Reduce Cardiovascular Risk in Patients with End-Stage Renal Disease on Hemodialysis: A Review. Cardiorenal Med 2017; 8:18-30. [PMID: 29344023 DOI: 10.1159/000479391] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Patients with end-stage renal disease on hemodialysis have excess cardiovascular disease (CVD) burden with substantially increased CV event rates compared with the general population. Summary Traditional interventions that, according to standard clinical guidelines, reduce CV risk such as antihypertensive therapy, diet, exercise, and statins are not similarly effective in the hemodialysis population. This raises the question of whether additional risk factors, such as enhanced inflammation and oxidative stress, may drive the increased CVD burden in hemodialysis patients. Eicosapentaenoic acid (EPA), an omega-3 polyunsaturated fatty acid, is incorporated into the atherosclerotic plaque as well as membrane phospholipid bilayers and produces beneficial effects on inflammatory and oxidative mechanisms involved in atherosclerotic plaque formation and progression. EPA levels and the ratio of EPA to the omega-6 polyunsaturated fatty acid arachidonic acid (AA) are reduced in hemodialysis patients. Serum EPA levels have been inversely correlated with proinflammatory cytokines, and the EPA/AA ratio has been inversely associated with CV events in hemodialysis cohorts. Three recent studies involving over 800 hemodialysis patients and follow-up of 2-3 years suggest that EPA therapy may improve clinical outcomes in this patient population as evidenced by significant reductions in cardiovascular mortality, all-cause mortality, and/or CV events. Key Messages Further studies with high-purity EPA are warranted in patients on hemodialysis, especially given the fact that other interventions including antihypertensives, diet, exercise, and statins have not provided meaningful benefit.
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Affiliation(s)
- Kenneth M Borow
- MediMergent, LLC and The National Medication Safety, Outcomes and Adherence Program, Bryn Mawr, Pennsylvania, USA
| | - R Preston Mason
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Elucida Research LLC, Beverly, Massachusetts, USA
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Mohebi R, Simforoosh A, Tohidi M, Azizi F, Hadaegh F. Obesity Paradox and Risk of Mortality Events in Chronic Kidney Disease Patients: A Decade of Follow-up in Tehran Lipid and Glucose Study. J Ren Nutr 2015; 25:345-50. [DOI: 10.1053/j.jrn.2014.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/28/2014] [Accepted: 12/15/2014] [Indexed: 12/30/2022] Open
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Feingold E, Adams J, Penprase B, Tubie B. Effect of body mass index and albumin on mortality rates for adult African-American hemodialysis patients. J Am Assoc Nurse Pract 2015; 27:637-45. [PMID: 25761048 DOI: 10.1002/2327-6924.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 11/16/2014] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this retrospective descriptive study was to investigate if body mass index (BMI) and serum albumin (SA) impacted mortality rates in adult African-American patients on hemodialysis (HD). DATA SOURCES Records of 204 patients on HD (N = 204) from a clinic in the metropolitan Detroit area were examined for the period January 1, 2007-December 31, 2012 to determine the relationship of BMI and SA on mortality rates in this population. Logistics regression was utilized to analyze the association of several risk factors (BMI and SA) on survival (mortality rates). CONCLUSION Research findings from this study demonstrated that both undernourishment (being underweight; BMI < 23 kg/m(2) ) and hypoalbuminemia (<3.2g/dL) were strong predictors of death in patients on HD. However, obesity provided a survival advantage for adult African-American patients on HD (p = .030). Patients with higher SA levels also survived longer (p < .001). IMPLICATIONS FOR PRACTICE Advanced practice nurses (APNs) working with adult African-American patients on HD could work on developing targeted nutritional interventions to maintain higher SAs and BMIs while awaiting the results of further research in this area.
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Affiliation(s)
- Edna Feingold
- School of Nursing, Oakland University, Rochester, Michigan
| | - Judy Adams
- School of Nursing, Oakland University, Rochester, Michigan
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8
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Body mass index and mortality in patients on maintenance hemodialysis: a meta-analysis. Int Urol Nephrol 2014; 46:623-31. [PMID: 24504687 DOI: 10.1007/s11255-014-0653-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 01/24/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE In patients undergoing maintenance hemodialysis (MHD), increasing numbers of studies have reported a reduced mortality in patients with an increased body mass index (BMI). This article provides a meta-analysis on the assessment of the relationship between BMI and mortality in MHD patients. METHODS A systemic literature review was conducted to identify studies that examined all-cause mortality, with or without cardiovascular events, on the basis of bodyweight or obesity measures in MHD population published before October 2012. RESULTS Eight observational studies with a total of 190,163 patients were included. Compared to the individuals with a normal BMI, overweight patients and obese patients were associated with lower all-cause mortality [relative risk (RR) 0.86, 95% confidence interval (CI) 0.84-0.88; RR 0.77, 95% CI 0.75-0.78, respectively] and cardiovascular mortality (RR 0.86; 95% CI 0.81-0.91; RR 0.78, 95% CI 0.73-0.83, respectively). Underweight patients had relatively higher all-cause and cardiovascular mortality (RR 1.22, 95% CI 1.20-1.25; RR 1.19, 95% CI 1.11-1.28, respectively). In an obesity-stratified analysis, the patients with moderate or severe obesity presented a strongly decreased all-cause mortality risk (RR 0.64, 95% CI 0.61-0.68) and cardiovascular mortality risk (RR 0.63, 95% CI 0.53-0.75) compared to patients with mild obesity (RR 0.74, 95% CI 0.71-0.77; RR 0.81, 95% CI 0.75-0.87, respectively). CONCLUSIONS These findings show that overweight and obese patients have lower all-cause and cardiovascular mortality rates in patients undergoing MHD. Body weight management and optimized nutritional and metabolic support should help to reduce the high mortality rates that are prevalent in the hemodialysis population.
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Orci LA, Majno PE, Berney T, Morel P, Mentha G, Toso C. The impact of wait list body mass index changes on the outcome after liver transplantation. Transpl Int 2012. [PMID: 23199077 DOI: 10.1111/tri.12017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is associated with poor health outcomes in the general population, but the evidence surrounding the effect of body mass index (BMI) on postliver transplantation survival is contradictory. The aim of this study was to assess the impact of wait list BMI and BMI changes on the outcomes after liver transplantation. Using the Scientific Registry of Transplant Recipients, we compared survival among different BMI categories and examined the impact of wait list BMI changes on post-transplantation mortality for patients undergoing liver transplantation. Cox proportional hazards multivariate regression was carried out to adjust for confounding factors. Among 38 194 recipients, underweight patients had a poorer survival compared with normal weight (HR = 1.3, 95% CI: 1.13-1.49). Conversely, overweight and mildly obese men experienced better survival rates compared with their lean counterparts (HR = 0.9, 95% CI: 0.84-0.96, and HR = 0.86, 95% CI: 0.79-0.93 respectively). Female patients gaining weight over 18.5 kg/m(2) while on the wait list showed improving outcomes (HR = 0.46, (95% CI: 0.28-0.76)) compared with those remaining underweight. This study supports the harmful impact of underweight on postliver transplant survival, and highlights the need for a specific monitoring and management of candidates with BMIs close to 18.5 kg/m(2) . Obesity does not constitute an absolute contraindication to liver transplantation.
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Affiliation(s)
- Lorenzo A Orci
- Divisions of visceral and transplantation surgery, Department of surgery, Geneva University Hospitals, Geneva, Switzerland.
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10
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Jalalzadeh M, Nazarian M, Vafaeimanesh J, Mirzamohammadi F. Comparison of azithromycin and clarithromycin triple therapy regimens for helicobacter pylori eradication in hemodialysis patients. Nephrourol Mon 2012; 4:571-7. [PMID: 23573488 PMCID: PMC3614284 DOI: 10.5812/numonthly.2794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/17/2011] [Accepted: 11/27/2011] [Indexed: 02/06/2023] Open
Abstract
Background Helicobacter pylori eradication with clarithromycin is more expensive than with azithromycin. Objectives This study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients. Patients and Methods This is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Urease Breath Test (UBT), were included in the study. The subjects consisted of 39 dialysis patients who were randomly divided into two groups that received medication twice daily. Group OAC received 20 mg omeprazol, 500 mg amoxycilin, and 250 mg clarithromycin, and Group OAAz received 20 mg omeprazol, 500 mg amoxicillin, and 250 mg azithromycin. Both regimens were administered for 14 days. Eradication was investigated by performing the UBT and the HpSAg test eight weeks later. Results This study began with 39 patients, 37 of which completed the treatment schedule (20 males and 17 females, mean age 59 years). Two patients died due to MI before beginning treatment. In the OAC group, negative results on the UBT and HpSAg tests were found in 82.4% and 88.2% of the participants, respectively. In the OAAz group, these values were 80% and 85%, respectively. The data showed that the difference between the two regimens was not significant (P = 1.0). Conclusions According to the data, no differences in eradication rates were apparent between the azitromycin and the claritromycin regimens. However, lower cost and fewer complaints could be considered as an advantage of the triple therapy with azithromycin.
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Affiliation(s)
- Mojgan Jalalzadeh
- Departments of Nephrology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Morteza Nazarian
- Departments of Gastroetrology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Jamshid Vafaeimanesh
- Departments of Internal Medicine, Qom University of Medical Sciences, Qom, IR Iran
- Corresponding author: Jamshid Vafaeimanesh, Departments of Internal Medicine, Qom University of Medical Sciences, Qom, IR Iran. Tel.: +989122248306, Fax: +9824122782476, E-mail:
| | - Fatemeh Mirzamohammadi
- Student Research Committee, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran
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11
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Sanlier N, Demircioğlu Y. Correlation of Dietary Intakes and Biochemical Determinates of Nutrition in Hemodialysis Patients. Ren Fail 2009; 29:213-8. [PMID: 17365938 DOI: 10.1080/08860220601098904] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the effect of dietary intakes on nutritional indicators of patients on hemodialysis. METHOD This study was carried out at the hemodialysis unit at the Ministry of Health, Ankara Hospital, from 2003-2004. Sixty-seven patients on regular hemodialysis were enrolled in the study. Nutritional status was assessed by biochemical parameters (urea, uric acid, creatinine, Na, K, Cl, Ca, P, alkaline phosphatase, SGOT, SGPT, cholesterol, total protein, albumin, hemoglobin, hematocrit) and anthropometric measurements (height, dry weight, body mass index), and dietary intakes were calculated. RESULTS In this study, the mean age of the patients was 45.3 +/- 13.49, and the duration of hemodialysis was 4.9 +/- 3.64 year. Dialysis time was 12.4 +/- 2.7 h/week. The ratio of individuals with BMI of 20 kg/m2 or below this value was 19.4%. Blood hemoglobin and hematocrit levels were below than the recommended level. Mean serum urea (148.0 +/- 27.76 mg/dL) and creatinine (8.8 +/- 2.13 mg/dL) were found to be high, while a significant negative correlation was found between blood urea level and dietary fat (p < 0.01, r = -0.31). A significant positive correlation was found between vitamin B1, vitamin B6, folate, potassium, iron, and magnesium; between uric acid and vitamin D; between blood creatinine level and dietary vitamin B1, vitamin B6, folate, vitamin C, potassium, iron, magnesium; between blood potassium level and dietary vitamin C only; and between blood cholesterol level and dietary vitamin D only (p < 0.01).
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Affiliation(s)
- Nevin Sanlier
- Department of Food and Nutrition Education in Gazi University, Ankara, Turkey.
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12
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Schold JD, Srinivas TR, Guerra G, Reed AI, Johnson RJ, Weiner ID, Oberbauer R, Harman JS, Hemming AW, Meier-Kriesche HU. A "weight-listing" paradox for candidates of renal transplantation? Am J Transplant 2007; 7:550-9. [PMID: 17173655 DOI: 10.1111/j.1600-6143.2006.01629.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Research suggests that end-stage renal disease patients with elevated body mass index (BMI) have superior outcomes on dialysis. In contrast, low and high BMI patients represent the highest risk cohorts for kidney transplant recipients. The important question remains concerning how to manage transplant candidates given the potentially incommensurate impact of BMI by treatment modality. We conducted a retrospective analysis of waitlisted and transplanted patients in the United States from 1990 to 2003. We constructed Cox models to evaluate the effect of BMI on mortality of waitlisted candidates and identified risk factors for rapid weight change. We then assessed the impact of weight change during waitlisting on transplant outcomes. Decline in BMI on the waiting list was not protective for posttransplant mortality or graft loss across BMI strata. Substantial weight loss pretransplantation was associated with rapid gain posttransplantation. The highest risk for death was among listed patients with low BMI (13-20 kg/m(2), adjusted hazard ratio = 1.47, p < 0.01). Approximately one-third of candidates had a change in BMI category prior to transplantation. While observed declines in BMI may be volitional or markers of disease processes, there is no evidence that candidates have improved transplant outcomes attributable to weight loss. Prospective trials are needed to evaluate the efficacy of weight loss protocols for candidates of kidney transplantation.
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Affiliation(s)
- J D Schold
- Department of Medicine, University of Florida, Gainesville, Florida, USA.
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13
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Srivastava T. Nondiabetic consequences of obesity on kidney. Pediatr Nephrol 2006; 21:463-70. [PMID: 16491417 DOI: 10.1007/s00467-006-0027-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2005] [Revised: 12/14/2005] [Accepted: 12/20/2005] [Indexed: 12/11/2022]
Abstract
There has been a major increase in obesity among children over the past twenty years. Obesity is associated with glomerular hyperperfusion and hyperfiltration from physiological (mal)adaptation resulting from afferent arteriolar vasodilatation. The renal injury from hyperfiltration in obesity is further exacerbated by concomitant presence of dyslipidemia, hyperglycemia and/or insulin resistance, inflammation and hypertension. The renal injury clinically manifests as microalbuminuria, proteinuria and/or poor renal function, and is histologically characterized by glomerulomegaly, mesangial expansion and/or sclerosis, which has been termed "obesity related glomerulopathy". Obesity portends a poor prognosis in subjects with chronic kidney diseases, IgA nephropathy and nephrectomy. Obese individuals on dialysis and renal transplant have mixed outcomes. The purpose of this review is to highlight the nondiabetic consequences of obesity on kidney for the pediatric nephrology community as we begin to address the obesity epidemic in children.
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Affiliation(s)
- Tarak Srivastava
- Section of Pediatric Nephrology, Children's Mercy Hospitals and Clinics and University of Missouri, Kansas City, MO 64108, USA.
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López-Gómez JM, Villaverde M, Jofre R, Rodriguez-Benítez P, Pérez-García R. Interdialytic weight gain as a marker of blood pressure, nutrition, and survival in hemodialysis patients. Kidney Int 2005:S63-8. [PMID: 15613071 DOI: 10.1111/j.1523-1755.2005.09314.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Excessive interdialytic weight gain (IDWG) is usually related to an overload of sodium and water, and is the most important factor for arterial hypertension in dialysis. On the other hand, food intake also contributes to IDWG, and is the basic factor for nutrition. The objective of this study is to assess the long-term prognostic effect of IDWG and its relationship with the nutritional status and blood pressure in patients in hemodialysis (HD). METHODS We describe the results of a 5-year prospective observation study in which 134 HD patients were included (70 males and 64 females), with ages between 18 and 81. Initially, the average data were collected during 4 weeks, including total IDWG and percentages according to dry weight (IDWG%), nutritional parameters, and blood pressure. Patients were divided into 3 cohorts according to IDWG% (<2.9, 2.9-3.9, and >3.9%, respectively). Student t test, ANOVA, linear regression analysis, and Kaplan-Meier survival curves compared with log-rank test were used as statistical tools. RESULTS The mean IDWG% for the whole studied population was 3.5 +/- 1.1% (1.5-8.0%). It was not related to gender, but had an inverse correlation with age (P < 0.000) and serum bicarbonate level (P= 0.009). It was directly correlated with predialysis systolic and diastolic blood pressure, nPCR, urea and creatinine levels (P < 0.01 for all of them), and the body mass index (P < 0.000). Serum levels of albumin (44.7 +/- 4.0 g/dL) and prealbumin (31.9 +/- 7.4 mg/dL) had a direct correlation with total IDWG (P < 0.01). We found no significant relationship between or IDWG% and ferritin and transferrin levels. Five-year actuarial survival was 0.38, 0.52, and 0.63, respectively, in the 3 cohorts for IDWG% (P < 0.01). CONCLUSION Our results show that a greater IDWG is directly associated with a better nutritional status, although it is also associated with higher predialysis blood pressure. The greater the IDWG%, the better the long-term prognosis of the patients. The beneficial effects of IDWG on the nutritional status and prognosis are greater than the negative aspects that depend on its effects on blood pressure. One must distinguish clearly between some isolated instances of not complying with a diet from those situations where a higher IDWG is merely a reflection of a good nutritional status, and one must be careful so that dietary recommendations will not have a negative influence on nutritional aspects. One must watch and correct the trend towards higher acidosis in patients with a greater IDWG.
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Nutrition perdialytique. NUTR CLIN METAB 2005. [DOI: 10.1016/j.nupar.2005.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wiggins KJ, Johnson DW. The influence of obesity on the development and survival outcomes of chronic kidney disease. Adv Chronic Kidney Dis 2005; 12:49-55. [PMID: 15719333 DOI: 10.1053/j.ackd.2004.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of obesity, defined as a body mass index (BMI) greater than 30 kg/m2 , has more than doubled in many Western countries over the past 2 decades and has become a major public health challenge. This epidemic of obesity in developed countries has been matched closely by alarming increases in the incidence of diabetes mellitus, hypertension, chronic kidney disease (CKD), and cardiovascular disease. However, the exact role that increased body size plays in the development of nephropathy and its subsequent contribution to cardiovascular morbidity and mortality remain unclear. For example, whether obesity per se is a risk factor for CKD independent of diabetes mellitus and hypertension is uncertain. Moreover, in patients with end-stage kidney disease, strong evidence suggests that obesity may paradoxically enhance patient survival. This review will focus on the evidence for obesity as an independent risk factor for the development and progression of CKD and as a paradoxical survival factor in patients with end-stage kidney failure. Possible mechanisms underlying these observed associations will be discussed.
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Affiliation(s)
- Kathryn J Wiggins
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
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