1
|
Fujiwara M, Ando I, Shishido Y, Imai Y, Terawaki H. Amino acid availability enhanced through glucose coadministration of amino acid supplementation during hemodiafiltration: two case reports. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00417-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Intravenous administration of amino acid (AA) formulation (IVAA) as intradialytic parenteral nutrition is widely used for malnourished patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) or hemodiafiltration (HDF). Although various therapy recipes such as AA compositions or simultaneous administration of glucose and/or lipids have been attempted, the specific effects of each recipe on AA behaviors and metabolic consequences have not been well investigated. To clarify the effect of simultaneous glucose administration with IVAA, we investigated the behavior of AAs, insulin as a metabolic hormone, and energy-related metabolites during an HDF session in two patients.
Case presentation
We aimed to determine the effect of IVAA with or without simultaneous glucose administration. The plasma levels of AAs, branched-chain AAs (leucine, isoleucine, and valine), major nonessential AAs (alanine and glutamine with glutamate), insulin, glucose, and ketone bodies were measured before HDF and at the second hour (prior to the meal in the HDF session). Lost AAs in the spent dialysate were also measured for the first two hours during the HDF session.
Conclusion
In the absence of glucose administration, plasma AA levels and the loss of AAs in the dialysate increased owing to IVAA, with the increase in plasma levels in ketone bodies occurring because of scarce secretion of plasma insulin. In the presence of glucose administration, plasma levels and the loss of AA decreased even when the same amount of AAs was injected, possibly because of the profound secretion of insulin with a decrease in ketone bodies. The present findings suggest that the metabolic effects of simultaneous glucose administration on IVAAs enhanced AA uptake into the body during HDF sessions, which might increase the effectiveness of IVAAs.
Collapse
|
2
|
The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial. Sci Rep 2022; 12:4529. [PMID: 35296793 PMCID: PMC8927103 DOI: 10.1038/s41598-022-08726-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
In hemodialysis (HD) patients, protein-energy wasting (PEW) is highly prevalent and firstly treated with oral nutritional supplements (ONS). The extent to which intradialytic parenteral nutrition (IDPN) contributes to improve PEW status in HD patients intolerable to ONS remains unclear. Maintenance PEW HD patients being unable to tolerate ONS adverse effects, and having spontaneous energy and protein intake of ≥ 20 kcal/kg/day and ≥ 0.8 g/kg/day, respectively were randomly assigned 1:1 into IDPN and control groups. In IDPN group, most concentrated 3-in-1, fish-oil based parenteral nutrition was infused during HD for 3 months. The control group received intensive dietary counselling once weekly for 3 months. Both groups were then followed for additional 3 months after intervention. A total of 38 patients were randomized (mean age 67.6 years). After 3 months, serum albumin was significantly higher in the IDPN (n = 18) compared with control group (from 3.5 ± 0.3 to 3.8 ± 0.2 vs from 3.6 ± 0.3 to 3.5 ± 0.3 g/dL, respectively, p = 0.01). Spontaneous dietary intake (p = 0.04), body weight (p = 0.01), and malnutrition inflammation score (MIS, p = 0.01) were improved in the IDPN, but not in the control group. Muscle mass, strength, serum prealbumin, interleukin-6, high sensitivity-c reactive protein, and acylated ghrelin were not significantly different but leptin levels increased in the control group after 3 months (p = 0.03). At 6 months, serum albumin in the IDPN group was persistently higher than baseline (p = 0.04). Neither volume overload nor uncontrolled hyperglycemia was found throughout the study. In conclusion, a 3-month IDPN supplementation demonstrated a significant increase in serum albumin, body weight, spontaneous oral intake, and MIS; and appeared to be superior to continuing intensive dietary counselling among HD patients intolerable to ONS. The impacts of IDPN therapy on clinical outcomes may require larger scale with longer period of study.
Collapse
|
3
|
El-Serw HESS, Bassiouni DARH, Al-Wakeil AA, El-Masry RSAI, Bakr AMAEB. Efficacy of intradialytic amino acids on nutritional status in children with stage 5 chronic kidney disease. Pediatr Nephrol 2021; 36:1561-1569. [PMID: 33206228 DOI: 10.1007/s00467-020-04806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Protein energy wasting (PEW) is a common cause of morbidity and mortality in patients with stage 5 chronic kidney disease (CKD 5). Intradialytic parenteral nutrition (IDPN) has been used as a therapy for preventing and treating PEW in children with CKD 5 when other conventional modalities fail. However, not enough data is available to define its effectiveness in treating malnutrition in children. This study aims to investigate potential benefits of IDPN in Egyptian children with CKD 5. METHODS In this prospective, placebo-controlled, parallel-group single blinded study, we enrolled 50 CKD 5 patients; 25 patients (intervention group) received intravenous amino acids (KIDIMN), while 25 patients (control group) received normal saline as placebo, each given during regular dialysis 3 times a week for 9 months. Patients were subjected to nutritional assessment at baseline and 3-, 6-, and 9-month follow-up using height Z-score, hand grip strength (HGS) for muscle power assessment, body composition monitor (BCM) for assessing lean tissue mass (LTM) and adipose tissue mass (ATM), and biochemical measures including serum albumin, serum triglyceride, and serum cholesterol. RESULTS When comparing baseline and 9-month follow-up values, significant improvement was recorded in height Z-score, LTM, and serum albumin in the intervention group unlike the control group where no significant changes were recorded. CONCLUSION IDPN is proposed to be an effective method for preventing and treating malnutrition in children with CKD 5. However, further multi-centric studies with larger sample size and longer duration of follow-up are still recommended.
Collapse
Affiliation(s)
| | | | - Angy Adel Al-Wakeil
- Faculty of Medicine, Pediatric Department, Mansoura University, Elgomhoria Street, Mansoura, Egypt
| | | | | |
Collapse
|
4
|
Mihaescu A, Masood E, Zafran M, Khokhar HT, Augustine AM, Filippo A, Van Biesen W, Farrigton K, Carrero JJ, Covic A, Nistor I. Nutritional status improvement in elderly CKD patients: a systematic review. Int Urol Nephrol 2021; 53:1603-1621. [PMID: 33459956 DOI: 10.1007/s11255-020-02775-6] [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: 10/13/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Almost all CKD patients have a poor nutritional status, while elderly CKD patients are specifically frail and malnourished. Our aim is to conduct a systematic review of the up to date primary studies that look at methods of improving nutritional status in CKD patients in the elderly demographic. METHODS A focussed and sensitive search strategy was applied to the PUBMED database to identify relevant English language articles. Once articles were identified a detailed quality and bias assessment was performed. Two independent researchers (MZ and SM) then subsequently carried out detailed data extraction and analysis and this was subsequently verified by a third researcher (IN). RESULTS A total of 19 studies were included in our systematic review which included 7 non-randomised control trials and 15 randomised controlled trials. The outcomes that we considered to be most relevant for our subject title were: mortality data, SGA, albumin, total protein, isoleucine, leucine, prealbumin, transferrin, leptin, valine, TAG, HDL, LDL and total amino acids. Detailed bias analysis of the different studies was also conducted. CONCLUSION This is the first systematic review of the literature, so far, on the subject, involving elderly CKD patients. The quality of trials is low, very heterogenic in patients, methods and outcomes. However, we found a positive effect of dietary interventions on the nutritional status of most patients studied, highlighted by improvement in serum albumin and SGA, the most measured outcomes.
Collapse
Affiliation(s)
- Adelina Mihaescu
- V Babes" University of Medicine and Pharmacy, Timișoara, Romania.,Nephrology Department, "P Brinzeu" Emergency County Hospital, Timișoara, Romania
| | - Emmad Masood
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
| | - Mohammed Zafran
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
| | - Hassan Tahir Khokhar
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
| | - Arlyn Maria Augustine
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania
| | - Aucella Filippo
- Scientific Institute for Research and Health Care, "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Wim Van Biesen
- Department of Internal Medicine - Nephrology, Ghent University, Ghent, Belgium
| | - Ken Farrigton
- East and North Hertfordshire NHS Trust, Lister Hospital, Stevenage, England
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Covic
- University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania.,Nephrology Department, "Dr. C.I. Parhon Hospital", Iasi, Romania
| | - Ionut Nistor
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. .,University of Medicine and Pharmacy "Grigore T. Popa", Iași, Romania. .,Nephrology Department, "Dr. C.I. Parhon Hospital", Iasi, Romania. .,Methodological Center for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy "Gr. T. Popa", Iași, Romania.
| |
Collapse
|
5
|
Li J, Hou G, Sun X, Chen A, Chai Y. A Low-Cost, Intradialytic, Protein-Rich Meal Improves the Nutritional Status in Chinese Hemodialysis Patients. J Ren Nutr 2020; 30:e27-e34. [DOI: 10.1053/j.jrn.2019.03.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/20/2019] [Accepted: 03/30/2019] [Indexed: 12/12/2022] Open
|
6
|
Anderson J, Peterson K, Bourne D, Boundy E. Effectiveness of Intradialytic Parenteral Nutrition in Treating Protein-Energy Wasting in Hemodialysis: A Rapid Systematic Review. J Ren Nutr 2019; 29:361-369. [PMID: 30686749 DOI: 10.1053/j.jrn.2018.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/06/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022] Open
Abstract
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. Data are limited on adverse events or cost-effectiveness of IDPN. Important limitations of the evidence, including limited measurement of clinically important outcomes, methodological concerns, and heterogeneity between studies, weaken our confidence in these findings. IDPN may be a reasonable treatment option for patients who fail to respond or cannot receive recommended treatments, but the broad usage of IDPN before recommended treatment options does not appear warranted.
Collapse
Affiliation(s)
- Johanna Anderson
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA.
| | - Kim Peterson
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| | - Donald Bourne
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| | - Erin Boundy
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| |
Collapse
|
7
|
Abstract
Children with end-stage renal disease (ESRD) on hemodialysis are at increased risk for malnutrition. Aggressive nutrition intervention such as intradialytic parenteral nutrition (IDPN) should be considered to prevent further co-morbidities and mortality associated with malnutrition when other interventions fail. IDPN is a non-invasive method of providing nutrition to malnourished hemodialysis (HD) patients via the HD access throughout the HD treatment. Although the evidence on the long-term benefits of IDPN is scant in pediatrics, there is evidence that it improves metabolic parameters and nutritional status. In this paper, therapy with IDPN including indications, goals of therapy, and elements to monitor will be described. In addition, a practice guideline for prescribing IDPN is provided.
Collapse
|
8
|
Kamimura MA, Majchrzak KM, Cuppari L, Pupim LB. Protein and Energy Depletion in Chronic Hemodialysis Patients: Clinical Applicability of Diagnostic Tools. Nutr Clin Pract 2017; 20:162-75. [PMID: 16207654 DOI: 10.1177/0115426505020002162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Protein and energy depletion states are common and associated with increased morbidity and mortality in chronic hemodialysis (CHD) patients. Therefore, proper use of diagnostic tools to assess depleted states in CHD patients is critical. Assessment of protein and energy status can be done by an array of methodologies that include simple estimates of the visceral and somatic pools of protein to more refined techniques to measure protein and energy balance. The nutritional and metabolic derangements in the CHD population are highly complex and can be confounded by multiple comorbidities and fluid shifts between body compartments. Therefore, assessment of protein and energy status in CHD patients requires a wide range of methodologies that not only identify depleted states but also monitor nutrition therapy and predict clinical outcome. Most important, these methods require cautious and individualized interpretation in order to minimize the interference of comorbid conditions frequently observed in the CHD population. Currently, there is not a single method that can be considered the gold standard for assessment of protein and energy status in CHD patients. Therefore, a combination of methods is recommended. In this review, we describe available methods to assess protein and energy status, with special considerations pertaining to CHD patients.
Collapse
Affiliation(s)
- M A Kamimura
- Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | |
Collapse
|
9
|
Farrington K, Covic A, Aucella F, Clyne N, de Vos L, Findlay A, Fouque D, Grodzicki T, Iyasere O, Jager KJ, Joosten H, Macias JF, Mooney A, Nitsch D, Stryckers M, Taal M, Tattersall J, Van Asselt D, Van den Noortgate N, Nistor I, Van Biesen W. Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR <45 mL/min/1.73 m2). Nephrol Dial Transplant 2016; 31:ii1-ii66. [DOI: 10.1093/ndt/gfw356] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
10
|
Kovesdy CP. Malnutrition in Dialysis Patients--The Need for Intervention Despite Uncertain Benefits. Semin Dial 2015; 29:28-34. [PMID: 26190025 DOI: 10.1111/sdi.12410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We are in the midst of an epidemic of overnutrition which has resulted in a widespread increase in obesity rates in modern societies. Yet for patients suffering from serious chronic illnesses such as end stage renal disease (ESRD), malnutrition (encompassing both inadequate quantity and quality of nutrient intake) represents a far more significant danger. Protein-energy wasting has been identified as one of the strongest risk factor for adverse outcomes in ESRD patients, and modeling studies have suggested that improving nutrition could result in substantial lowering of mortality rates and other benefits. To date there is ample evidence that various interventions can have a positive impact on the nutritional status of ESRD patients, yet we still lack randomized controlled clinical trials showing that the same interventions could indeed lead to better survival or other clinical benefits. This knowledge gap, which is all too common for clinical problems encountered in nephrology, should not act as a deterrent, but it should rather incentivize us to continue exploring novel interventions aimed at improving malnutrition in ESRD.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, Tennessee.,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| |
Collapse
|
11
|
Bossola M, Tazza L, Giungi S, Rosa F, Luciani G. Artificial Nutritional Support in Chronic Hemodialysis Patients: A Narrative Review. J Ren Nutr 2010; 20:213-23. [DOI: 10.1053/j.jrn.2010.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Indexed: 11/11/2022] Open
|
12
|
Druml W, Kierdorf HP. Parenteral nutrition in patients with renal failure - Guidelines on Parenteral Nutrition, Chapter 17. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc11. [PMID: 20049069 PMCID: PMC2795369 DOI: 10.3205/000070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 12/04/2022]
Abstract
Partial EN (enteral nutrition) should always be aimed for in patients with renal failure that require nutritional support. Nevertheless PN (parenteral nutrition) may be necessary in renal failure in patient groups with acute or chronic renal failure (ARF or CRF) and additional acute diseases but without extracorporeal renal replacement therapy, or in patients with ARF or CRF with additional acute diseases on extracorporeal renal replacement therapy, haemodialysis therapy (HD), peritoneal dialysis (PD) or continuous renal replacement therapy (CRRT), or in patients on HD therapy with intradialytic PN. Patients with renal failure who show marked metabolic derangements and changes in nutritional requirements require the use of specifically adapted nutrient solutions. The substrate requirements of acutely ill, non-hypercatabolic patients with CRF correspond to those of patients with ARF who are not receiving any renal replacement patients therapy (utilisation of the administered nutrients has to be monitored carefully). In ARF patients and acutely ill CRF patients on renal replacement therapy, substrate requirements depend on disease severity, type and extent/frequency of extracorporeal renal replacement therapy, nutritional status, underlying disease and complications occurring during the course of the disease. Patients under HD have a higher risk of developing malnutrition. Intradialytic PN (IDPN) should be used if causes of malnutrition cannot be eliminated and other interventions fail. IDPN should only be carried out when modifiable causes of malnutrition are excluded and enhanced oral (like i.e. additional energy drinks) or enteral supply is unsuccessful or cannot be carried out.
Collapse
Affiliation(s)
- W. Druml
- Clinical Dept. of Nephrology and Dialysis, University of Vienna, Austria
| | | | | |
Collapse
|
13
|
Kovesdy CP, Kalantar-Zadeh K. Review article: Biomarkers of clinical outcomes in advanced chronic kidney disease. Nephrology (Carlton) 2009; 14:408-15. [PMID: 19563383 PMCID: PMC5501737 DOI: 10.1111/j.1440-1797.2009.01119.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic kidney disease (CKD) is a complex condition, where the decrease in kidney function is accompanied by numerous metabolic changes affecting virtually all the organ systems of the human body. Many of the biomarkers characteristic of the individually affected organ systems have been associated with adverse outcomes including higher mortality in advanced CKD, whereas in persons without CKD these biomarkers may have no bearing on survival. It is believed that the high mortality seen in CKD is a result of several abnormalities conspiring to induce or aggravate a heightened degree of cardiovascular morbidity and predisposition to wasting syndrome. Not all the biomarkers may, however, be causally responsible for the adverse outcomes associated with them. We review various biomarkers of protein-energy wasting, inflammation, oxidative stress, potassium disarrays, acid-base disorders, bone and mineral disorders, glycemic status, and anemia. Although all of these biomarkers have shown associations with worsened outcomes in CKD, markers of protein-energy wasting, especially serum albumin, remain the strongest predictor of survival in CKD patients, especially those undergoing maintenance dialysis treatment. We also review the putative pathophysiologic mechanisms behind these associations, and present potential therapeutic interventions that could result in remedies to improve poor clinical outcomes in CKD, pending the results of current and future controlled trials.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Salem Veterans Affairs Medical Center, 1970 Roanoke Blvd., Salem, VA 24153, USA.
| | | |
Collapse
|
14
|
Abstract
Observational studies in chronic kidney disease (CKD) populations consistently have shown the strong mortality-predictability of such markers of protein-energy wasting (PEW) as hypoalbuminemia, low serum cholesterol levels, low body mass index, and reduced dietary protein intake. Even though the PEW-mortality association data traditionally are reported mostly in maintenance dialysis patients, emerging studies extend the existence of these associations to predialysis stages of CKD. Paradoxic risk factor patterns (reverse epidemiology) for both obesity and cholesterol recently have been reported in predialysis CKD, underscoring the overwhelming impact of PEW, a short-term killer, on reversing the long-term effect of conventional cardiovascular risk factors. Multiple pathophysiologic mechanisms have been suggested to explain the link between PEW and mortality in CKD, including derangements in muscle, adipose tissue, and the gastrointestinal, hematopoietic, and immune systems; complications related to deficiencies of multiple micronutrients; and the maladaptive activation of the inflammatory cascade. In addition to well-described pathophysiologic mechanisms involved in the higher mortality seen with PEW, we also discuss the potential role of novel factors such as circulating actin, gelsolin, and proinflammatory high-density lipoprotein. Whether PEW is causally related to adverse outcomes in CKD needs to be verified in randomized controlled trials of nutritional interventions. The initiation of major clinical trials targeting nutritional interventions with the goal of improving survival in CKD offer the promise of extending the survival of this vulnerable patient population.
Collapse
Affiliation(s)
- Csaba P Kovesdy
- Division of Nephrology, Salem Veterans Affairs Medical Center, Salem, VA 24153, USA.
| | | |
Collapse
|
15
|
Watanabe M, Suliman ME, Qureshi AR, Garcia-Lopez E, Bárány P, Heimbürger O, Stenvinkel P, Lindholm B. Consequences of low plasma histidine in chronic kidney disease patients: associations with inflammation, oxidative stress, and mortality. Am J Clin Nutr 2008; 87:1860-6. [PMID: 18541578 DOI: 10.1093/ajcn/87.6.1860] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Histidine is considered as an antiinflammatory and antioxidant factor. Histidine deficiency may contribute to an impaired nutritional state in patients with chronic kidney disease (CKD). OBJECTIVE We aimed to investigate the consequences of plasma histidine deficiency in CKD patients. DESIGN CKD patients (n = 325; 203 M) with a median age of 54 y (range: 19-70 y) were evaluated shortly before the beginning of renal replacement therapy. The median glomerular filtration rate was 6.4 mL/min (range: 0.8-14.5 mL/min). Nutritional status was assessed by subjective global assessment. Survival was followed for up to 60 mo; 101 patients died. RESULTS Plasma histidine concentrations were significantly lower in CKD patients with history of cardiovascular disease, presence of plaques, protein-energy wasting, and inflammation. Plasma histidine was negatively associated with age, C-reactive protein, interleukin-6, leukocytes, thrombocytes, fibrinogen, hepatocyte growth factor, adhesion molecules, insulin-like growth factor-1, and 8-hydroxy-2'-deoxyguanosine and was positively associated with handgrip strength, hemoglobin, S-albumin and fetuin-A. A multivariate regression analysis showed that histidine concentrations were independently associated with hepatocyte growth factor, hemoglobin, and fetuin-A. In unadjusted analysis, a low histidine concentration was associated with all-cause mortality (log rank chi-square test = 8.9; P = 0.002). After adjustment for age, sex, cardiovascular disease, inflammation, diabetes mellitus, serum S-albumin, and amino acid supplementation, the association between low histidine and mortality remained significant (hazard ratio: 1.55; 95% CI: 1.02, 2.40; P < 0.05). CONCLUSION Low plasma concentrations of histidine are associated with protein-energy wasting, inflammation, oxidative stress, and greater mortality in CKD patients.
Collapse
Affiliation(s)
- Makoto Watanabe
- Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Fouque D, McKenzie J, de Mutsert R, Azar R, Teta D, Plauth M, Cano N. Use of a renal-specific oral supplement by haemodialysis patients with low protein intake does not increase the need for phosphate binders and may prevent a decline in nutritional status and quality of life. Nephrol Dial Transplant 2008; 23:2902-10. [DOI: 10.1093/ndt/gfn131] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Cano NJM, Saingra Y, Dupuy AM, Lorec-Penet AM, Portugal H, Lairon D, Cristol JP, Come A, Le Brun A, Atlan P, Leverve XM. Intradialytic parenteral nutrition: comparison of olive oil versus soybean oilbasedlipid emulsions. Br J Nutr 2007; 95:152-9. [PMID: 16441928 DOI: 10.1079/bjn20051595] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lipid, oxidative and inflammatory parameters are frequently altered in dialysis patients and may be worsened by intravenous lipid emulsions (ILE). We assessed the efficacy and tolerance of olive as compared with standard soybean oil-based ILE during intradialytic parenteral nutrition (IDPN). IDPN mixtures containing amino acids, glucose, and either olive oil (OO group,n17) or soybean oil-based ILE (SO group,n18) were administered in a 5-week randomized, double-blind study. On days 0 and 35, patients' nutritional status was assessed by BMI, normalized protein catabolic rate, predialytic creatinine, serum albumin and transthyretin; lipid metabolism by plasma LDL- and HDL-cholesterol, triacylglycerols, phospholipids, apo A-I, A-II, B, C-II, C-III, E and lipoprotein (a); oxidative status by α-tocopherol, retinol, selenium, glutathione peroxidase, malondialdehyde and advanced oxidized protein products; inflammatory status by serum C-reactive protein, orosomucoid, IL-2 and IL-6. No serious adverse event was observed. Significant changes were observed from day 0 to day 35 (P<0·05): nutritional criteria improved (albumin in OO; albumin, transthyretin and creatinine in SO); LDL-cholesterol, apo B, C-II, C-III and apo A-I/A-II ratio increased in both groups. HDL-cholesterol decreased in OO; apo E increased and lipoprotein (a) decreased in SO; α-tocopherol/cholesterol ratio increased in OO; malondialdehyde decreased in both groups; IL-2 increased in both groups. The between-group comparison only showed the following differences: α-tocopherol/cholesterol increased in OO; lipoprotein (a) decreased in SO. From these data, it was concluded that OO- and SO-based IDPNs similarly improved nutritional status and influenced plasma lipid, oxidative, inflammatory and immune parameters.
Collapse
Affiliation(s)
- Noël J M Cano
- Service d'Hépatogastroentérologie et Nutrition, Clinique Résidence du Parc, Rue Gaston Berger, 13362, Marseille cedex 10, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Fouque D, Guebre-Egziabher F. An update on nutrition in chronic kidney disease. Int Urol Nephrol 2006; 39:239-46. [PMID: 17476582 DOI: 10.1007/s11255-006-9108-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 08/31/2006] [Indexed: 11/24/2022]
Abstract
The prevalence of malnutrition in the course of chronic kidney disease has not changed recently and is still between 30 and 50%. About 10% of patients on maintenance dialysis show signs of severe malnutrition. Recent progress has been made on protein metabolism, the validation of new diagnostic tools, and the use of anabolic compounds. Large clinical trials have characterized the use of medications for renutrition, and international guidelines are currently updated. Neverthless, physicians will be mostly efficient at the stage of malnutrition prevention, by implementing an early, interactive dietary and nutritional care programs in close collaboration with specialized dietitians.
Collapse
Affiliation(s)
- Denis Fouque
- Department of Nephrology and Centre de Recherche en Nutrition Humaine, Edouard Herriot Hospital, 69437 Lyon Cedex 03, France.
| | | |
Collapse
|
19
|
Bossola M, Muscaritoli M, Tazza L, Giungi S, Tortorelli A, Rossi Fanelli F, Luciani G. Malnutrition in Hemodialysis Patients: What Therapy? Am J Kidney Dis 2005; 46:371-86. [PMID: 16129199 DOI: 10.1053/j.ajkd.2005.05.031] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 05/31/2005] [Accepted: 05/31/2005] [Indexed: 11/11/2022]
Abstract
Malnutrition is common in hemodialysis patients and is a powerful predictor of morbidity and mortality. Although much progress has been made in recent years in identifying the causes and pathogenesis of malnutrition in hemodialysis patients, as well as recognizing the link between malnutrition and morbidity and mortality, no consensus has been reached concerning its management. Along with such conventional interventions as nutritional counseling, oral nutritional supplements, and intradialytic parenteral nutrition, novel preventive and therapeutic strategies have been tested, such as appetite stimulants, growth hormone, androgenic anabolic steroids, and anti-inflammatory drugs, with contradictory and nonconclusive results. Malnutrition still remains a great challenge for nephrologists in the third millennium.
Collapse
Affiliation(s)
- Maurizio Bossola
- Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
20
|
Orellana P, Juarez-Congelosi M, Goldstein SL. Intradialytic Parenteral Nutrition Treatment and Biochemical Marker Assessment for Malnutrition in Adolescent Maintenance Hemodialysis Patients. J Ren Nutr 2005; 15:312-7. [PMID: 16007561 DOI: 10.1016/j.jrn.2004.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Protein-energy malnutrition (PEM) is a significant cause of morbidity and mortality for patients receiving maintenance hemodialysis. Minimal study has evaluated therapeutic options for and biochemical marker assessment of pediatric patient PEM. In 2001, we expanded the indications for intradialytic parenteral nutrition (IDPN) treatment of PEM to all maintenance hemodialysis patients, regardless of etiology, who had a >10% weight loss and were at less than the 90th percentile of ideal body weight. Nine patients received thrice weekly IDPN from 3 to 22 months with minimal side effects. Six patients had weight and body mass index increase, 1 patient stopped losing weight, and 2 patients continued to lose weight during the initial 5 months of IDPN therapy. Cohort subanalysis showed that all patients with organic PEM responded to IDPN therapy, whereas patients with psychosocial causes of PEM did not. The normalized protein catabolic rate increased significantly for patients whose condition responded to IDPN therapy, whereas serum albumin did not change. The current study suggests that IDPN is effective treatment of organic causes of PEM in pediatric patients receiving maintenance hemodialysis and that normalized protein catabolic rate may be superior to serum albumin as a marker of nutrition status. The observation that IDPN was not sufficient to reverse PEM in patients with psychosocial PEM causes should direct caregivers to address the relevant underlying causes as well as to provide intensive nutrition therapy.
Collapse
|