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Zhang D, Fu Z, Wan X, Wu X, Ding L. Correlation between geriatric nutritional risk index and intradialytic hypotension in elderly patients undergoing maintenance hemodialysis: a case-control study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:80. [PMID: 38849963 PMCID: PMC11161997 DOI: 10.1186/s41043-024-00551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND There is a correlation between nutritional status and treatment outcomes and long-term survival in MHD patients but there is limited research on the relationship between GNRI and IDH. This case-control study aimed to investigate the correlation between Geriatric Nutritional Risk Index (GNRI) and intradialytic hypotension (IDH) in elderly patients undergoing maintenance hemodialysis (MHD). METHODS This study was carried out on 129 cases of MHD patients with IDH and 258 non-IDH-controls in Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China, between June 2020 and May 2022. Professional researchers collected patients' general information on gender, primary disease, dialysis-related indicators, anthropometric measures, laboratory biochemicals, and GNRI. Logistic regression analysis was used to evaluate the correlation between GNRI and IDH. RESULTS A total of 385 elderly MHD patients were included. Compared with GNRI Q4 group, the odds ratios for the risk of IDH in GNRI Q3 group, GNRI Q2 group, and GNRI Q1 group of elderly MHD patients were 1.227, 2.196, and 8.350, respectively, showing a significant downward trend (P-trend < 0.05). The area under the curve of GNRI for predicting IDH was 0.839 (95% CI: 0.799-0.879). Between different genders, a decrease in GNRI was closely related to an increase in IDH risk (P for trend < 0.05). CONCLUSIONS This research shows a significant association between GNRI and the incidence of IDH among elderly MHD patients and has an important warning effect. Encouraging the incorporation of GNRI assessment into the clinical assessment protocols of older patients with MHD may help to improve the nutritional status of those suffering from it and reduce the risk of IDH.
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Affiliation(s)
- Dan Zhang
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 888 Shuangding Road, Jiading District, Shanghai, 201801, China
| | - Zhoushan Fu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 888 Shuangding Road, Jiading District, Shanghai, 201801, China
| | - Xiaoqin Wan
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 888 Shuangding Road, Jiading District, Shanghai, 201801, China
| | - Xiaojing Wu
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 888 Shuangding Road, Jiading District, Shanghai, 201801, China
| | - Lin Ding
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 888 Shuangding Road, Jiading District, Shanghai, 201801, China.
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López-Cisneros S, Ramos-Acevedo S, Reyes-Ramírez LM, Rodríguez-Gómez L, Serralde-Zúñiga AE, González-Ortiz A, Espinosa-Cuevas Á. Does intradialytic oral nutrition impact hemodialysis patients' quality of Life, appetite, and safety? A pilot study of a crossover clinical trial. NUTR HOSP 2024. [PMID: 38450518 DOI: 10.20960/nh.04703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION due to the catabolic characteristics of hemodialysis (HD), patients should consume foods or supplements during this treatment to meet their energy requirements and maintain a neutral nitrogen balance; however, there are some outcomes in which the effect of intradialytic oral nutrition (ION) is scarcely known. OBJECTIVES this study aims to evaluate the effect of two types of ION (liquid and solid) on QoL, appetite, and safety in HD patients. METHODS a pilot randomized, crossover clinical trial was performed in 18 patients on chronic HD. One group received ION for 18 HD sessions, after the crossover continued for 18 more sessions in the control group, and vice versa. We recorded QoL, appetite, systolic blood pressure (SBP), and intradialytic hypotension (IH) events. RESULTS clinical improvement was observed for most QoL components. Regardless of the consistency of supplementation, SBP increased to 4.10 mmHg. Both study groups reported a "very good-to-good" appetite. CONCLUSION favorable clinical changes were observed in QoL scores during the study. Five of six IH events were reported for patients in the ION group, and SBP increased within the safe range (≤ 10 mmHg); appetite remained stable in both groups. Therefore, we concluded that this strategy, regardless of implementation consistency, is safe to be used in stable patients.
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Affiliation(s)
| | - Samuel Ramos-Acevedo
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Luis Rodríguez-Gómez
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | - Aurora E Serralde-Zúñiga
- Clinical Nephrology Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
| | | | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
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Chung MK, Kim DH, Park JI, Lee S, Park HC, Kim K, Kang YS, Ko K, Kim J, Koo H, Kim HJ, Cha JJ, Kwon YE, Kim JH. Adaptive Nutrition Intervention Stabilizes Serum Phosphorus Levels in Hemodialysis Patients: A Multicenter Decentralized Clinical Trial Using Real-World Data. J Ren Nutr 2024; 34:47-57. [PMID: 37586668 DOI: 10.1053/j.jrn.2023.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 06/02/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the effect of an adaptive nutritional and educational intervention for patients on hemodialysis (HD) in a routine care setting, using real-world data from electronic health records. METHODS Decentralized clinical trial of seven HD facilities recruited patients who have been on HD for over 3 months (N = 153) for an 8-week adaptive intervention protocol. Patients were divided into four groups: (1) control (2) education intervention (3) meal intervention (4) education and meal interventions. Educational contents were digitally delivered via mobile phones and premade meals tailored on laboratory findings were home-delivered. Changes in serum electrolytes and malnutrition inflammation score (MIS) were analyzed. RESULTS Meal intervention statistically significantly stabilized serum phosphorus level (β = -0.81 mg/dL, 95% confidence interval = [-1.40, -0.22]) at week 8, with increased likelihood of being within target serum value range (odds ratio = 1.21, 95% confidence interval = [1.04, 1.40]). Meal group showed better nutritional status (MIS = 3.65) than the education group (MIS = 5.10) at week 8 (adjusted p < .05). No significant changes were observed in serum potassium level, depression, and self-efficacy. CONCLUSION It was demonstrated that an adaptive meal intervention in a real-world care setting may benefit serum phosphorus control and nutritional status of patients on HD, without negative effect on depression levels or self-efficacy. More work is needed to develop an effective educational intervention.
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Affiliation(s)
- Moon Kyung Chung
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ji In Park
- Division of Nephrology, Department of Internal Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea
| | - Sunhwa Lee
- Division of Nephrology, Department of Internal Medicine, Kangwon National University Hospital, Gangwon-do, Republic of Korea
| | - Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyungmin Kim
- Division of Nephrology, Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, Republic of Korea
| | - Young Sun Kang
- Division of Nephrology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
| | - Kangji Ko
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jieun Kim
- Division of Nephrology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hoseok Koo
- Division of Nephrology, Department of Internal Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | | | - Jin Joo Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea.
| | - Young Eun Kwon
- Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Ju Han Kim
- Division of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Hunter EG, Shukla A, Andrade JM. Barriers to and Strategies for Dietary Adherence: A Qualitative Study Among Hemodialysis/Peritoneal Dialysis Patients and Health Care Providers. J Ren Nutr 2023; 33:682-690. [PMID: 37315706 DOI: 10.1053/j.jrn.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES The objectives of this study were: (1) investigate hemodialysis (HD)/peritoneal dialysis (PD) patients' barriers to dietary adherence, (2) identify strategies to overcome these barriers, and (3) examine dialysis providers' perceptions toward patients' barriers to dietary adherence and strategies to overcome these barriers. METHODS A qualitative descriptive approach was conducted from February-May 2022. A total of 21 HD/PD participants and 11 health care providers participated in individual interviews. HD/PD participants also responded to a 57-item food frequency questionnaire. Six months of serum laboratory values were obtained from the medical charts. Content analysis methodology was used to identify themes. Mann-Whitney U tests were conducted to examine diet quality and laboratory values of the HD and PD participants using SPSS v.27 with statistical significance of P < .05. RESULTS The median (interquartile range) diet quality score for HD/PD patients was 36 (26-43) with no differences observed between the patient populations. Mann-Whitney U tests showed no differences between serum laboratory values between the patient populations. Barriers identified by the HD/PD patients were communication/patient education and dietary habits. Barriers identified by the health care providers were communication/patient education and socioeconomic status. Strategies to overcome these barriers were enhancing communication between all parties involved in the care and tailoring educational information to the patient's background. CONCLUSIONS Communication and patient education were themes identified among both health care providers and patients. Therefore, open communication among the patients and providers and enhancement of the nutrition education handouts may improve dietary adherence.
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Affiliation(s)
- Elizabeth G Hunter
- Student, Food Science and Human Nutrition Department, University of Florida, Gainesville, Florida
| | - Ashutosh Shukla
- Professor of Nephrology, Division of Nephrology, Hypertension and Renal Physiology, University of Florida, Gainesville, Florida
| | - Jeanette M Andrade
- Assistant Professor, Food Science and Human Nutrition Department, University of Florida, Gainesville, Florida.
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Hamrahian SM, Vilayet S, Herberth J, Fülöp T. Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects. Int J Nephrol Renovasc Dis 2023; 16:173-181. [PMID: 37547077 PMCID: PMC10404053 DOI: 10.2147/ijnrd.s245621] [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: 05/06/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.
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Affiliation(s)
| | - Salem Vilayet
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Johann Herberth
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Tibor Fülöp
- Department of Medicine - Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
- Medicine Services, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Avci M, Arikan F. The effect of food intake during hemodialysis on blood pressure: A nonrandomized experimental trial. Ther Apher Dial 2023. [PMID: 36606660 DOI: 10.1111/1744-9987.13967] [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: 10/20/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intradialytic hypotension (IDH) is one of the most important intradialytic complications and is thought to be associated with intradialytic food intake. Allowing intradialytic feeding is still unclear. This study aimed to determine the relationship between IDH and intradialytic food intake. METHODS A nonrandomized experimental study was conducted to determine the effect of intradialytic food intake on blood pressure (BP) in hemodialysis patients. Each patient was assessed twice using an ambulatory BP monitor with and without intradialytic food intake. RESULTS The study was completed with 54 patients. Intradialytic hypotension developed in 40 patients (74.1%) during the food intake session, while intradialytic hypotension developed in 22 participants (40%) in the no-food session. Repeated BP readings showed that eating 2 h or more after the start of hemodialysis significantly reduced BP. CONCLUSIONS Intradialytic food intake affects the development of IDH. Patients who ate during hemodialysis had a trend of higher of IDH than those who ate nothing during hemodialysis. Eating during dialysis is not recommended.
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Affiliation(s)
- Melek Avci
- Health Services Vocational School, Akdeniz University, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Feeding during Dialysis Increases Intradialytic Blood Pressure Variability and Reduces Dialysis Adequacy. Nutrients 2022; 14:nu14071357. [PMID: 35405970 PMCID: PMC9002965 DOI: 10.3390/nu14071357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Whether hemodialysis patients should be allowed or even encouraged to eat during dialysis remains a controversial topic. This cross-over study aimed to evaluate the impact of feeding during dialysis on intradialytic blood pressure (BP) profile and dialysis adequacy in 26 patients receiving thrice-weekly, in-center hemodialysis. Over three consecutive mid-week dialysis sessions, intradialytic BP was monitored using the Mobil-O-Graph device (IEM, Stolberg, Germany). Blood samples were also obtained for the determination of the urea reduction ratio (URR). At baseline, patients underwent dialysis without the provision of a meal. In phases A and B, a meal with either high-protein (1.5 gr/kg of body weight) or low-protein (0.7 gr/kg of body weight) content was administered 1 h after the initiation of dialysis. The sequence of meals (high-protein and low-protein or vice versa) was randomized. Average intradialytic systolic BP (SBP) was similar on all three occasions. However, compared with baseline, the standard deviation (SD) (11.7 ± 4.1 vs. 15.6 ± 7.6 mmHg, p < 0.01), coefficient of variation (CV) (9.5 ± 3.7% vs. 12.4 ± 6.0%, p < 0.01) and average real variability (ARV) (9.4 ± 3.9 vs. 12.1 ± 5.2 mmHg, p < 0.01) of intradialytic SBP were higher in phase A. Similarly, compared with the baseline evaluation, all three indices of intradialytic SBP variability were higher in phase B (SD: 11.7 ± 4.1 vs. 14.1 ± 4.5 mmHg, p < 0.05; CV: 9.5 ± 3.7% vs. 11.1 ± 3.8%, p < 0.05; ARV: 9.4 ± 3.9 vs. 10.9 ± 3.9 mmHg, p < 0.05). Compared with dialysis without a meal, the consumption of a high-protein or low-protein meal resulted in a lower URR (73.4 ± 4.3% vs. 65.7 ± 10.7%, p < 0.001 in phase A and 73.4 ± 4.3% vs. 67.6 ± 4.3%, p < 0.001 in phase B, respectively). In conclusion, in the present study, feeding during dialysis was associated with higher intradialytic SBP variability and reduced adequacy of the delivered dialysis.
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8
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Schaminee DPE, Kosters CM, Verbeek FHO, Atsma F, van den Berg MGA. Protein and energy intake: Comparison of two food services in patients during hemodialysis treatment. Nutrition 2021; 90:111260. [PMID: 33975065 DOI: 10.1016/j.nut.2021.111260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Radboud University Medical Center introduced a new food service (NFS) to the hemodialysis (HD) department, which contains several small protein-rich foods and adheres to the Dutch dietary HD guidelines. The objectives were to investigate whether the NFS improves protein and energy intake compared with the old food service (OFS), the number of symptomatic hypotensive events (SHEs), and patient satisfaction. METHODS This was a prospective cohort (pilot) study of 25 adult patients with HD at the Radboud University Medical Center between August 2018 and February 2019. Differences in protein and energy intake over time by repeated measurements of the OFS and NFS were evaluated by linear mixed models with adjustments for confounders. SHEs, defined as a systolic drop >20 mmHg between two blood pressure measurements and 1) temporary or permanent stop ultrafiltration, 2) nausea, or 3) dizziness were collected. Patient satisfaction was determined by means of a self-developed questionnaire. RESULTS Protein and energy intake for the OFS and NFS differed significantly. Mean ± standard deviation for protein intake was 26 ± 11 g and 31 ± 13 g, respectively, and for energy intake 603 ± 218 kcal and 724 ± 244 kcal, respectively. No increase in SHEs occurred between the food services (2 SHEs at OFS vs 1 SHE at NFS). OFS patient satisfaction was graded 6.7 ± 2.3 and NFS was graded 7.3 ± 1.7. CONCLUSIONS NFS resulted in increased protein and energy intake and patient satisfaction, but no increase in SHEs was observed.
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Affiliation(s)
- Demi P E Schaminee
- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Nijmegen, Netherlands.
| | - Catharina M Kosters
- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Nijmegen, Netherlands.
| | - Frank H O Verbeek
- Radboud University Medical Center, Department of Nephrology, Nijmegen, Netherlands
| | - Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, Netherlands
| | - Manon G A van den Berg
- Radboud University Medical Center, Department of Gastroenterology and Hepatology, Dietetics and Intestinal Failure, Nijmegen, Netherlands
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Abstract
Individuals with chronic kidney disease (CKD), particularly those undergoing maintenance dialysis, are prone to protein-energy wasting (PEW), the latter of which can be ameliorated with different methods of nutrition support. Dietary counseling guided by dietitians is the key for preventing and managing PEW in CKD. If dietary counseling per se fails to meet the recommended energy and protein requirements, the addition of oral nutrition supplements (ONSs) would be necessary. When these initial measures cannot attain the recommended energy and protein requirements, nutrition support, including enteral tube feeding or parenteral nutrition (PN), should be considered as a viable option to improve nutrition status. Partial PN, comprising intraperitoneal PN (IPPN) and intradialytic PN (IDPN) therapies, may be attempted as supplemental nutrition support in patients with PEW requiring peritoneal dialysis and hemodialysis, respectively. Despite the debatable effectiveness of IPPN for patients undergoing peritoneal dialysis, it remains a feasible means in these patients. The indications for IPPN in patients undergoing peritoneal dialysis include inadequate dietary intake of energy and protein, and barriers of oral intake and other forms of enteral supplementation such as issues with suitability, tolerance, and compliance. Nonetheless, in the case of spontaneous dietary consumption of energy and protein meeting the difference between the IDPN provision and the nutrition targets, the use of IDPN is rational. In patients with PEW and malfunctioning gastrointestinal tract, as well as those whose enteral intake (with or without partial PN) is below the recommended nutrient requirements, total PN becomes a relevant nutrition intervention.
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Affiliation(s)
- Winnie Chan
- School of Sport, Exercise and Rehabilitation Sciences, The University of Birmingham, Edgbaston, Birmingham, United Kingdom.,Department of Nephrology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, United Kingdom
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10
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Jelicic I. Relationship of a food intake during hemodialysis and symptomatic intradialytic hypotension. Hemodial Int 2021; 25:333-337. [PMID: 33694255 DOI: 10.1111/hdi.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Intradialytic hypotension is the most common complication during hemodialysis and is associated with increased cardiovascular disease, mortality, and overall hospital admissions. We analyzed the influence of food intake during hemodialysis on intradialytic hypotension. METHODS A total of 105 patients treated with chronic hemodialysis were observed for 8 weeks-4 weeks with a meal during hemodialysis and 4 weeks without a meal. FINDINGS A statistically significant decrease of hypotensive events (p < 0.001) and cramping episodes (p = 0.035) was observed during a 4-week period without a meal. Patients who were particularly susceptible to intradialytic hypotension were those who were diabetic, had low urinary excretion, and were treated with hemodialysis for a long time. On a follow up, there was a significant increase in serum albumin after 3 months (p = 0.01) and 6 months (p = 0.036) despite meal withdrawal during hemodialysis. DISCUSSION Fasting during hemodialysis may cause a significantly lower frequency of intradialytic hypotension and cramping episodes without affecting the nutritional status.
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Affiliation(s)
- Ivo Jelicic
- Renal Unit, University Hospital Split, Split, Croatia
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11
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Ramos-Acevedo S, González-Ortiz A, Serralde-Zúñiga AE, Colín-Ramírez E, Miranda-Alatriste P, López-Cisneros S, Rodríguez-González N, Correa-Rotter R, Atilano-Carsi X, Espinosa-Cuevas Á. Frequency of Intradialytic Hypotension Events Do Not Increase with Oral Nutritional Supplementation during Hemodialysis Treatment: A Randomized Controlled Trial. J Ren Nutr 2021; 31:669-678. [PMID: 33648870 DOI: 10.1053/j.jrn.2020.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/22/2020] [Accepted: 10/21/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE This study aimed to compare the effect of the use of a renal-specific oral nutritional supplement (RS-ONS) during hemodialysis sessions and the use of RS-ONS at home on the incidence of intradialytic hypotension. METHODS A single-center, 12-week, open-label, randomized controlled clinical trial was conducted. The intervention was a RN-ONS divided into two portions: 100 and 137 mL. The first portion was given after 1 hour of hemodialysis (HD) treatment, while the second portion was given 45 minutes before the end of HD. The research staff registered the baseline and final nutritional parameters and systolic arterial pressure (SAP) from the screen of the HD device during 36 HD sessions. Hypotension symptoms were also recorded every hour during each HD session. The nutritional and functional status was also assessed. RESULTS We registered a total of 16 hypotensive events during 1082 HD sessions: 9 were in patients supplemented at home (551 HD sessions) and 7 occurred in patients supplemented during HD P = .668. Incidence of intradialytic hypotension (IH) during 1082 HD sessions was 1.4%. The total malnutrition inflammation score (MIS) decreased in both groups (P < .01), and the percentage of cachexia improved in the supplemented-during-HD group (P < .05). CONCLUSIONS In this randomized controlled trial, intradialytic hypotension events did not increase with the RS-ONS during HD treatment. This strategy appears to be a safe anabolic nutritional strategy for the prevention of PEW, selecting stable patients and administering a fractioned volume of the supplement after the first hour of HD treatment. More studies with larger samples size are required to confirm these findings.
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Affiliation(s)
- Samuel Ramos-Acevedo
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ailema González-Ortiz
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Eloisa Colín-Ramírez
- Research Associate, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Paola Miranda-Alatriste
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Sonia López-Cisneros
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Norberto Rodríguez-González
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ricardo Correa-Rotter
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ximena Atilano-Carsi
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Ángeles Espinosa-Cuevas
- Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City.
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Joshi S, Moore LW, Kalantar-Zadeh K. The Future of Nutrition in Kidney Disease: Plant-Based Diets, Gut Microbiome, and Beyond. J Ren Nutr 2021; 31:97-99. [DOI: 10.1053/j.jrn.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
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13
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Rao NS, Chandra A, Saran S, Kulshreshta MR, Mishra P, Tiwari P. Predialytic versus Intradialytic Nutrition: A Study to Assess Effects on Intradialytic Blood Pressure, Dialysis Adequacy, and Urea Removal. Blood Purif 2021; 50:823-828. [PMID: 33508845 DOI: 10.1159/000512540] [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: 07/15/2020] [Accepted: 10/23/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Provision of oral protein in hemodialysis (HD) is desirable due to improved compliance to protein requirements and better nutritional status, but the risks of hypotension and underdialysis need to be considered. This study compared 2 different timings for administering oral nutritional supplements (ONS), predialysis and mid-dialysis, with respect to hemodynamics, dialysis adequacy, urea removal, and tolerability. METHODS This single-center, prospective crossover study analyzed 72 stable patients with ESRD on twice a week maintenance HD with a mean age of 38.7 (±11.2) years and a dialysis vintage of 28.2 (±13.1) months. In the first week, all the patients received ONS (450 kcal energy, 20 g protein) 1 h prior to start of dialysis (group 1) and in the next week, the supplement was administered after 2 h of start of dialysis (group 2), with a predialysis fasting period of at least 3 h in both groups. Blood pressures, serum, and spent dialysate samples were collected and nausea occurrence was noted by severity. RESULTS Predialytic intake (group 1) was associated with higher predialysis and 1st hour blood urea, dialysis adequacy, and urea removal than group 2. Both groups achieved mean Kt/V > 1.2, and the occurrence of symptomatic hypotensive episodes and nausea was not significantly different between the groups. On repeated measures ANOVA, changes in blood urea over time showed significant group effect. CONCLUSIONS Predialytic supplementation was associated with better dialysis adequacy and urea removal than intradialytic supplementation. However, both timings were equally tolerated and not associated with underdialysis.
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Affiliation(s)
- Namrata S Rao
- Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Abhilash Chandra
- Department of Nephrology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India,
| | - Sai Saran
- Department of Critical Care Medicine, Super Speciality Cancer Institute & Hospital, Lucknow, India
| | - Manish Raj Kulshreshta
- Department of Biochemistry, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Poonam Tiwari
- Department of Dietetics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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14
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Hendriks FK, Kooman JP, van Loon LJ. Dietary protein interventions to improve nutritional status in end-stage renal disease patients undergoing hemodialysis. Curr Opin Clin Nutr Metab Care 2021; 24:79-87. [PMID: 33060457 PMCID: PMC7752218 DOI: 10.1097/mco.0000000000000703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Poor nutritional status is prevalent among end-stage renal disease patients undergoing hemodialysis. Chronic hemodialysis patients show an accelerated decline in skeletal muscle mass and strength, which is associated with higher mortality rates and a reduced quality of life. The current review aims to summarize recent advances regarding underlying causes of muscle loss and interventions that support muscle mass maintenance in patients with chronic hemodialysis. RECENT FINDINGS Muscle maintenance in chronic hemodialysis patients is compromised by low dietary protein intake levels, anabolic resistance of skeletal muscle tissue, sedentary behavior, and amino acid removal during hemodialysis. Studies assessing the effect of increased protein intake on nutritional status generally show beneficial results, especially in hypoalbuminemic chronic hemodialysis patients. The muscle protein synthetic response following protein ingestion in chronic hemodialysis patients may be enhanced through incorporation of structured physical activity and/or concurrent ketoacid ingestion. SUMMARY A coordinated program that combines nutritional and physical activity interventions is likely required to attenuate the decline in muscle mass and strength of chronic hemodialysis patients. Nephrologists, dieticians, and exercise specialists should collaborate closely to establish guidelines regarding the appropriate quantity and timing of protein ingestion. In addition, they should provide tailored nutritional and physical activity interventions for chronic hemodialysis patients (see video, Supplemental Digital Content 1, Video abstract, http://links.lww.com/COCN/A14).
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Affiliation(s)
- Floris K. Hendriks
- Department of Human Biology
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism
| | - Jeroen P. Kooman
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
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15
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Machado J, Miyahira RF, Marques M, Moura-Nunes N, Guimarães RR, Zago L, Santana I, Leite Junior M, Avesani CM. Development of muffins as dialysis snacks for patients undergoing hemodialysis: results of chemical composition and sensory analysis. J Nephrol 2020; 34:1281-1289. [PMID: 32860211 PMCID: PMC8357674 DOI: 10.1007/s40620-020-00831-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022]
Abstract
Objective This study aimed to develop two non-industrial food products as financially accessible options to prevent and treat malnutrition in hemodialysis (HD) patients. These food products were developed and intended for use as dialysis snacks. Methods This is a cross-sectional and multi-step study. First, 183 adult HD patients (55 ± 14 years; 50.8% males), replied to a questionnaire with their food preferences regarding taste (salty, sweet, bitter, sour) and consistency (liquid, solid, pasty) for a dialysis snack. Most patients preferred a food product with a solid consistency (90%) and a salty flavor (81.4%). Second, three muffin formulations of fine herbs were developed; one enriched with whey protein concentrate (WPC), a second with textured soy protein (TSP) and a third standard formulation without protein for comparison with the protein-enriched muffins, for which the chemical and nutritional compositions were analyzed. In the third step, 60 patients on HD (61 ± 15 years; 53% males) were enrolled in a sensory analysis by applying a 9-point structured hedonic scale, ranging from “extremely liked” (score 9) to “extremely disliked” (score 1). Results When compared with the standard formulation, the formulations enriched with WPC and TSP protein had a significantly higher amount of protein/serving (Standard: 5.9 ± 0.3 g vs WPC: 14.5 ± 0.9 g and TSP 10.8 ± 0.7 g; P < 0.05) but a lower amount of carbohydrate (Standard: 13.1 ± 2.2 g vs WPC: 5.6 ± 0.8 g and TSP 6.0 ± 1.2 g vs; P < 0.05). The mineral content/serving of the protein-enriched muffins was low in phosphorus (50 mg) and sodium (180 mg). The potassium content/serving was moderate for the WPC muffin (225.2 mg) and low for the TSP muffin (107.9 mg). The acceptability index (AI) for the enriched protein muffins was higher than 70% and similar to the standard formulation. Conclusion The muffins with fine herbs and enriched with protein were well-accepted by all patients and appropriate to serve as dialysis snacks for HD patients.
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Affiliation(s)
- Jessica Machado
- Graduation Program in Food, Nutrition and Health, Institute of Nutrition, Rio de Janeiro State University, R São Francisco Xavier, 524, Rio de Janeiro, RJ, 20550-900, Brazil
| | - Roberta Fontanive Miyahira
- Department of Basic and Experimental Nutrition, Institute of Nutrition, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-900, Brazil
| | - Monica Marques
- Department of Organic Chemistry, Institute of Chemistry, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-90, Brazil
| | - Nathalia Moura-Nunes
- Department of Basic and Experimental Nutrition, Institute of Nutrition, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-900, Brazil
| | - Renata Rangel Guimarães
- Department of Basic and Experimental Nutrition, Institute of Nutrition, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-900, Brazil
| | - Lilia Zago
- Department of Basic and Experimental Nutrition, Institute of Nutrition, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-900, Brazil
| | - Isabelle Santana
- Department of Basic and Experimental Nutrition, Institute of Nutrition, Rio de Janeiro State University, R Sao Francisco Xavier, 524, Rio de Janeiro, 20550-900, Brazil
| | - Maurilo Leite Junior
- Nephrology Division, Rio de Janeiro Federal University, Av Pedro Calmon, 550, Rio de Janeiro, 21941-901, Brazil
| | - Carla Maria Avesani
- Graduation Program in Food, Nutrition and Health, Institute of Nutrition, Rio de Janeiro State University, R São Francisco Xavier, 524, Rio de Janeiro, RJ, 20550-900, Brazil. .,Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Baxter Novum, Karolinska Institute, M99 Karolinska University Hospital Huddinge, Huddinge, 14186, Sweden.
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16
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Kalantar-Zadeh K, Moore LW. Why the Nutritional Management of Acute Versus Chronic Kidney Disease Should Differ. J Ren Nutr 2020; 29:265-268. [PMID: 31230723 DOI: 10.1053/j.jrn.2019.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/27/2019] [Indexed: 01/29/2023] Open
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17
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Mouillot T, Filancia A, Boirie Y, Brindisi MC, Hafnaoui N, Van Wymelbeke V, Teillet E, Meintani I, Jacquin-Piques A, Leloup C, Pénicaud L, Mousson C, Brondel L. Hemodialysis Affects Wanting and Spontaneous Intake of Protein-Rich Foods in Chronic Kidney Disease Patients. J Ren Nutr 2020; 31:164-176. [PMID: 32723525 DOI: 10.1053/j.jrn.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Protein-energy wasting is a risk factor for mortality and morbidity in hemodialysis patients (HD patients). Food intake could be modified by HD-related changes in the food reward system (i.e., liking and wanting of specific macronutrients). In HD patients on days with and without dialysis, we evaluated (1) the reward system for protein-, fat-, and carbohydrate-rich foods, plasma hormones, and metabolite changes; and (2) the spontaneous ad libitum intake of macronutrients. (DESIGN AND) METHODS Twenty-four HD patients evaluated their liking and wanting of macronutrients at 7:30 AM and 11:30 AM on a day with and a day without dialysis. Concentrations of hormones and plasma amino acids were determined. An additional 18 HD patients ate what they wanted from a buffet lunch comprising 8 dishes on a day with and a day without dialysis. Healthy subjects, age-, sex-, and body mass index-matched, served as controls. RESULTS At 11:30 AM, wanting for protein-rich foods was higher on the day with than on the day without dialysis (P < .01), bringing wanting levels close to those of healthy subjects. This increase correlated with changes in the concentrations of plasma amino acids (P < .01). HD patients ate more protein from the buffet on the day with than on the day without dialysis (P < .01) and more than healthy subjects (P < .01). CONCLUSIONS In HD patients, wanting and spontaneous intake of protein-rich foods increase immediately after dialysis. This increase correlated with decreased concentrations of plasma amino acids. Thus, in clinical practice, protein-rich foods should be recommended during and after dialysis in patients with protein-energy wasting.
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Affiliation(s)
- Thomas Mouillot
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France; Department of Hepato-Gastroenterology, University Hospital of Dijon, Dijon, France
| | - Anna Filancia
- Department of Nephrology, Hospital of Macon, Macon, France
| | - Yves Boirie
- University of Clermont Auvergne, INRA, Human Nutrition Unit, CRNH, BP 10448, Clermont-Ferrand, France; Clinical Nutrition Department, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Claude Brindisi
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France; Department of Endocrinology, University Hospital of Dijon, Dijon, France
| | - Noureddine Hafnaoui
- University of Clermont Auvergne, INRA, Human Nutrition Unit, CRNH, BP 10448, Clermont-Ferrand, France
| | - Virginie Van Wymelbeke
- The Research Unit, Department of Geriatric Medicine, University Hospital of Dijon, Dijon, France
| | - Eric Teillet
- SensoStat, Center for Taste and Feeding Behavior, Dijon, France
| | - Ioanna Meintani
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France
| | - Agnès Jacquin-Piques
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France; Department of Neurophysiology, University Hospital of Dijon, Dijon, France
| | - Corinne Leloup
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France
| | - Luc Pénicaud
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France; STROMALab, CNRS 5273 INSERM U1031, University of Toulouse III Paul Sabatier, Toulouse, France
| | | | - Laurent Brondel
- Centre for Taste and Feeding Behavior, Agrosup Dijon, UMR CNRS 6265, INRA 1324, University of Bourgogne Franche-Comté, Dijon, France; Department of Hepato-Gastroenterology, University Hospital of Dijon, Dijon, France.
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18
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Kalantar-Zadeh K, Moore LW. Does Kidney Longevity Mean Healthy Vegan Food and Less Meat or Is Any Low-Protein Diet Good Enough? J Ren Nutr 2020; 29:79-81. [PMID: 30782404 DOI: 10.1053/j.jrn.2019.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Kamyar Kalantar-Zadeh
- Director Clinical Research, Department of Surgery, Houston Methodist Hospital, Houston, Texas USA.
| | - Linda W Moore
- Director Clinical Research, Department of Surgery, Houston Methodist Hospital, Houston, Texas USA
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19
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Tsai WC, Wu HY, Peng YS, Hsu SP, Chiu YL, Yang JY, Chen HY, Pai MF, Lin WY, Hung KY, Chu FY, Tsai SM, Chien KL. Short-Term Effects of Very-Low-Phosphate and Low-Phosphate Diets on Fibroblast Growth Factor 23 in Hemodialysis Patients: A Randomized Crossover Trial. Clin J Am Soc Nephrol 2019; 14:1475-1483. [PMID: 31519550 PMCID: PMC6777602 DOI: 10.2215/cjn.04250419] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/11/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The short-term effects of low-phosphate diets on fibroblast growth factor 23 (FGF23) level and the optimal amount of dietary phosphate restriction in patients undergoing hemodialysis remain unknown. DESIGN SETTING, PARTICIPANTS, & MEASUREMENTS This was a randomized, active-controlled trial with a crossover design that included 35 adults with ESKD undergoing thrice-weekly hemodialysis and with a serum phosphate level >5.5 mg/dl or between 3.5 and 5.5 mg/dl with regular phosphate binder use at a hemodialysis unit of tertiary teaching hospital in Taiwan. Subjects were randomized 1:1 to receive a very-low-phosphate diet, with a phosphate-to-protein ratio of 8 mg/g, or a low-phosphate diet, with a phosphate-to-protein ratio of 10 mg/g for 2 days, each with a 5-day washout during which subjects adhered to their usual diet. The primary outcome measure was mean difference in change-from-baseline intact FGF23 level between intervention groups. Secondary outcomes included difference in change-from-baseline serum phosphate, intact parathyroid hormone (PTH), and C-terminal FGF23 level between intervention groups. RESULTS There was no significant difference in the mean change-from-baseline in intact FGF23 levels between the two study diets. The very-low-phosphate diet significantly lowered serum phosphate (mean difference, 0.6 mg/dl; 95% confidence interval [95% CI], 0.2 to 1.0; P=0.002). There were no significant differences in change-from-baseline intact PTH and C-terminal FGF23 levels between the two study diets. CONCLUSIONS Over the 2-day period, the FGF23-lowering effect of the very-low-phosphate diet is similar to that of the low-phosphate diet. The very-low-phosphate diet has an additional phosphate-lowering effect compared with the low-phosphate diet.
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Affiliation(s)
- Wan-Chuan Tsai
- Division of Nephrology, Department of Internal Medicine, .,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.,Center for General Education, Lee-Ming Institute of Technology, New Taipei City, Taiwan.,Department of Marketing and Distribution Management, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Hon-Yen Wu
- Division of Nephrology, Department of Internal Medicine.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Yu-Sen Peng
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Shih-Ping Hsu
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Yen-Ling Chiu
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.,Graduate Program in Biomedical Informatics and
| | - Ju-Yeh Yang
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hung-Yuan Chen
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Mei-Fen Pai
- Division of Nephrology, Department of Internal Medicine.,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Wan-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Kuan-Yu Hung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Fang-Yeh Chu
- Department of Clinical Pathology, and.,Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan; and.,Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City, Taiwan.,School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei City, Taiwan
| | - Shu-Min Tsai
- Dietary Department, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan; .,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.,School of Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan
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20
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Spatola L, Finazzi S, Angelini C, Badalamenti S. High Animal and Vegetarian Protein Intake in Hemodialysis Patients. J Ren Nutr 2018; 29:248. [PMID: 30309782 DOI: 10.1053/j.jrn.2018.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/20/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Leonardo Spatola
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano (MI), Italy.
| | - Silvia Finazzi
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
| | - Claudio Angelini
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
| | - Salvatore Badalamenti
- Division of Nephrology and Hemodialysis, Humanitas Clinical and Research Hospital, Rozzano (MI), Italy
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