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Frankel AH, Wahba M, Ashworth V, Bedi R, Berrington R, Buckley M, Chandrasekharan L, Doyle F, Duval D, Game F, Hamilton S, Hussain S, James J, Jebb H, Karalliedde J, Kong MF, Kuverji A, Lambie M, Main C, Price S, Wijewickrama P, Williams J, Dhatariya K, Chowdhury TA. Management of adults with diabetes on dialysis: Summary of recommendations of the Joint British Diabetes Societies guidelines 2022. Diabet Med 2023; 40:e15027. [PMID: 36524709 DOI: 10.1111/dme.15027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Diabetes is the commonest cause of end-stage kidney disease in many parts of the world, and many people on dialysis programmes live with diabetes. Such people are vulnerable to complications from their diabetes, and their care may be fragmented due to the many specialists involved. This updated guidance from the Joint British Diabetes Societies aims to review and update the 2016 guidance, with particular emphasis on glycaemic monitoring in the light of recent advances in this area. In addition, the guidance covers clinical issues related to the management of diabetes in people on peritoneal dialysis, along with acute complications such as hypoglycaemia and ketoacidosis, and chronic complications such as foot and eye disease.
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Affiliation(s)
| | - Mona Wahba
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | - Vicky Ashworth
- School of Health Sciences, Institute of Clinical Sciences, University of Liverpool, Liverpool, UK
| | - Rachna Bedi
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | - Fiona Doyle
- Epsom and St Helier University Hospitals NHS Trust, Carshalton, UK
| | | | - Frances Game
- University Hospitals of Derby and Burton NHS Foundation, Derby, UK
- University of Nottingham, Nottingham, UK
| | - Susie Hamilton
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - June James
- Leicester Diabetes Centre, Leicester, UK
| | - Hannah Jebb
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | - Apexa Kuverji
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | - Sara Price
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Ketan Dhatariya
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Tahseen A Chowdhury
- Department of Diabetes and Metabolism, The Royal London Hospital, London, UK
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Wijewickrama P, Williams J, Bain S, Dasgupta I, Chowdhury TA, Wahba M, Frankel AH, Lambie M, Karalliedde J. Narrative Review of glycaemic management in people with diabetes on peritoneal dialysis. Kidney Int Rep 2023; 8:700-714. [PMID: 37069983 PMCID: PMC10105084 DOI: 10.1016/j.ekir.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/09/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
There is an increasing number of people with diabetes on peritoneal dialysis (PD) worldwide. However, there is a lack of guidelines and clinical recommendations for managing glucose control in people with diabetes on PD. The aim of this review is to provide a summary of the relevant literature and highlight key clinical considerations with practical aspects in the management of diabetes in people undergoing PD. A formal systematic review was not conducted because of the lack of sufficient and suitable clinical studies. A literature search was performed using PubMed, MEDLINE, Central, Google Scholar and ClinicalTrials.gov., from 1980 through February 2022. The search was limited to publications in English. This narrative review and related guidance have been developed jointly by diabetologists and nephrologists, who reviewed all available current global evidence regarding the management of diabetes in people on PD.We focus on the importance of individualized care for people with diabetes on PD, the burden of hypoglycemia, glycemic variability in the context of PD and treatment choices for optimizing glucose control. In this review, we have summarized the clinical considerations to guide and inform clinicians providing care for people with diabetes on PD.
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Affiliation(s)
- Piyumi Wijewickrama
- Department of Diabetes and Endocrinology, University College London Hospital, London, UK
| | - Jennifer Williams
- Department of Renal Medicine, Royal Devon and Exeter Hospital, Exeter, UK
| | - Steve Bain
- Diabetes Research Unit, Swansea University, Swansea, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, Heartlands Hospital Birmingham, Brimingham, UK
| | | | - Mona Wahba
- Department of Renal Medicine, St. Helier Hospital, Carshalton, UK
| | - Andrew H. Frankel
- Department of Renal Medicine, Imperial College Healthcare, London, UK
| | - Mark Lambie
- Department of Renal Medicine, Keele University, Keele, UK
| | - Janaka Karalliedde
- School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
- Correspondence: Janaka Karalliedde, School of Cardiovascular and Metabolic Medicine and Sciences, King's College London, London SE1 9NH, UK.
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Castro-Barquero S, Arias-Guillén M, Pi-Oriol S, Sacanella E, Romano-Andrioni B, Vidal-Lletjós S, Ruiz-León AM, Estruch R, Casas R. A Comparative Study of the Efficacy of an Intervention with a Nutritional Supplement for Patients with Chronic Kidney Disease: A Randomized Trial. J Clin Med 2022; 11:jcm11061647. [PMID: 35329972 PMCID: PMC8951226 DOI: 10.3390/jcm11061647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease (CKD) involves heterogeneous diseases that affect the renal structure and function. Malnutrition plays a crucial role during patients with CKD on hemodialysis (HD) treatment and is associated with an increased rate and duration of hospitalizations. The aim of this randomized, parallel, intervention-controlled trial was to assess whether the use of daily supplementation with a new nutritional product developed by the Grand Fontaine Laboratories improves the nutritional status and anthropometric parameters of stage 5 CKD patients, compared with standard renal dietary advice, after three months of follow-up. Dietary intake, anthropometric measurements, physical activity, and blood samples were collected at baseline and after three months of intervention. Significant improvements were observed within the intervention group in body weight (1.5 kg [95% CI: 0.9 to 2.12 kg]) and BMI (0.54 kg/m2 [95% CI: 0.31 to 0.77]; p-value between groups, 0.002 and 0.006, respectively). In the control group, significant decreases were observed in transferrin saturation (-5.04% [95% CI: -8.88 to -1.21]) and alpha-tocopherol levels (-3.31 umol/L [95% CI: -6.30 to -0.32]). We concluded that daily dietary intake of a specific renal nutritional complement in CKD patients with or at risk of malnutrition may prevent deterioration in nutritional parameters.
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Affiliation(s)
- Sara Castro-Barquero
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Marta Arias-Guillén
- Department of Nephrology, Hospital Clínic Barcelona, 08036 Barcelona, Spain;
| | - Sofia Pi-Oriol
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
| | - Emilio Sacanella
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | | | | | - Ana María Ruiz-León
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Mediterranean Diet Foundation, 08021 Barcelona, Spain
| | - Ramon Estruch
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Rosa Casas
- Department of Medicine, Faculty of Medicine and Life Sciences, University of Barcelona, 08036 Barcelona, Spain; (S.C.-B.); (S.P.-O.); (E.S.); (R.E.)
- Department of Internal Medicine, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clinic, 08036 Barcelona, Spain;
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-2275745; Fax: +34-93-2275758
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Mahjoub F, Mizouri R, Jamoussi H. [Nutritional status of elderly hemodialysis people in Tunisia]. Nephrol Ther 2021; 17:168-174. [PMID: 33994140 DOI: 10.1016/j.nephro.2020.10.004] [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: 01/08/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The nutritional status of old hemodialysis patients determines their prognosis. The aim of this study was to evaluate the spontaneous dietary intake of hemodialysis of elderly patients. METHODS This cross-sectional descriptive study included 40 elderly hemodialysis patients recruited at the M8 nephrology department of Charles Nicolle hospital in Tunis. All patients went through a clinical examination to specify anthropometric measurements and a dietary survey based on food registration for 3 consecutive days to obtain a nutritional assessment. RESULTS The evaluation of patients' energy intake showed an average daily intake of 25.3±12.3kcal/kg of ideal weight/day. The average total energy intake of patients on dialysis and non-dialysis days was 29.7±17.7kcal/kg and 20.9±6.9kcal/kg, respectively, with a statistically significant difference (P=0.001). The average daily protein intake was 0.99±0.57g/kg on the day of no dialysis. It decreased statistically significantly (P=0.005) on the day of no dialysis at 0.73±0.28g/kg. Phosphorus consumption was excessive on dialysis and non-dialysis days respectively in 20% and 3% of cases. Deficiency of calcium intake affected the entire population studied on the day of non-dialysis. Only 6% of patients had a calcium intake satisfactory on the day of dialysis. CONCLUSION A lot of dietary errors were noticed in our study. The assessment of nutritional intake in elderly people with hemodialysis should be part of their management systematically.
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Affiliation(s)
- Faten Mahjoub
- Service A, institut national de nutrition et de technologie alimentaire de Tunis, 8, rue des Lilas, cité Jardins de l'Aouina, 2045 Tunis, Tunisie
| | - Ramla Mizouri
- Service A, institut national de nutrition et de technologie alimentaire de Tunis, 8, rue des Lilas, cité Jardins de l'Aouina, 2045 Tunis, Tunisie.
| | - Henda Jamoussi
- Service A, institut national de nutrition et de technologie alimentaire de Tunis, 8, rue des Lilas, cité Jardins de l'Aouina, 2045 Tunis, Tunisie
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Brown TJ, Williams H, Mafrici B, Jackson HS, Johansson L, Willingham F, McIntosh A, MacLaughlin HL. Dietary interventions with dietitian involvement in adults with chronic kidney disease: A systematic review. J Hum Nutr Diet 2021; 34:747-757. [PMID: 33682964 DOI: 10.1111/jhn.12870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A comprehensive evidence base is needed to support recommendations for the dietetic management of adults with chronic kidney disease (CKD). The present study aimed to determine the effect of dietary interventions with dietitian involvement on nutritional status, well-being, kidney risk factors and clinical outcomes in adults with CKD. METHODS Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PsycINFO and EMBASE.com were searched from January 2000 to November 2019. Intentional weight loss and single nutrient studies were excluded. Risk of bias was assessed using the Cochrane risk-of-bias tool. Effectiveness was summarised using the mean difference between groups for each outcome per study. RESULTS Twelve controlled trials (1906 participants) were included. High fruit and vegetable intake, as well as a multidisciplinary hospital and community care programme, slowed the decline in glomerular filtration rate in adults with stage 3-4 CKD. Interventions addressing nutrition-related barriers increased protein and energy intake in haemodialysis patients. A Mediterranean diet and a diet with high n-3 polyunsaturated fatty acids improved the lipid profile in kidney transplant recipients. CONCLUSIONS A limited number of studies suggest benefits as a result of dietary interventions that are delivered by dietitians and focus on diet quality. We did not identify any studies that focussed on our primary outcome of nutritional status or studies that examined the timing or frequency of the nutritional assessment. This review emphasises the need for a wider body of high-quality evidence to support recommendations on what and how dietetic interventions are delivered by dietitians for adults with CKD.
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Affiliation(s)
- Tamara J Brown
- Usher Institute, Old Medical School, University of Edinburgh, Edinburgh, UK
| | - Harriet Williams
- Department of Nutrition and Dietetics, Betsi Cadwaladr University Health Board, Bangor, UK
| | - Bruno Mafrici
- Renal and Transplant Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Helena S Jackson
- Renal and Transplantation Unit (Nutrition & Dietetics), St George's University Hospitals NHS Trust, London, UK
| | - Lina Johansson
- Department of Metabolism, Digestion and Reproduction, Imperial Healthcare NHS Trust, London, UK
| | - Fiona Willingham
- Dietetic department, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Ashleigh McIntosh
- Faculty of Health Sciences and Medicine, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Helen L MacLaughlin
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Challenges of reducing protein-bound uremic toxin levels in chronic kidney disease and end stage renal disease. Transl Res 2021; 229:115-134. [PMID: 32891787 DOI: 10.1016/j.trsl.2020.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
The prevalence of chronic kidney disease (CKD) in the worldwide population is currently estimated between 11% and 13%. Adequate renal clearance is compromised in these patients and the accumulation of a large number of uremic retention solutes results in an irreversible worsening of renal function which can lead to end stage renal disease (ESRD). Approximately three million ESRD patients currently receive renal replacement therapies (RRTs), such as hemodialysis, which only partially restore kidney function, as they are only efficient in removing mainly small, unbound solutes from the circulation while leaving larger and protein-bound uremic toxins (PBUTs) untouched. The accumulation of PBUTs in patients highly increases the risk of cardiovascular events and is associated with higher mortality and morbidity in CKD and ESRD. In this review, we address several strategies currently being explored toward reducing PBUT concentrations, including clinical and medical approaches, therapeutic techniques, and recent developments in RRT technology. These include preservation of renal function, limitation of colon derived PBUTs, oral sorbents, adsorbent RRT technology, and use of albumin displacers. Despite the promising results of the different approaches to promote enhanced removal of a small percentage of the more than 30 identified PBUTs, on their own, none of them provide a treatment with the required efficiency, safety and cost-effectiveness to prevent CKD-related complications and decrease mortality and morbidity in ESRD.
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Silva MZC, Vogt BP, Reis NSC, Oliveira RC, Caramori JCT. Which Method Should Be Used to Assess Protein Intake in Peritoneal Dialysis Patients? Assessment of Agreement Between Protein Equivalent of Total Nitrogen Appearance and 24-Hour Dietary Recall. J Ren Nutr 2020; 31:320-326. [PMID: 32958375 DOI: 10.1053/j.jrn.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/20/2020] [Accepted: 08/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES After dialysis initiation, a high protein diet is recommended due to significant nutrient losses through dialysate and increased risk of protein energy wasting. In peritoneal dialysis (PD) patients, protein intake can be assessed through different methods that have some advantages and limitations, which affect its use on routine care. The aim of this study is to evaluate the agreement between 2 different methods (24-hour dietary recall and PNA-protein equivalent of total nitrogen appearance) on estimating protein intake in PD patients. DESIGN AND METHODS Patients on PD for at least 3 months, aged 18 years old or more, were enrolled. To estimate protein intake, 24-hour dietary recall and PNA was used. PNA was calculated from 24-hour urine on the same day of the 24-hour dietary recall. RESULTS Fifty individuals on PD were included, mean age 55.7 ± 16.2 years, and body mass index 26.0 ± 4.5 kg/m2. The average energy consumption was 1788.79 ± 504.40 kcal/day, which corresponds to 26.81 ± 9.11 kcal/kg current body weight (BW)/day and 29.82 ± 8.39 kcal/kg ideal body weight (IBW)/day. The median of total daily and normalized protein intake estimated using dietary recall was 61.43 (45.28-87.40) g/day, 0.90 (0.58-1.22) g/kg current BW/day, and 1.04 (0.77-1.32) g/kg IBW/day, respectively. Daily protein intake estimated by PNA was 55.75 (48.27-67.74) g/day, protein intake normalized by current BW was 0.81 (0.72-0.99) g/kg and 0.92 (0.83-1.06) g/kg IBW/day. Bland-Altman analysis indicates no systematic bias for the assessment of total protein intake and normalized protein intake for current and ideal BW. Significant proportionality bias was observed for both evaluations, showing there is a dispersion of the values. CONCLUSIONS Despite the absence of systematic bias in the Bland-Altman analysis, there is no agreement in the assessment of protein intake by dietary recall and PNA, due to the existence of proportionality bias. Thus, values can be influenced biased by the magnitude of the measures.
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Affiliation(s)
- Maryanne Zilli Canedo Silva
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Barbara Perez Vogt
- Medical School, Federal University of Uberlândia (UFU), Uberlândia, Brazil
| | - Nayrana Soares Carmo Reis
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
| | - Rogerio Carvalho Oliveira
- Department of Internal Medicine, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil
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Byrne FN, Gillman B, Kiely M, Bowles M, Connolly P, Earlie J, Murphy J, Rennick T, Reilly EO, Shiely F, Kearney P, Eustace J. Revising Dietary Phosphorus Advice in Chronic Kidney Disease G3-5D. J Ren Nutr 2020; 31:132-143. [PMID: 32586712 DOI: 10.1053/j.jrn.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/20/2022] Open
Abstract
We summarize how practicing dietitians combined available evidence with clinical experience, to define revised dietary recommendations for phosphorus in chronic kidney disease G3-5D. As well as a review of the evidence base, 4 priority topics were reviewed. These were translated into 3 nutrient level recommendations: the introduction of some plant protein where phosphorus is largely bound by phytate; consideration of protein intake in terms of phosphorus load and the phosphorus to protein ratio; and an increased focus on avoiding phosphate additives. This review summarizes and interprets the available evidence in order to support the development of practical food-based advice for patients with chronic kidney disease.
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Affiliation(s)
- Fiona N Byrne
- Department of Nutrition & Dietetics, Cork University Hospital, Cork, Ireland; Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland.
| | - Barbara Gillman
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Mairead Kiely
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Maria Bowles
- Department of Nutrition & Dietetics, University Hospital Limerick, Limerick, Ireland
| | - Pauline Connolly
- Department of Nutrition & Dietetics, Cavan General Hospital, Cavan, Ireland
| | - Joyce Earlie
- Beacon Renal, Sandyford & Tallaght, Dublin, Ireland
| | - Jean Murphy
- Department of Nutrition & Dietetics, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Theresa Rennick
- Department of Nutrition & Dietetics, Midland Regional Hospital, Tullamore, Ireland
| | | | - Frances Shiely
- Health Research Board, Clinical Research Facility, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | | | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, Cork, Ireland; Health Research Board, Clinical Research Facility, Cork, Ireland
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9
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Glavinovic T, Hurst H, Hutchison A, Johansson L, Ruddock N, Perl J. Prescribing high-quality peritoneal dialysis: Moving beyond urea clearance. Perit Dial Int 2020; 40:293-301. [PMID: 32063213 DOI: 10.1177/0896860819893571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Urea removal in peritoneal dialysis (PD) has been a primary measure of dialysis adequacy, but its utility remains limited due to its poor correlation with the clearance of other important uraemic retention solutes and the low certainty of evidence relating peritoneal urea clearance and survival of individuals doing PD. Indeed, clearances of other uraemic solutes, electrolyte imbalances, hypoalbuminaemia and nutritional status, may provide a more holistic measure of dialysis adequacy when evaluating individuals on PD in addition to focusing on person-centred outcomes. Here, we review the history of the urea and creatinine-centric approach to dialysis adequacy and explore the potential importance of other uraemic retention solutes, electrolyte disturbances, phosphorus control, peritoneal protein losses and hypoalbuminaemia, as well as nutritional management to promote a broader multidimensional concept of clearance for PD.
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Affiliation(s)
- Tamara Glavinovic
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Helen Hurst
- Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Trust, UK
| | - Alastair Hutchison
- Manchester Academic Health Science Centre, The University of Manchester, Manchester University NHS Trust, UK
| | - Lina Johansson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | | | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada.,Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center, Li Ka Shing Knowledge Institute, University of Toronto, Ontario, Canada
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Lambert K, Bahceci S, Lucan B, Ryan M. A practical guide for the use of very low calorie diets in adults with chronic kidney disease. Nephrology (Carlton) 2019; 25:281-289. [PMID: 31715058 DOI: 10.1111/nep.13680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
Obesity is increasingly common in individuals with chronic kidney disease (CKD). Being overweight or obese is associated with both the development and progression of kidney disease. Lifestyle interventions such as the use of very low-calorie diets (VLCD) are being used increasingly for patients with CKD despite warnings from manufacturers that they should be avoided or used with caution. Whilst these diets are effective and can induce rapid weight loss and suppress appetite, their use in patients with chronic and end stage kidney disease is more complex than in the general population. VLCD use in adults with kidney disease requires a more nuanced approach to prescription and closer monitoring for unintended side effects. This review describes the indications and clinical management of patients with CKD undertaking a very low-calorie diet and provides practical guidance regarding how to manage a VLCD, particularly for the latter stages of CKD.
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Affiliation(s)
- Kelly Lambert
- School of Medicine, Faculty of Science, Medicine and Health, and Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, New South Wales, Australia
| | - Su Bahceci
- Nutrition and Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Beth Lucan
- Nutrition Services, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Murielle Ryan
- Department of Nutrition, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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11
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Wright M, Southcott E, MacLaughlin H, Wineberg S. Clinical practice guideline on undernutrition in chronic kidney disease. BMC Nephrol 2019; 20:370. [PMID: 31619185 PMCID: PMC6796390 DOI: 10.1186/s12882-019-1530-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
| | | | | | - Stuart Wineberg
- Patient Representative, c/o The Renal Association, Bristol, UK
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12
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Saglimbene VM, Wong G, Teixeira-Pinto A, Ruospo M, Garcia-Larsen V, Palmer SC, Natale P, Campbell K, Carrero JJ, Stenvinkel P, Gargano L, Murgo AM, Johnson DW, Tonelli M, Gelfman R, Celia E, Ecder T, Bernat AG, Del Castillo D, Timofte D, Török M, Bednarek-Skublewska A, Duława J, Stroumza P, Hansis M, Fabricius E, Felaco P, Wollheim C, Hegbrant J, Craig JC, Strippoli GFM. Dietary Patterns and Mortality in a Multinational Cohort of Adults Receiving Hemodialysis. Am J Kidney Dis 2019; 75:361-372. [PMID: 31515137 DOI: 10.1053/j.ajkd.2019.05.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/26/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE & OBJECTIVE Clinical practice guidelines for dietary intake in hemodialysis focus on individual nutrients. Little is known about associations of dietary patterns with survival. We evaluated the associations of dietary patterns with cardiovascular and all-cause mortality among adults treated by hemodialysis. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS 8,110 of 9,757 consecutive adults on hemodialysis (January 2014 to June 2017) treated in a multinational private dialysis network and with analyzable dietary data. EXPOSURES Data-driven dietary patterns based on the GA2LEN food frequency questionnaire. Participants received a score for each identified pattern, with higher scores indicating closer resemblance of their diet to the identified pattern. Quartiles of standardized pattern scores were used as primary exposures. OUTCOMES Cardiovascular and all-cause mortality. ANALYTICAL APPROACH Principal components analysis with varimax rotation to identify common dietary patterns. Adjusted proportional hazards regression analyses with country as a random effect to estimate the associations between dietary pattern scores and mortality. Associations were expressed as adjusted HRs with 95% CIs, using the lowest quartile score as reference. RESULTS During a median follow-up of 2.7 years (18,666 person-years), there were 2,087 deaths (958 cardiovascular). 2 dietary patterns, "fruit and vegetable" and "Western," were identified. For the fruit and vegetable dietary pattern score, adjusted HRs, in ascending quartiles, were 0.94 (95% CI, 0.76-1.15), 0.83 (95% CI, 0.66-1.06), and 0.91 (95% CI, 0.69-1.21) for cardiovascular mortality and 0.95 (95% CI, 0.83-1.09), 0.84 (95% CI, 0.71-0.99), and 0.87 (95% CI, 0.72-1.05) for all-cause mortality. For the Western dietary pattern score, the corresponding estimates were 1.10 (95% CI, 0.90-1.35), 1.11 (95% CI, 0.87-1.41), and 1.09 (95% CI, 0.80-1.49) for cardiovascular mortality and 1.01 (95% CI, 0.88-1.16), 1.00 (95% CI, 0.85-1.18), and 1.14 (95% CI, 0.93-1.41) for all-cause mortality. LIMITATIONS Self-reported food frequency questionnaire, data-driven approach. CONCLUSIONS These findings did not confirm an association between mortality among patients receiving long-term hemodialysis and the extent to which dietary patterns were either high in fruit and vegetables or consistent with a Western diet.
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Affiliation(s)
- Valeria M Saglimbene
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.
| | - Germaine Wong
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Armando Teixeira-Pinto
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | | | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Patrizia Natale
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Katrina Campbell
- Department of Nutrition and Dietetics, University of Queensland at Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelo M Murgo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - David W Johnson
- Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia; Translational Research Institute, University of Queensland, Woolloongabba, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Rubén Gelfman
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Eduardo Celia
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Tevfik Ecder
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | | | - Delia Timofte
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Marietta Török
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Anna Bednarek-Skublewska
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Medical University of Lublin, Lublin
| | - Jan Duława
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Medical University of Silesia, Katowice, Poland
| | - Paul Stroumza
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Martin Hansis
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Paolo Felaco
- Nephrology and dialysis Presidio Ospedaliero Penne, Unita' Sanitaria Locale Pescara
| | | | | | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Giovanni F M Strippoli
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia; Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden; Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy; Diaverum Academy, Diaverum, Bari, Italy
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13
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Ahola AJ, Forsblom C, Harjutsalo V, Groop PH. Dietary intake in type 1 diabetes at different stages of diabetic kidney disease. Diabetes Res Clin Pract 2019; 155:107775. [PMID: 31271811 DOI: 10.1016/j.diabres.2019.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/27/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022]
Abstract
AIM Diet plays an important role in the kidney health of individuals with type 1 diabetes. However, not much is known about dietary practices at different stages of diabetic nephropathy. We aimed at investigating food intake, dietary patterns, and nutrient intakes in individuals with type 1 diabetes differing in renal status. METHODS Data were available from 1874 individuals with type 1 diabetes (45% men, age 48 ± 13 years). Diet was assessed at the levels of food items and diet patterns (diet questionnaire), and energy and nutrient intakes (food record). Six groups were formed based on the eGFR or dialysis and transplantation status. RESULTS Reductions in liquid-milk product and salt consumption, and increase in special diet adherence were observed at the early stages of eGFR decline. Reduced coffee consumption was observed after eGFR was <30 ml/min/1.73 m2. With advancing kidney failure, rye bread consumption decreased, but that of wheat bread increased. Compared to those with intact kidney function (the index group), the Fish and vegetable diet pattern scores were higher in individuals with mildly-to-severely decreased eGFR. Instead, the Sweet pattern scores were lower than in the index group in all other groups. Energy intake was lower in all groups compared to those with intact kidney function. Advancing kidney failure was associated with reductions in protein intake per body weight, and in the intakes of sodium, potassium, calcium, and phosphorus. CONCLUSIONS Differences in the dietary intake are seen already at the early stages of kidney function decline.
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Affiliation(s)
- Aila J Ahola
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Finland; Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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14
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Mackay HJ, Campbell KL, van der Meij BS, Wilkinson SA. Establishing an evidenced‐based dietetic model of care in haemodialysis using implementation science. Nutr Diet 2019; 76:150-157. [DOI: 10.1111/1747-0080.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/11/2019] [Accepted: 02/15/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Hannah J. Mackay
- Department of Dietetics and FoodservicesMater Health Brisbane Queensland Australia
| | - Katrina L. Campbell
- Faculty of Health Sciences and MedicineBond University Gold Coast Queensland Australia
| | - Barbara S. van der Meij
- Department of Dietetics and FoodservicesMater Health Brisbane Queensland Australia
- Faculty of Health Sciences and MedicineBond University Gold Coast Queensland Australia
- Mater Research Institute, University of Queensland Brisbane Queensland Australia
| | - Shelley A. Wilkinson
- Department of Dietetics and FoodservicesMater Health Brisbane Queensland Australia
- Mater Research Institute, University of Queensland Brisbane Queensland Australia
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15
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Hannah J, Roe M, Warthon-Medina M, Pinchen H, Barrett M, Perry S. Phosphorus in food: limitations of food composition data. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/jokc.2018.3.6.362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Limiting the amount of phosphorus in the diet is the first line for management of hyperphosphatemia in chronic kidney disease, and it is therefore important that dietitians have access to accurate data on the phosphorus content of foods. However, food composition datasets have several limitations for use. In this article, Julie Hannah and colleagues describe the limitations of food composition data, and call for further research into this area
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Affiliation(s)
- Julie Hannah
- Renal Dietitian, Department of Renal Medicine, York Teaching Hospital NHS Trust, UK
| | - Mark Roe
- Senior Food and Nutrition Data Scientist, EuroFIR, Brussels, Belgium
| | - Marisol Warthon-Medina
- Registered Public Health Nutritionist, Food Databanks National Capability, Quadram Institute Bioscience, Norwich, UK
| | - Hannah Pinchen
- Research Scientist, Food Databanks National Capability, Quadram Institute Bioscience, Norwich, UK
| | - Maria Barrett
- Renal Dietitian, Department of Dietetics, Manchester University NHS Foundation Trust, UK
| | - Sue Perry
- Deputy Head of Dietetics, Department of Nutrition and Dietetics, Hull and East Yorkshire Hospitals NHS Trust, UK
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Davies R. The metabolomic quest for a biomarker in chronic kidney disease. Clin Kidney J 2018; 11:694-703. [PMID: 30288265 PMCID: PMC6165760 DOI: 10.1093/ckj/sfy037] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
Chronic kidney disease (CKD) is a growing burden on people and on healthcare for which the diagnostics are niether disease-specific nor indicative of progression. Biomarkers are sought to enable clinicians to offer more appropriate patient-centred treatments, which could come to fruition by using a metabolomics approach. This mini-review highlights the current literature of metabolomics and CKD, and suggests additional factors that need to be considered in this quest for a biomarker, namely the diet and the gut microbiome, for more meaningful advances to be made.
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Affiliation(s)
- Robert Davies
- School of Biomedical and Healthcare Sciences, University of Plymouth School of Biological Sciences, Plymouth, UK
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17
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Lambert K, Mansfield K, Mullan J. How do patients and carers make sense of renal dietary advice? A qualitative exploration. J Ren Care 2018; 44:238-250. [DOI: 10.1111/jorc.12260] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Kelly Lambert
- Department of Clinical Nutrition, Wollongong Hospital; Illawarra Shoalhaven Local Health District; Wollongong New South Wales Australia
| | - Kylie Mansfield
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
| | - Judy Mullan
- Graduate Medicine, Faculty of Science, Medicine and Health; University of Wollongong; Wollongong New South Wales Australia
- Director Illawarra Health Information Platform, Australian Health Services Research Institute; University of Wollongong; Wollongong New South Wales Australia
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18
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Liu PJ, Ma F, Wang QY, He SL. The effects of oral nutritional supplements in patients with maintenance dialysis therapy: A systematic review and meta-analysis of randomized clinical trials. PLoS One 2018; 13:e0203706. [PMID: 30212514 PMCID: PMC6136747 DOI: 10.1371/journal.pone.0203706] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/25/2018] [Indexed: 12/22/2022] Open
Abstract
Background/objective This systematic review aims to determine the potential effects of oral nutritional supplements (ONS) in patients receiving maintenance dialysis therapy (MDT). Methods Electronic databases were searched without language limits through to July 2018. Randomized controlled trials (RCTs) that involved comparisons of ONS versus placebo or routine care are included in this meta-analysis. RevMan 5.3 statistical software was used for meta-analysis. Results 15 articles with 589 subjects were included in our study. There are insufficient comparable data of randomized trials to allow meta-analysis of mortality. Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients. Compared with the control group, serum albumin levels and BMI in the ONS group were increased by 1.58 g/L (95% CI, 0.52–2.63, P = 0.003; I2 = 85%) and 0.40 kg/m2 (95% CI, 0.10–0.71, P = 0.01; I2 = 49%), respectively. In the subgroup analysis of patients receiving hemodialysis, albumin levels in ONS group were increased by 2.17 g/L (95% CI, 0.89–3.45, P<0.001; I2 = 90%). ONS may not influence serum phosphorus and potassium levels. Conclusions Very low-quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients, without influence on serum potassium levels. High-quality and large RCTs, particularly regarding the effects of ONS on mortality and quality of life, are needed to further validate our findings.
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Affiliation(s)
- Peng Ju Liu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
- * E-mail:
| | - Fang Ma
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
| | - Qi Yan Wang
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
| | - Shu Li He
- Department of Clinical Nutrition, Peking Union Medical College Hospital, China Academic Medical Science and Peking Union Medical College, Beijing, PR China
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19
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Frailty Intervention Trial iN End-Stage patientS on haemodialysis (FITNESS): study protocol for a randomised controlled trial. Trials 2018; 19:457. [PMID: 30143028 PMCID: PMC6109321 DOI: 10.1186/s13063-018-2842-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/06/2018] [Indexed: 01/31/2023] Open
Abstract
Background Frailty is a state of low physiological reserve and multi-systemic dysregulation that leads to susceptibility to external stressors; it is associated with adverse outcomes. North American data suggest that haemodialysis recipients are more likely to be frail than the general population, although data on UK cohorts are lacking. Furthermore, with a multitude of assessment tools, it is difficult for the clinician to ascertain which is most suitable for this population. The FITNESS Study aims to measure the prevalence and outcomes associated with frailty in a large UK haemodialysis cohort to determine the optimum frailty tool as defined by predictive value for mortality/hospitalisation and to conduct a feasibility study exploring a multi-disciplinary clinical intervention to improve frailty among haemodialysis recipients. Methods/design The study will follow a cohort multiple randomised controlled trial design; the initial cohort study will identify participants to be invited into a subsequent open-label randomised controlled trial. Eligible patients will be identified and recruited from their usual haemodialysis session. They will be invited to complete tasks and questionnaires collecting data on sarcopenia, immunosenescence, mood, cognition, disability, and comorbidity. Fifty pre-frail participants with suitable English proficiency will be randomly selected from this cohort to participate in the randomised controlled trial phase of the study. Further stratified randomisation will occur to assign these 50 participants to active or passive groups. The active group will receive a psychologically supported, patient-centred, multi-disciplinary intervention into frailty, in what we believe to be a first within this patient group. The control group will receive usual haemodialysis standard of care. All participants will be followed up using electronic patient records for outcomes to include hospitalisation and mortality. Primary outcomes for this phase of the study will be feasibility and tolerability of the clinical intervention study. Discussion The study will collect data on multiple aspects of frailty allowing for a rich dataset for detailed analysis. We believe this will be the first study to explore a psychologically supported, patient-centred intervention in this patient group. Trial registration Clinicaltrials.gov, NCT03071107. Registered on 6 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2842-x) contains supplementary material, which is available to authorized users.
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20
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Tinôco JDDS, Paiva MDGMND, Macedo BMD, Cossi MS, Delgado MF, Lira ALBDC. Pruritus in hemodialysis patients: association with phosphorus intake and serum calcium level. ACTA ACUST UNITED AC 2018; 39:e20170081. [PMID: 30043941 DOI: 10.1590/1983-1447.2018.2017-0081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/28/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the association between the occurrence of pruritus and adherence to the prescribed diet, biochemical indicators of renal function and the quality of hemodialysis in chronic renal patients. METHOD A cross-sectional study performed at a dialysis clinic in the Northeast of Brazil, with 200 patients undergoing hemodialysis in the first half of 2015.To analyze the data, inferential statistics were used, using Chi-Square and Fisher's Exact tests; and Mann Whitney U test. RESULTS The pruritus was present in 51% of the sample, being associated statistically with phosphorus consumption (P = 0.024) and elevation of serum calcium (P = 0.009). CONCLUSION Pruritus in chronic renal patients undergoing hemodialysis is influenced by adequate nonadherence to the prescribed diet, in addition to the elevation of biochemical indicators of renal function.
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Affiliation(s)
- Jéssica Dantas de Sá Tinôco
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
| | - Maria das Graças Mariano Nunes de Paiva
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
| | - Beatriz Medeiros de Macedo
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
| | - Marcelly Santos Cossi
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
| | - Millena Freire Delgado
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
| | - Ana Luisa Brandão de Carvalho Lira
- Universidade Federal do Rio Grande do Norte (UFRN). Centro de Ciências da Saúde. Programa de Pós-graduação em Enfermagem. Natal, Rio Grande do Norte, Brasil
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Salame C, Eaton S, Grimble G, Davenport A. Protein Losses and Urea Nitrogen Underestimate Total Nitrogen Losses in Peritoneal Dialysis and Hemodialysis Patients. J Ren Nutr 2018; 28:317-323. [PMID: 29709365 DOI: 10.1053/j.jrn.2018.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/02/2017] [Accepted: 01/29/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE Muscle wasting is associated with increased mortality and is commonly reported in dialysis patients. Hemodialysis (HD) and peritoneal dialysis (PD) treatments lead to protein losses in effluent dialysate. We wished to determine whether changes in current dialysis practice had increased therapy-associated nitrogen losses. DESIGN Cross-sectional cohort study. METHODS Measurement of total protein, urea and total nitrogen in effluent dialysate from 24-hour collections from PD patients, and during haemodiafiltration (HDF) and haemodialysis (HD) sessions. SUBJECTS One hundred eight adult dialysis patients. INTERVENTION Peritoneal dialysis, high-flux haemodialysis and haemodiafiltration. MAIN OUTCOME MEASURE Total nitrogen and protein losses. RESULTS Dialysate protein losses were measured in 68 PD and 40 HD patients. Sessional losses of urea (13.9 [9.2-21.1] vs. 4.8 [2.8-7.8] g); protein (8.6 [7.2-11.1] vs. 6.7 [3.9-11.1] g); and nitrogen (11.5 [8.7-17.7] vs. 4.9 [2.6-9.5] g) were all greater for HD than PD, P < .001. Protein-derived nitrogen was 71.9 (54.4-110.4) g for HD and 30.8 (16.1-59.6) g for PD. Weekly protein losses were lower with HD 25.9 (21.5-33.4) versus 46.6 (27-77.6) g/week, but nitrogen losses were similar. We found no difference between high-flux HD and HDF: urea (13.5 [8.8-20.6] vs. 15.3 [10.5-25.5] g); protein (8.8 [7.3-12.2] vs. 7.6 [5.8-9.0] g); and total nitrogen (11.6 [8.3-17.3] vs. 10.8 [8.9-22.5] g). Urea nitrogen (UN) only accounted for 45.1 (38.3-51.0)% PD and 63.0 (55.3-62.4)% HD of total nitrogen losses. CONCLUSION Although sessional losses of protein and UN were greater with HD, weekly losses were similar between modalities. We found no differences between HD and HDF. However, total nitrogen losses were much greater than the combination of protein and UN, suggesting greater nutritional losses with dialysis than previously reported.
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Affiliation(s)
- Clara Salame
- UCL Division of Medicine, University College London, London, United Kingdom
| | - Simon Eaton
- Development Biology and Cancer Programme, Great Ormond Street Institute of Child Health London, University College London, London, United Kingdom
| | - George Grimble
- UCL Institute for Liver and Digestive Health, Division of Medicine, University College London, London, United Kingdom
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, United Kingdom.
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22
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Saglimbene VM, Wong G, Craig JC, Ruospo M, Palmer SC, Campbell K, Garcia-Larsen V, Natale P, Teixeira-Pinto A, Carrero JJ, Stenvinkel P, Gargano L, Murgo AM, Johnson DW, Tonelli M, Gelfman R, Celia E, Ecder T, Bernat AG, Del Castillo D, Timofte D, Török M, Bednarek-Skublewska A, Duława J, Stroumza P, Hoischen S, Hansis M, Fabricius E, Felaco P, Wollheim C, Hegbrant J, Strippoli GFM. The Association of Mediterranean and DASH Diets with Mortality in Adults on Hemodialysis: The DIET-HD Multinational Cohort Study. J Am Soc Nephrol 2018; 29:1741-1751. [PMID: 29695436 DOI: 10.1681/asn.2018010008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/28/2018] [Indexed: 12/28/2022] Open
Abstract
Background Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain.Methods Mediterranean and DASH diet scores were derived from the GA2LEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category).Results During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. Corresponding estimates for the same DASH diet score tertiles were 1.01 (0.85 to 1.21) and 1.19 (0.99 to 1.43), respectively, for cardiovascular mortality and 1.03 (0.92 to 1.15) and 1.00 (0.89 to 1.12), respectively, for all-cause mortality. The association between DASH diet score and all-cause death was modified by age (P=0.03); adjusted hazard ratios for the middle and highest DASH diet score tertiles were 1.02 (0.81 to 1.29) and 0.70 (0.53 to 0.94), respectively, for younger patients (≤60 years old) and 1.05 (0.93 to 1.19) and 1.08 (0.95 to 1.23), respectively, for older patients.Conclusions Mediterranean and DASH diets did not associate with cardiovascular or total mortality in hemodialysis.
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Affiliation(s)
- Valeria M Saglimbene
- Sydney School of Public Health, University of Sydney, Sydney, Australia; .,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia.,Department of Renal Medicine, Westmead Hospital, Westmead, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | - Marinella Ruospo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Division of Nephrology and Transplantation, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | | | - Vanessa Garcia-Larsen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrizia Natale
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia
| | | | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | - Angelo M Murgo
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - David W Johnson
- Division of Medicine, Department of Nephrology, University of Queensland at the Princess Alexandra Hospital, Woolloongabba, Australia.,Translational Research Institute, University of Queensland, Woolloongabba, Australia
| | - Marcello Tonelli
- Cumming School of Medicine, Health Sciences Centre, University of Calgary, Calgary, Alberta, Canada
| | - Rubén Gelfman
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Eduardo Celia
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Tevfik Ecder
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | | | - Delia Timofte
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Marietta Török
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | - Anna Bednarek-Skublewska
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Faculty of Medicine, Medical University of Lublin, Lublin, Poland
| | - Jan Duława
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Paul Stroumza
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Martin Hansis
- Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden
| | | | - Paolo Felaco
- Nefrología e dialisi, Presidio Ospedaliero Penne, Unità Sanitaria Locale Pescara, Pescara, Italy; and
| | | | | | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, Sydney, Australia.,Diaverum Medical-Scientific Office, Diaverum, Lund, Sweden.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Diaverum Academy, Diaverum, Bari, Italy
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23
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Salamon KM, Lambert K. Oral nutritional supplementation in patients undergoing peritoneal dialysis: a randomised, crossover pilot study. J Ren Care 2017; 44:73-81. [DOI: 10.1111/jorc.12224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Kelly Lambert
- MSc (Nutr& Diet); Advanced Accredited Practising Dietitian, Illawarra Shoalhaven Local Health District; Wollongong NSW Australia
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24
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Duff EA, Chawke FM. A service review to assess if innovative intensive phosphate dietary education can help reduce phosphate levels to the recommended range in a hemodialysis population. Hemodial Int 2017; 21 Suppl 2:S22-S26. [DOI: 10.1111/hdi.12593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eileen A Duff
- Renal Dietetics Department; Queen Alexandra Hospital; Portsmouth England
| | - Fiona M Chawke
- Renal Dietetics Department; Queen Alexandra Hospital; Portsmouth England
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25
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Florens N, Yi D, Juillard L, Soulage CO. Using binding competitors of albumin to promote the removal of protein-bound uremic toxins in hemodialysis: Hope or pipe dream? Biochimie 2017; 144:1-8. [PMID: 28987629 DOI: 10.1016/j.biochi.2017.09.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 09/28/2017] [Indexed: 02/08/2023]
Abstract
Chronic kidney disease is associated with the accumulation of a large range of uremic retention solutes as referred to as uremic toxins. Some of these compounds belong to the group of Protein Bound Uremic Toxins (PBUT) due to their tight interactions with plasma proteins and especially serum albumin. These PBUT therefore exist in the bloodstream into two forms: a major bound (and non-diffusible) fraction and a minor free fraction. As a result, these compounds are poorly removed by most of the renal replacement therapies (such as hemodialysis) and their concentration can hardly be decreased in end-stage renal disease patients. An increase of the free fraction of PBUT could be achieved using chemical displacers that could compete with PBUT for binding to serum albumin. This review summarizes and discusses the interest of chemicals displacers as a valuable option to enhance PBUT removal in CKD patients.
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Affiliation(s)
- Nans Florens
- Univ. Lyon, CarMeN, INSERM U1060, INSA de Lyon, INRA U1397, F-69621, Villeurbanne, France; Hospices Civils de Lyon, Department of Nephrology, Hôpital E. Herriot, Lyon, F-69003, France.
| | - Dan Yi
- Univ. Lyon, CarMeN, INSERM U1060, INSA de Lyon, INRA U1397, F-69621, Villeurbanne, France
| | - Laurent Juillard
- Univ. Lyon, CarMeN, INSERM U1060, INSA de Lyon, INRA U1397, F-69621, Villeurbanne, France; Hospices Civils de Lyon, Department of Nephrology, Hôpital E. Herriot, Lyon, F-69003, France
| | - Christophe O Soulage
- Univ. Lyon, CarMeN, INSERM U1060, INSA de Lyon, INRA U1397, F-69621, Villeurbanne, France
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26
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Milazi M, Bonner A, Douglas C. Effectiveness of educational or behavioral interventions on adherence to phosphate control in adults receiving hemodialysis: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:971-1010. [PMID: 28398983 DOI: 10.11124/jbisrir-2017-003360] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) develop impaired excretion of phosphate. Hyperphosphatemia develops in ESKD as a result of the kidney's reduced ability to excrete ingested phosphate load and is characterized by high bone turnover and increased musculoskeletal morbidity including bone pain and muscle weakness. Increased serum phosphate levels are also associated with cardiovascular disease and associated mortality. These effects are significant considering that cardiovascular disease is the leading cause of death in ESKD, making phosphate control a crucial treatment goal. OBJECTIVES To determine the effectiveness of education or behavioral interventions on adherence to phosphate control in adults with ESKD receiving hemodialysis (HD). INCLUSION CRITERIA TYPES OF PARTICIPANTS Adults aged over 18 years with ESKD undergoing HD, attending dialysis facilities regardless of frequency and duration of treatment sessions per week. Studies with participants receiving hemodiafiltration were excluded. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST All types of educational and behavioral interventions aimed at improving adherence to dietary phosphate restriction, phosphate binder medication and HD. TYPES OF STUDIES Randomized controlled trials (RCTs), non-RCTs, before and after and cohort studies. OUTCOMES Outcome measures included serum phosphate levels, patient knowledge and adherence to phosphate control methods, chronic kidney disease (CKD) self-management behavior and perceived self-efficacy for CKD related to phosphate control. SEARCH STRATEGY A search was conducted in CINAHL, MEDLINE, The Cochrane Library, Embase, Web of Science, PsycINFO and ProQuest Dissertations and Theses Global to find published studies between January 2005 and December 2015. METHODOLOGICAL QUALITY Risk of bias was assessed by three reviewers prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). DATA EXTRACTION Data were extracted using the standardized data extraction tool from JBI-MAStARI. DATA SYNTHESIS Data were pooled using JBI software. Mean differences (95% confidence interval [CI]) and effect size estimates were calculated for continuous outcomes. Meta-analysis using a random-effects model was performed for serum phosphate levels, and where the findings could not be pooled using meta-analysis, results have been presented in a narrative form. Standard GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence assessment of outcomes has been reported. RESULTS A total of 18 studies were included in the review: seven studies focused on dietary phosphate, four studies focused on medications (phosphate binders) and six studies focused on dietary phosphate and medications. Only one study taught patients about diet, medications and HD to control phosphate. Sixteen studies showed significant improvements in phosphate levels. Meta-analysis of eight RCTs favored educational or behavioral interventions over standard care for serum phosphate control, with a weighted mean reduction of -0.23 mmol/l (95% CI -0.37, -0.08) in treatment groups. CONCLUSION Overall, educational or behavioral interventions increase adherence to phosphate control. Studies in this systematic review revealed improved outcomes on serum phosphate levels, patient knowledge and adherence to phosphate control methods, CKD self-management behavior and perceived self-efficacy for CKD related to phosphate control. However, there is a lack of sufficient data on how some of the studies implemented their interventions, suggesting that further research is required. Successful strategies that improve and optimize long-term adherence to phosphate control still need to be formulated.
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Affiliation(s)
- Molly Milazi
- 1School of Nursing, Queensland University of Technology, Brisbane, Australia 2Renal Nursing Professorial Unit, Kidney Health Services, Royal Brisbane and Women's Hospital, Brisbane, Australia 3CEBHA (Centre for Evidence-Based Healthy Ageing): a Joanna Briggs Institute Centre of Excellence
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27
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Kelly JT, Rossi M, Johnson DW, Campbell KL. Beyond Sodium, Phosphate and Potassium: Potential Dietary Interventions in Kidney Disease. Semin Dial 2017; 30:197-202. [PMID: 28239979 DOI: 10.1111/sdi.12580] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
People with kidney disease are advised to restrict individual nutrients, such as sodium, potassium, and phosphate, in line with current best practice guidelines. However, there is limited evidence to support the efficacy of single nutrient strategies, and compliance remains a challenge for clinicians to overcome. Many factors contribute to poor compliance with dietary prescriptions, including conflicting priorities for single nutrient restriction, the arduous self-monitoring required, and the health-related knock-on effects resulting from targeting these nutrients in isolation. This paper reviews the evidence base for the overall pattern of eating as a potential tool to deliver a diet intervention in which all the nutrients and foods work cumulatively and synergistically to improve clinical outcomes. These interventions may assist in kidney disease management and overcome these innate challenges that single nutrient interventions possess. Healthy dietary patterns are typically plant-based and lower in sodium and animal proteins. These patterns may have numerous mechanistic benefits for cardiovascular health in kidney disease, most notably through the increase in fruit, vegetables, and plant-based protein, as well as improved gut health through the increase in dietary fiber. The evidence to date on optimal dietary patterns points toward use of a predominantly plant-based diet, and suggests its adoption may improve clinical outcomes in dialysis patients. However, clinical trials are needed to determine whether these diet interventions are feasible, safe, and effective in this patient population.
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Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Megan Rossi
- Diabetes and Nutritional Sciences Division, Kings College London, London, UK
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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28
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Gryp T, Vanholder R, Vaneechoutte M, Glorieux G. p-Cresyl Sulfate. Toxins (Basel) 2017; 9:toxins9020052. [PMID: 28146081 PMCID: PMC5331431 DOI: 10.3390/toxins9020052] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/16/2022] Open
Abstract
If chronic kidney disease (CKD) is associated with an impairment of kidney function, several uremic solutes are retained. Some of these exert toxic effects, which are called uremic toxins. p-Cresyl sulfate (pCS) is a prototype protein-bound uremic toxin to which many biological and biochemical (toxic) effects have been attributed. In addition, increased levels of pCS have been associated with worsening outcomes in CKD patients. pCS finds its origin in the intestine where gut bacteria metabolize aromatic amino acids, such as tyrosine and phenylalanine, leading to phenolic end products, of which pCS is one of the components. In this review we summarize the biological effects of pCS and its metabolic origin in the intestine. It appears that, according to in vitro studies, the intestinal bacteria generating phenolic compounds mainly belong to the families Bacteroidaceae, Bifidobacteriaceae, Clostridiaceae, Enterobacteriaceae, Enterococcaceae, Eubacteriaceae, Fusobacteriaceae, Lachnospiraceae, Lactobacillaceae, Porphyromonadaceae, Staphylococcaceae, Ruminococcaceae, and Veillonellaceae. Since pCS remains difficult to remove by dialysis, the gut microbiota could be a future target to decrease pCS levels and its toxicity, even at earlier stages of CKD, aiming at slowing down the progression of the disease and decreasing the cardiovascular burden.
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Affiliation(s)
- Tessa Gryp
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Raymond Vanholder
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
| | - Mario Vaneechoutte
- Laboratory for Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, Ghent University, 9000 Ghent, Belgium.
| | - Griet Glorieux
- Department of Internal Medicine, Nephrology Division, Ghent University Hospital, 9000 Ghent, Belgium.
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29
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Abstract
Nutrition in older adults on peritoneal dialysis is an important aspect of a patient's clinical management as well as being influenced by their overall well-being, both mental and physical. This is especially pertinent as individuals age, since the potential impact of life changes and physical changes contribute to the development of protein-energy wasting and potentially exacerbating sarcopenia and wasting. This article provides an outline of the nutritional issues to consider in older adults on peritoneal dialysis (PD).
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Affiliation(s)
- Lina Johansson
- Imperial College Healthcare NHS Trust, London, United Kingdom
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30
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Bovio G, Esposito C, Montagna G, Brazzo S, Esposito V, Torreggiani M, Semeraro L, Cena H. Inadequate Macronutrient and Micronutrient Intakes in Hemodialysis and Peritoneal Dialysis Patients: Data from a Seven-Day Weighed Dietary Record. Nephron Clin Pract 2016; 133:253-60. [PMID: 27394723 DOI: 10.1159/000447723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS It is very important to assess the nutritional intake in patients on dialysis given the high prevalence of poor nutritional status of those in this population. The aim of this study was to assess nutrient intakes in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS A clinical cross-sectional study was conducted over 7 days on 14 dialysis patients (98 days) who were trained to keep a weighed food record and a 7-day food diary. Nutrient intake adequacy was compared with specific guidelines for Italians and dialysis patients. RESULTS The mean daily protein intake (0.92 ± 0.36 g/kg) and energy intake (EI; 25.3 ± 7.4 kcal/kg) were inadequate according to the European best practice guidelines (EBPG). The ratio of EI to resting energy expenditure was 1.22. Inadequate intakes, compared to the EBPG, were found for calcium (525 ± 162 mg/day) and iron (8.7 ± 2.1 mg/day). Dietary fiber (14.7 ± 8.7 g/day), niacin (14.4 ± 5.2 mg/day), thiamine (0.8 ± 0.3 mg/day) and riboflavin (1.1 ± 0.4 mg/day) were also inadequate according to the Italian recommended dietary allowances (LARN). HD patients did not display different nutrient intakes between the dialysis days and the interdialytic period. Overall, the percentage of days during which nutrient recommendations were not satisfied ranged from 16 to 100% depending on the nutrient. CONCLUSION Macronutrient and micronutrient intakes in HD and PD patients are largely inadequate compared to the EBPG. The weighed dietary record appears to be a useful and accurate tool for individual assessment of food intake in motivated patients. No nutrient intake differences were found between dialytic and interdialytic days in patients on HD.
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Affiliation(s)
- Giacomo Bovio
- Metabolic-Nutritional Unit and Palliative Care Unit, Salvatore Maugeri Foundation, IRCCS Rehabilitation Institute of Pavia, Pavia, Italy
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31
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Johansson L, Fouque D, Bellizzi V, Chauveau P, Kolko A, Molina P, Sezer S, ter Wee PM, Teta D, Carrero JJ. As we grow old: nutritional considerations for older patients on dialysis. Nephrol Dial Transplant 2016; 32:1127-1136. [DOI: 10.1093/ndt/gfw201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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32
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Young V, Balaam S, Orazio L, Bates A, Badve SV, Johnson DW, Campbell KL. APPETITE PREDICTS INTAKE AND NUTRITIONAL STATUS IN PATIENTS RECEIVING PERITONEAL DIALYSIS. J Ren Care 2016; 42:123-31. [PMID: 27060338 DOI: 10.1111/jorc.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sub-optimal nutrition status is common amongst patients receiving peritoneal dialysis (PD) and leads to poor clinical outcome. This population experiences multi-factorial challenges to achieving optimal nutritional status, particularly driven by inadequate intake. OBJECTIVES The aim of this investigation was to identify factors associated with inadequate protein intake and sub-optimal nutritional status in patients undergoing PD. DESIGN/PARTICIPANTS This was a cross-sectional study of 67 adult patients receiving PD (mean age 59 ± 14 years; 57% male) within a single centre. Participants were consecutively recruited and interviewed by renal dietitians, collecting: Subjective Global Assessment (SGA); quality of life (using EQ-5D); dietary intake (via dietary interview); and appetite (using Appetite and Diet Assessment Tool). Participant demographics were obtained via survey or medical charts. Main outcome measures were inadequate dietary protein intake (<1.1 g/kg adjusted body weight/day) and malnutrition (as defined by SGA rating B or C). RESULTS Overall, 15 (22%) patients were malnourished and 29 (43%) had inadequate protein intake. Poor appetite (anorexia) was reported in 62% (18/29) of participants with inadequate protein malnourished patients reported anorexia versus 12 (23%) of the well-nourished patients (p = 0.0001). CONCLUSION Anorexia was a key risk factor for inadequate protein intake and malnutrition in patients undergoing PD. These findings highlight a need to closely monitor patients with appetite disturbances.
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Affiliation(s)
- Valerie Young
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sarah Balaam
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Linda Orazio
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Annerley Bates
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sunil V Badve
- University of Queensland, Brisbane, Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Centre for Kidney Disease Research, Brisbane, Queensland, Australia.,Metro South and Ipswich Nephrology and Transplant Services, Brisbane, Queensland, Australia
| | - Katrina L Campbell
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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33
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Olvera-Soto MG, Valdez-Ortiz R, López Alvarenga JC, Espinosa-Cuevas MDLÁ. Effect of Resistance Exercises on the Indicators of Muscle Reserves and Handgrip Strength in Adult Patients on Hemodialysis. J Ren Nutr 2016; 26:53-60. [DOI: 10.1053/j.jrn.2015.06.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/11/2022] Open
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34
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Therrien M, Byham-Gray L, Beto J. A Review of Dietary Intake Studies in Maintenance Dialysis Patients. J Ren Nutr 2015; 25:329-38. [DOI: 10.1053/j.jrn.2014.11.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 10/29/2014] [Accepted: 11/17/2014] [Indexed: 12/31/2022] Open
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35
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Nutrition prescription to achieve positive outcomes in chronic kidney disease: a systematic review. Nutrients 2014; 6:416-51. [PMID: 24451311 PMCID: PMC3916870 DOI: 10.3390/nu6010416] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 12/31/2013] [Accepted: 01/07/2014] [Indexed: 11/17/2022] Open
Abstract
In Chronic Kidney Disease (CKD), management of diet is important in prevention of disease progression and symptom management, however evidence on nutrition prescription is limited. Recent international CKD guidelines and literature was reviewed to address the following question “What is the appropriate nutrition prescription to achieve positive outcomes in adult patients with chronic kidney disease?” Databases included in the search were Medline and CINAHL using EBSCOhost search engine, Embase and the Cochrane Database of Systematic Reviews published from 2000 to 2009. International guidelines pertaining to nutrition prescription in CKD were also reviewed from 2000 to 2013. Three hundred and eleven papers and eight guidelines were reviewed by three reviewers. Evidence was graded as per the National Health and Medical Research Council of Australia criteria. The evidence from thirty six papers was tabulated under the following headings: protein, weight loss, enteral support, vitamin D, sodium, fat, fibre, oral nutrition supplements, nutrition counselling, including protein and phosphate, nutrients in peritoneal dialysis solution and intradialytic parenteral nutrition, and was compared to international guidelines. While more evidence based studies are warranted, the customary nutrition prescription remains satisfactory with the exception of Vitamin D and phosphate. In these two areas, additional research is urgently needed given the potential of adverse outcomes for the CKD patient.
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36
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Koppe L, Arkouche W, Fouque D. Which optimal protein intake in maintenance dialysis patients? J Hum Nutr Diet 2013; 26:313-4. [DOI: 10.1111/jhn.12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L. Koppe
- Department of Nephrology and CENS; Centre Hospitalier Lyon Sud; Lyon France
- INSERM U1060; CARMEN; Université de Lyon; Lyon France
| | | | - D. Fouque
- Department of Nephrology and CENS; Centre Hospitalier Lyon Sud; Lyon France
- INSERM U1060; CARMEN; Université de Lyon; Lyon France
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